12d56f587bbd99044a9bfc48e5734c56 pmc_11506682.pdf 79343d2171cbac051241beef733a23a18cb3f321 pmc_11506682.pdf 9fd28d8e07df5059f83295cccac880edfd0ff63670ce8b3fd57ec4ea945efc8c pmc_11506682.pdf Title: Unveiling a Surgical Revolution: The Use of Conventional Histology versus Ex Vivo Fusion Confocal Microscopy in Breast Cancer Surgery Subject: Ex vivo fusion confocal microscopy (EVFCM) enables the rapid examination of breast tissue and has the potential to reduce the surgical margins and the necessity for further surgeries. Traditional methods, such as frozen section analysis, are limited by the distortion of tissue and artefacts, leading to false negatives and the need for additional surgeries. This study on observational diagnostic accuracy evaluated the ability of EVFCM to detect breast cancer. A total of 36 breast tissue samples, comprising 20 non-neoplastic and 16 neoplastic cases, were analysed using EVFCM and compared to the results obtained from routine histopathology. A Mohs surgeon experienced in EVFCM (evaluator A) and two breast pathologists unfamiliar with EVFCM (evaluators B and C) performed blinded analyses. EVFCM showed high concordance with the histopathology and the detection of neoplasia, with significant kappa values (p < 0.001). Evaluator A achieved 100% sensitivity and specificity. Evaluators B and C achieved a sensitivity of >87%, a specificity of >94%, positive predictive values of >95%, and negative predictive values of 81% and 94%, respectively. EVFCM therefore offers a promising technique for the assessment of margins in breast-conserving surgery. Its widespread adoption could significantly reduce re-excisions, lower healthcare costs, and improve cosmetic and oncological outcomes. Keywords: breast cancer detection; breast conserving surgery; ex vivo fusion confocal microscopy; surgical pathology Author: Daniel Humaran, Javiera Pérez-Anker, Pedro L. Fernández, Lidia Blay, Iciar Pascual, Eva Castellà, Laia Pérez, Susana Puig, Josep Malvehy and Joan F. Julián Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Sat Oct 12 15:18:21 2024 CEST ModDate: Sat Oct 12 15:25:53 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 10062151 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- NCRKTZ+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 ZBIMAL+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 CAKXSP+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 DSABZU+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 EBSUHN+VnURWPalladioL Type 1 Custom yes yes yes 32 0 PFKOHU+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 48 0 CEGBLO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 75 0 CEGBLP+PalatinoLinotype CID TrueType Identity-H yes yes yes 78 0 CEGBMA+PalatinoLinotype TrueType WinAnsi yes yes no 84 0 CEGBMC+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 87 0 CEGCCA+PalatinoLinotype TrueType MacRoman yes yes no 90 0 CEGBLO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 112 0 CEGBLP+PalatinoLinotype CID TrueType Identity-H yes yes yes 115 0 CEGBMA+PalatinoLinotype TrueType WinAnsi yes yes no 121 0 CEGBMC+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 124 0 CEGCCA+PalatinoLinotype TrueType MacRoman yes yes no 127 0 CEGBLO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 152 0 CEGBMA+PalatinoLinotype TrueType WinAnsi yes yes no 155 0 CEGBMC+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 158 0 CEGCCA+PalatinoLinotype TrueType MacRoman yes yes no 161 0 CEGBLO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 176 0 CEGBLP+PalatinoLinotype CID TrueType Identity-H yes yes yes 179 0 CEGBMA+PalatinoLinotype TrueType WinAnsi yes yes no 185 0 CEGBMC+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 188 0 CEGCCA+PalatinoLinotype TrueType MacRoman yes yes no 191 0 WCBGZO+EURM10 Type 1 Builtin yes yes yes 199 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 207 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-02-08 02:53:21 CET RepresentationInformation: pmc_11506682.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-02-06 02:51:57 CET Size: 10062151 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 364 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Tissue Selection, Staining, and Imaging Destination: subsection.2.1 Item: Title: Confocal Image Evaluation and Pathologist Assessments Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Neoplasia Presence Accuracy Destination: subsection.3.1 Item: Title: Histologic Subtype Recognition Destination: subsection.3.2 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Unveiling a Surgical Revolution: The Use of Conventional Histology versus Ex Vivo Fusion Confocal Microscopy in Breast Cancer Surgery Author: Daniel Humaran, Javiera Pérez-Anker, Pedro L. Fernández, Lidia Blay, Iciar Pascual, Eva Castellà, Laia Pérez, Susana Puig, Josep Malvehy and Joan F. Julián Subject: Ex vivo fusion confocal microscopy (EVFCM) enables the rapid examination of breast tissue and has the potential to reduce the surgical margins and the necessity for further surgeries. Traditional methods, such as frozen section analysis, are limited by the distortion of tissue and artefacts, leading to false negatives and the need for additional surgeries. This study on observational diagnostic accuracy evaluated the ability of EVFCM to detect breast cancer. A total of 36 breast tissue samples, comprising 20 non-neoplastic and 16 neoplastic cases, were analysed using EVFCM and compared to the results obtained from routine histopathology. A Mohs surgeon experienced in EVFCM (evaluator A) and two breast pathologists unfamiliar with EVFCM (evaluators B and C) performed blinded analyses. EVFCM showed high concordance with the histopathology and the detection of neoplasia, with significant kappa values (p < 0.001). Evaluator A achieved 100% sensitivity and specificity. Evaluators B and C achieved a sensitivity of >87%, a specificity of >94%, positive predictive values of >95%, and negative predictive values of 81% and 94%, respectively. EVFCM therefore offers a promising technique for the assessment of margins in breast-conserving surgery. Its widespread adoption could significantly reduce re-excisions, lower healthcare costs, and improve cosmetic and oncological outcomes. 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