The American Society of Breast Surgeons
Rapid noninvasive optical imaging of tissue composition in breast tumor margins

https://doi.org/10.1016/j.amjsurg.2009.06.018Get rights and content

Abstract

Background

In women undergoing breast conserving surgery (BCS), up to 60% can require re-excision. Our objective is to develop an optically based technology which can differentiate benign from malignant breast tissues intraoperatively through differences in tissue composition factors.

Methods

A prospective study of optical imaging of BCS margins is being performed. Optical images are transformed into tissue composition maps with parameters of total hemoglobin concentration, b-carotene concentration and scattering. The predicted outcome is then compared to the margin-level pathology.

Results

Fifty-five margins from 48 patients have undergone assessment. Within 34 specimens with pathologically confirmed positive margins, the ratio map of b-carotene/scattering showed the most significant difference reflecting a decrease in adipose and an increase in cell density within malignant margins (p=.002). These differences were notable in both in-situ and invasive disease.

Conclusions

We present a novel optical spectral imaging device that provides a rapid, non-destructive assay of the tissue composition of breast tumor margins.

Section snippets

Patients

The study was approved by the institutional review board at Duke University in accordance with assurances filed with and approved by the Department of Health and Human Services. Informed consent was obtained from eligible participants (women >18 y) undergoing primary BCT for an invasive or noninvasive breast malignancy. A subgroup recruited to this study had undergone neoadjuvant endocrine or chemotherapy before their surgical procedure. Surgeries were performed by 5 breast surgical oncologists

Results

From December 2007 to September 2008, 54 patients were enrolled in this study. Optical spectral imaging data from 6 patients were not used in this analysis because the pathologic outcomes could not be coregistered accurately with the specified margins. From the remaining 48 patients, 55 margins were evaluated with the optical spectral imaging device. Table 1 contains a summary of the patient and margin characteristics for the participants in this study. Twenty-one patients had negative margins,

Comments

Most women with early stage breast cancer can undergo BCT. As the number of women who are treated neoadjuvantly with endocrine or chemotherapy increases, the eligible population for BCT will continue to grow. Recognizing, however, that anywhere from 16% to 60% of patients with BCT require a second surgery, a rapid, noninvasive, readily available technology is necessary to reduce this inability to detect tumor at the edge of a breast specimen in the operating room.11, 12, 13, 14, 15 This study

Acknowledgments

This publication was made possible by grant number 1UL1 RR024128-01 from the National Center for Research Resources, a component of the National Institutes of Health, and National Institutes of Health Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or National Institutes of Health.

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