Our Summary

The research paper talks about a new development in cancer surgery. It involves the use of a fluorescent imaging technique, where a special substance called pegulicianine is injected into the bloodstream. This substance helps to highlight the edges of the cancerous tissue during surgery, using a specific device and software. The goal is to make sure that all cancerous tissue is removed during the first surgery, reducing the need for a second operation, which is often required if any cancer is found at the edges of the tissue that was removed. In simpler terms, it’s like using a high-tech marker to make sure no cancer is left behind during surgery.

FAQs

  1. What is the role of fluorescence imaging in oncology surgeries?
  2. How does the use of intravenous pegulicianine with an optical head device improve the precision of lumpectomies?
  3. How does intraoperative identification of lumpectomy margins with residual cancer help in avoiding a second surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lumpectomy is to thoroughly discuss with their surgeon the importance of achieving clear margins during the procedure. Clear margins refer to the removal of all cancerous tissue surrounding the tumor, reducing the likelihood of cancer recurrence. Patients should also be informed about the possibility of needing additional surgery if margins are not clear initially, and the potential benefits of intraoperative imaging technologies in improving surgical precision.

Suitable For

Patients who are typically recommended lumpectomy include those with early-stage breast cancer, particularly those with small tumors that have not spread beyond the breast. Lumpectomy may also be recommended for patients with ductal carcinoma in situ (DCIS), a non-invasive form of breast cancer. Lumpectomy may not be recommended for patients with large tumors, tumors that are close to the chest wall, or tumors that are difficult to remove with clear margins. Additionally, patients who have already undergone radiation therapy to the breast may not be good candidates for lumpectomy. It is important for patients to discuss their individual case with their healthcare provider to determine the best treatment option for them.

Timeline

Before lumpectomy:

  • Patient is diagnosed with breast cancer through a biopsy
  • Patient undergoes preoperative imaging tests such as mammogram, ultrasound, and MRI to determine the extent of the cancer
  • Patient may undergo neoadjuvant therapy (chemotherapy or radiation) to shrink the tumor before surgery
  • Patient meets with surgeon to discuss surgical options and risks

After lumpectomy:

  • Patient undergoes lumpectomy procedure to remove the cancerous tumor and surrounding tissue
  • Intraoperative fluorescence imaging is used to identify lumpectomy margins with residual cancer and ensure complete excision
  • Pathology report is generated to confirm if margins are clear or if there is residual cancer left behind
  • If margins are clear, patient may not need further treatment; if margins are positive, patient may need additional surgery or radiation therapy
  • Patient follows up with oncologist for further treatment and surveillance

Overall, the use of intraoperative fluorescence imaging with devices like pegulicianine can improve the accuracy of lumpectomy procedures and reduce the need for additional surgeries, leading to better outcomes for breast cancer patients.

What to Ask Your Doctor

  1. What is a lumpectomy and why is it recommended for my specific situation?
  2. What are the potential risks and complications of a lumpectomy procedure?
  3. How will the use of intravenous pegulicianine and optical head device affect the outcome of my surgery?
  4. How accurate is the device in identifying lumpectomy margins with residual cancer?
  5. Will I still need additional treatments, such as radiation therapy, after the lumpectomy?
  6. What is the recovery process like after a lumpectomy?
  7. Are there any alternative treatment options to consider instead of a lumpectomy?
  8. How frequently will I need follow-up appointments and monitoring after the lumpectomy?
  9. What are the chances of recurrence after a lumpectomy?
  10. Are there any lifestyle changes or precautions I should take after the surgery to promote healing and reduce the risk of complications?

Reference

Authors: Turza LC, Shriver CD. Journal: NEJM Evid. 2023 Jul;2(7):EVIDe2300114. doi: 10.1056/EVIDe2300114. Epub 2023 Jun 27. PMID: 38320169