Treatment for Basal Cell Carcinoma (BCC) includes an excisional surgery to remove cancerous tissues, using a cautery tool to make burns along a defined resection margin around the tumor. Margin evaluation occurs post-surgically, requiring repeat surgery if positive margins are detected. Rapid Evaporative Ionization Mass Spectrometry (REIMS) can help distinguish healthy and cancerous tissue but does not provide spatial information about the cautery tool location where the spectra are acquired. We propose using intraoperative surgical video recordings and deep learning to provide surgeons with guidance to locate sites of potential positive margins. Frames from 14 intraoperative videos of BCC surgery were extracted and used to train a sequence of networks. The first network extracts frames showing surgery in-progress, then, an object detection network localizes the cautery tool and resection margin. Finally, our burn prediction model leverages the effectiveness of both a Long Short-Term Memory (LSTM) network and a Receiver Operating Characteristic (ROC) curve to accurately predict when the surgeon is cutting. The cut identifications will be used in the future for synchronization with iKnife data to provide localizations when cuts are predicted. The model was trained with four-fold cross-validation on a patient-wise split between training, validation, and testing sets. Average recall over the four folds of testing for the LSTM and ROC were 0.80 and 0.73, respectively. The video-based approach is simple yet effective at identifying tool-to-skin contact instances and may help guide surgeons, enabling them to deliver precise treatments in combination with iKnife data.
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