@article {NasuteFauerbach2021,
	title = {Lack of definitive presurgical pathological diagnosis is associated with inadequate surgical margins in breast-conserving surgery},
	journal = {European Journal of Surgical Oncology},
	year = {2021},
	month = {06/2021},
	abstract = {<p>Purpose To determine the impact of definitive presurgical diagnosis on surgical margins in breast-conserving surgery (BCS) for primary carcinomas; clinicopathological features were also analyzed. Methods This retrospective study included women who underwent BCS for primary carcinomas in 2016 and 2017. Definitive presurgical diagnosis was defined as having a presurgical core needle biopsy (CNB) and not being upstaged between biopsy and surgery. Biopsy data and imaging findings including breast density were retrieved. Inadequate surgical margins (IM) were defined per latest ASCO and ASTRO guidelines. Univariable and multivariable analyses were performed. Results 360 women (median age, 66) met inclusion criteria with 1 having 2 cancers. 82.5\% (298/361) were invasive cancers while 17.5\% (63/361) were ductal carcinoma in situ (DCIS). Most biopsies were US-guided (284/346, 82.0\%), followed by mammographic (60/346, 17.3\%), and MRI-guided (2/346, 0.6\%). US and mammographic CNB yielded median samples of 2 and 4, respectively, with a 14G needle. 15 patients (4.2\%) lacked presurgical CNB. The IM rate was 30.0\%. In multivariable analysis, large invasive cancers (\&gt;20\&nbsp;mm), dense breasts, and DCIS were associated with IM (p\&nbsp;=\&nbsp;0.029, p\&nbsp;=\&nbsp;0.010, and p\&nbsp;=\&nbsp;0.013, respectively). Most importantly, lack of definitive presurgical diagnosis was a risk factor for IM (OR, 2.35; 95\% CI: 1.23{\textendash}4.51, p\&nbsp;=\&nbsp;0.010). In contrast, neither patient age (\&lt;50) nor aggressive features (e.g., LVI) were associated with IM. Conclusion Lack of a definitive presurgical diagnosis was associated with a two-fold increase of IM in BCS; other risk factors were dense breasts, large invasive cancers, and DCIS.</p>
},
	keywords = {Breast cancer, Breast-conserving surgery (BCS), Core needle biopsy and vacuum-assisted biopsy, Definitive presurgical diagnosis, High-risk lesions, Surgical margins},
	issn = {0748-7983},
	doi = {https://doi.org/10.1016/j.ejso.2021.05.047},
	url = {https://www.sciencedirect.com/science/article/pii/S0748798321005424},
	author = {Paola V. Nasute Fauerbach and Kathrin Tyryshkin and Silvia Perez Rodrigo and John Rudan and Gabor Fichtinger and Michael Reedijk and Sonal Varma and David M. Berman}
}
@article {Harish2016c,
	title = {Monitoring electromagnetic tracking error in computer-navigated breast cancer surgery},
	year = {2016},
	publisher = {Imaging Network Ontario (ImNO)},
	address = {Toronto, Canada},
	keywords = {Breast cancer, EM Tracking, Lumpectomy},
	author = {Vinyas Harish and A Baksh and Tamas Ungi and Andras Lasso and Zachary M C Baum and G Gauvin and C. Jay Engel and John Rudan and Gabor Fichtinger}
}
@article {Pompeu-Robinson2011,
	title = {Immobilization and Catheter Guidance for Breast Brachytherapy},
	journal = {International Journal of Computer Assisted Radiology and Surgery},
	volume = {Online First},
	year = {2011},
	month = {05/2011},
	abstract = {<p>Purpose: Brachytherapy is an important mode of breast cancer treatment; however, improvements in both treatment planning and delivery are needed. In order to meet these specific needs, integration of pre-operative imaging, supplemented by computerized surgical planning and mathematical optimization were used to develop and test an intra-operative immobilization and catheter guidance system. Method: A custom template specific to each patient with optimally placed guide holes for catheter insertion was designed and fabricated. Creation of the template is based on a virtual reality reconstruction of the patient{\textquoteright}s anatomy from computed tomography imaging. The template fits on the patient{\textquoteright}s breast, immobilizing the soft tissue, and provides pre-planned catheter insertion holes for guidance to the tumor site. Agar-based phantom and target models were used for quantitative validation of the template by ascertaining the precision and accuracy of the templates. Results: Tests were performed on agar-based tissue models using computed tomography imaging for template planning and validation. Planned catheter tracks were compared to post-insertion image data and distance measurements from target location were used to create an error measure. Initial results yielded an average error of 4.5 mm. Once the workflow and template design were improved, an average error of 2.6 mm was observed, bringing the error close to a clinically acceptable range. Conclusion: Use of a patient-specific template for breast brachytherapy is feasible and may improve the procedure accuracy and outcome.</p>
},
	keywords = {Brachytherapy, Breast cancer, Guidance, Immobilization, Radiotherapy},
	doi = {DOI 10.1007/s11548-011-0600-6},
	author = {Alexandra M. Pompeu-Robinson and M. Kunz and Conrad Falkson and John Schreiner and C.P. Joshi and Gabor Fichtinger}
}
