Intra-operative spectroscopic assessment of surgical margins during breast conserving surgery

• Published in: Breast cancer research : BCR Vol. 20; no. 1; pp. 69 - 14
• Main Authors: Shipp, Dustin W., Rakha, Emad A., Koloydenko, Alexey A., Macmillan, R. Douglas, Ellis, Ian O., Notingher, Ioan
• Format: Journal Article
• Language: English
• Published: London BioMed Central 09.07.2018; BioMed Central Ltd; Springer Nature B.V; BMC
• Subjects: Accuracy; Algorithms; Auto-fluorescence; Automation; Biomedical and Life Sciences; Biomedicine; Breast; Breast cancer; Breast carcinoma; Cancer Research; Care and treatment; Diagnosis; Histopathology; Intra-operative margin evaluation; Invasiveness; Lumpectomy; Mass spectrometry; Microscopy; Oncology; Raman spectroscopy; Reorganization and restructuring; Research Article; Risk factors; Scientific imaging; Surgery; Surgical Oncology; Tumors; Auto-fluorescence; Breast cancer; Raman spectroscopy; Intra-operative margin evaluation
• ISSN: 1465-542X; 1465-5411; 1465-542X
• DOI: 10.1186/s13058-018-1002-2

Background In over 20% of breast conserving operations, postoperative pathological assessment of the excised tissue reveals positive margins, requiring additional surgery. Current techniques for intra-operative assessment of tumor margins are insufficient in accuracy or resolution to reliably detect small tumors. There is a distinct need for a fast technique to accurately identify tumors smaller than 1 mm 2 in large tissue surfaces within 30 min. Methods Multi-modal spectral histopathology (MSH), a multimodal imaging technique combining tissue auto-fluorescence and Raman spectroscopy was used to detect microscopic residual tumor at the surface of the excised breast tissue. New algorithms were developed to optimally utilize auto-fluorescence images to guide Raman measurements and achieve the required detection accuracy over large tissue surfaces (up to 4 × 6.5 cm 2 ). Algorithms were trained on 91 breast tissue samples from 65 patients. Results Independent tests on 121 samples from 107 patients - including 51 fresh, whole excision specimens - detected breast carcinoma on the tissue surface with 95% sensitivity and 82% specificity. One surface of each uncut excision specimen was measured in 12–24 min. The combination of high spatial-resolution auto-fluorescence with specific diagnosis by Raman spectroscopy allows reliable detection even for invasive carcinoma or ductal carcinoma in situ smaller than 1 mm 2 . Conclusions This study provides evidence that this multimodal approach could provide an objective tool for intra-operative assessment of breast conserving surgery margins, reducing the risk for unnecessary second operations.