Intraoperative Evaluation of Breast Tumor Margins with Optical Coherence Tomography

Abstract

As breast cancer screening rates increase, smaller and more numerous lesions are being identified earlier, leading to more breast-conserving surgical procedures. Achieving a clean surgical margin represents a technical challenge with important clinical implications. Optical coherence tomography (OCT) is introduced as an intraoperative high-resolution imaging technique that assesses surgical breast tumor margins by providing real-time microscopic images up to 2 mm beneath the tissue surface. In a study of 37 patients split between training and study groups, OCT images covering 1 cm 2 regions were acquired from surgical margins of lumpectomy specimens, registered with ink, and correlated with corresponding histologic sections. A 17-patient training set used to establish standard imaging protocols and OCT evaluation criteria showed that areas of higher scattering tissue with a heterogeneous pattern were indicative of tumor cells and tumor tissue in contrast to lower scattering adipocytes found in normal breast tissue. The remaining 20 patients were enrolled into the feasibility study. Of these lumpectomy specimens, 11 were identified with a positive or close surgical margin and 9 were identified with a negative margin under OCT. Based on histologic findings, 9 true positives, 9 true negatives, 2 false positives, and 0 false negatives were found, yielding a sensitivity of 100% and specificity of 82%. These results show the potential of OCT as a real-time method for intraoperative margin assessment in breast-conserving surgeries. [Cancer Res 2009;69(22):8790-6]

Autofluorescence Imaging and Spectroscopy of Human Lung Cancer

“…Currently, the haematoxylin and eosin (HE)-stained histopathology is applied as the gold standard to assess and diagnose disease by pathologists, but is time-consuming, usually taking up to one week [7]. During tumor resection, intraoperative frozen section examination can aid the surgeon to distinguish tumor and normal tissues, which still requires the staining process and takes about 20-30 min [8,9].…”

Molecular mobility and activity in an intravital imaging setting – implications for cancer progression and targeting

“…Assessing/identifying tumour margins (Alawi et al, 2013;Nguyen et al, 2009) Cancer diagnosis (Chen et al, 2007;Gora et al, 2013;Karl et al, 2010;Kim et al, 2009) Combined OCT and Raman spectroscopy to detect colon and breast cancers based on signature of lipids, collagen and DNA (Ashok et al, 2013;Patil et al, 2008) Coherent Multi-modal CARS imaging for pathological detection and live imaging of cancer (Evans and Xie, 2008;Evans et al, 2007;Heuke et al, 2013;Lee et al, 2015;Lee and Serrels, 2016;Meyer et al, 2011;Meyer et al, 2013;Xu et al, 2013b) Link metabolic changes to disease (Le et al, 2009(Le et al, , 2007 with ongoing advances in CARS endoscopy (Légaré et al, 2006) Fluorescence lifetime imaging microscopy (FLIM) of endogenous compounds…”

Harnessing the Power of Light to See and Treat Breast Cancer

“…Various optical microscopy techniques including reflectance and fluorescence [12,17,18], Raman [19], confocal [20,21], and optical coherence tomography [22,23] have been used to exploit intrinsic sources of contrast in thick tissues. Additionally, fluorescence microscopy has been combined with vital fluorescent stains such as acridine orange (AO) [24][25][26], acriflavine [27,28], and DAPI [29] to visualize micro-anatomical features in skin [24], breast [29], ovarian [26], oral [27], and esophageal [28] cancers.…”

“…Optical imaging approaches have the potential to address the limitations of traditional methods to detect breast cancer and monitor response to therapy and can provide the ability to image lesions in real time with minimal invasion [27,[62][63][64][65][66][67][68][69][70][71]. With the introduction of fiber optic probes, images can be acquired intraoperatively or through needles with high spatial resolution to visualize subcellular morphology and tumor microenvironment [27,63,72].…”