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Study into the displacement of tumor localization needle during navigated breast cancer surgery

机译:乳腺癌手术中肿瘤定位针移位的研究

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PURPOSE: Early stage breast cancer is typically treated with lumpectomy. During lumpectomy, electromagnetic tracking can be used to monitor tumor position using a localization needle with an electromagnetic sensor fixed on the needle shaft. This needle is stabilized in the tumor with tissue locking wire hooks, which are deployed once the needle is inserted. The localization needle may displace from its initial position of insertion due to mechanical forces, providing false spatial information about the tumor position and increasing the probability of an incomplete resection. This study investigates whether gravitational and mechanical forces affected the magnitude of needle displacement. METHODS: Ten ultrasound scans were evaluated to measure needle displacement in vivo. Needle position was approximated by the distance between the needle tip and the tumor boundary on a 2D ultrasound image, and needle displacement was defined by the change in position. The angle between the localization needle and the coronal plane was computed in an open-source platform. RESULTS: A significant relationship (p = 0.04) was found between the needle to coronal plane angle and increased needle displacement. Needles inserted vertically, pointing towards the operating room ceiling, tended to exhibit greater needle displacement. Average needle displacement was 1.7 ±1.2 mm. CONCLUSION: Angle between the needle and the horizontal plane has been shown to affect needle displacement, and should be taken into consideration when inserting the localization needle. Future works can be directed towards improving the clinical workflow and mechanical design of the localization needle to reduce slippage during surgery.
机译:目的:早期乳腺癌通常用乳房切除术治疗。在肿块切除术中,可以使用定位针将电磁跟踪用于监视肿瘤位置,该定位针的电磁传感器固定在针杆上。用组织锁定线钩将针头固定在肿瘤中,一旦插入针头,钩子就会展开。定位针可能会由于机械力而从其初始插入位置移开,从而提供有关肿瘤位置的错误空间信息,并增加不完全切除的可能性。这项研究调查了重力和机械力是否影响了针头位移的大小。方法:评估十次超声扫描以测量体内针头位移。针头位置由2D超声图像上的针尖与肿瘤边界之间的距离来近似,而针头位移则由位置的变化来定义。定位针和冠状平面之间的角度是在开源平台上计算的。结果:发现针与冠状平面角和针位移增加之间存在显着关系(p = 0.04)。垂直插入并指向手术室天花板的针头倾向于出现更大的针头移位。平均针头位移为1.7±1.2毫米。结论:已经表明,针与水平面之间的角度会影响针的位移,在插入定位针时应予以考虑。未来的工作可以针对改善临床工作流程和定位针的机械设计,以减少手术过程中的打滑。

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