Elastic scattering spectroscopy for intraoperative determination of sentinel lymph node status in the breast

Abstract

The ability to provide the best treatment for breast cancer depends on establishing whether or not the cancer has spread to the lymph nodes under the arm. Conventional assessment requires tissue removal, preparation, and expert microscopic interpretation. In this study, elastic scattering spectroscopy (ESS) is used to interrogate excised nodes with pulsed broadband illumination and collection of the backscattered light. Multiple spectra are taken from 139 excised nodes (53 containing cancer) in 68 patients, and spectral analysis is performed using a combination of principal component analysis and linear discriminant analysis to correlate the spectra with conventional histology. The data are divided into training and test sets. In test sets containing spectra from only normal nodes and nodes with complete replacement by cancer, ESS detects the spectra from cancerous nodes with 84% sensitivity and 91% specificity (per-spectrum analysis). In test sets that included normal nodes and nodes with partial as well as complete replacement by cancer, ESS detects the nodes with cancer with an average sensitivity of 75% and specificity of 89% (per-node analysis). These results are comparable to those from conventional touch imprint cytology and frozen section histology, but do not require an expert pathologist for interpretation. With automation of the technique, results could be made available almost instantaneously. ESS is a promising technique for the rapid, accurate, and straightforward detection of metastases in excised sentinel lymph nodes.

Spectrroscopic Sensing of Cancer and Cancer Therapy: Current Status of Translational Research

“…For sentinel nodes, more recently we reported on the next phase of the study, in which a larger dataset and new statistical methods were used. 44 From patients with breast cancer undergoing either sentinel node biopsy or axillary node clearance, sentinel nodes were identified using the combination technique of pre-operative lymphoscintigraphy using Tc 99 labeled albumin colloid, intra-operative blue dye injection and gamma probe guided detection. All removed nodes were bivalved, and spectra were taken from several locations on the cut surfaces of both halves with the small fiber probe in gentle contact with the node.…”

Mueller polarimetric imaging for surgical and diagnostic applications: a review

“…More advanced fibre optic probes for PLSS made use of gradient-index (GRIN) lens to implement depth selective measurement from a range of near surface depths (100-200 mm) to interrogate blood supply [66,67]. A great number of translational studies for diagnosis of breast cancer [68], prostate cancer [69], intraoperative determination of sentinel lymph node status in the breast [70], colonic lesions [71], oral premalignancy [72], high grade dysplasia and cancer in Barrett's oesophagus [73,74], cervix neoplasia [75,76], investigation of the nature of aceto-whitening in cervix cancer inspection [77][78][79][80][81][82], gold nanoparticle sizing [83], and monitoring apoptosis in cell cultures [84][85][86] have demonstrated that LSS provides a promising solution for cell culture monitoring, tissue surveillance and biopsy guidance in a relatively simple and cost effective configuration.…”

Optical Detection of Cancers

“…[21][22][23][24] Recently, Johnson et al reported the study of spectral reflectance data, between 340 and 900 nm, acquired from 139 cancerous and normal sentinel nodes removed from 68 patients with breast cancers. [25] Statistical analysis of the spectral data yielded scores for discriminating different types of nodes with sensitivity and specificity comparable to those of frozen section histology.…”