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New Test Could Improve Breast-Conserving Surgery (dateline March 25, 2009)

Researchers are investigating a new test that could be more accurate in determining whether 100 percent of the cancer is removed after breast-conserving surgery. Currently, between 20 and 50 percent of women who undergo a lumpectomy have remain cancer cells that must be removed with a second surgery. However, in a new study, researchers developed a rapid, automated image screening process that was more accurate in distinguishing between cancerous and non-cancerous cells than the current standard practice. According to new study results, the technique, could lead to better ways to determine whether all of the cancer has been removed after the surgery and reduce the chances of another surgery.

The study was led by breast surgeon Sarah Blair, MD, associate clinical professor of surgery at the University of California-San Diego School of Medicine. Blair and her co-workers examined samples of normal breast tissue from 10 women and tumor samples from 24 women with cancer.

"We compared manual microscopy, looking at the tissue cells on a slide under the microscope, with automated programs, in which we taught a computer how to look at the slides with a microscope, and they correlated pretty well," Blair said, in a Science Daily news release. The study results were reported in the Annals of Surgical Oncology.

A camera connected to the microscope takes photos of the slide, which are then analyzed for cancer. "We thought that if we automated it, we could teach the computer what to look for and have the pathologist quickly correlate the computer findings with their findings. We're hoping that the method makes the process more objective," said Blair.

The researchers were able to demonstrate that the automated microscopy, with the help of specially designed computer software, could correctly identify invasive breast cancer cells in 83 percent of the tumor specimens, whereas a normal microscope only identified cancer in 65 percent of the cancer specimens.

The researchers used a method called "touch prep" to collect the cancer cells for evaluation, which entails gathering cells to be stained and then examined and which normally requires a specialized pathologist to subjectively interpret. In this case, the scientists used the center of the tumor, rather than the outer tissue edges, where it is more difficult to identify cancer cells, to confirm that the technique actually worked

"The majority of women are good candidates for breast conservation surgery," said breast surgeon Sarah Blair, MD, associate clinical professor of surgery at the UC San Diego School of Medicine, who led the work. "The problem is getting negative margins - meaning the edge of what we remove has no cancer - the first time we operate because we are dealing sometimes with small tumors that can be difficult to see or feel. Right now there is no good way during the operation to make sure that we have removed every cancer cell. We'd like to reduce the need for second operations, which will spare the patient the trauma of surgery again and reduce costs."

Blair cautioned that the results of the study are preliminary and require confirmation in larger studies. As the researchers continue their work, they will be able to eventually test its use in examining breast tissue margins.

Lumpectomy, also known as breast-conserving surgery, involves the surgical removal of a cancerous tumor in the breast, along with a small margin of the surrounding normal breast tissue. The procedure is often performed on women with small or localized breast cancers and can be an attractive surgical treatment option for breast cancer because it allows women to maintain most of their breast after surgery. Several studies have shown that women with small breast tumors have an equal chance of surviving breast cancer regardless of whether they have a lumpectomy, followed by a full course of radiation therapy, or mastectomy (complete breast removal, which generally does not require post-operative radiation treatment).

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