Intraoperative spectroscopic evaluation of sentinel lymph nodes in breast cancer surgery

Barkur, Surekha; Boitor, Radu A; Mihai, Raluca; Raja Gopal, Navarasi S; Leeney, Samuel; Koloydenko, Alexey A; Khout, Hazem; Rakha, Emad; Notingher, Ioan

Abstract

Background and objectives: Sentinel lymph node (SLN) biopsy is a standard procedure for patients with breast cancer and normal axilla on imaging. Positive SLNs on histological examination can lead to a subsequent surgery for axillary lymph node clearance (ALNC). Here we report a non-destructive technique based on autofluorescence (AF) imaging and Raman spectroscopy for intra-operative assessment of SLNs excised in breast cancer surgery. Methods: A microscope integrating AF imaging and Raman spectroscopy modules was built to allow scanning of lymph node biopsy samples. During AF-Raman measurements, AF imaging determined optimal sampling locations for Raman spectroscopy measurements. After optimisation of the AF image analysis and training of classification models based on data from 85 samples, the AF-Raman technique was tested on an independent set of 81 lymph nodes comprising 58 fixed and 23 fresh specimens. The sensitivity and specificity of AF-Raman were calculated using post-operative histology as a standard of reference. Results: The independent testset contained 66 negative lymph nodes and 15 positive lymph nodes according to the reference standard, collected from 78 patients. For this set of specimens, the area under the receiver operating characteristic (ROC) curve for the AF-Raman technique was 0.93 [0.83–0.98]. AF-Raman was then operated in a regime that maximised detection specificity, producing a 94% detection accuracy: 80% sensitivity and 97% specificity. The main confounders for SLN metastasis were areas rich in histiocytes clusters, for which only few Raman spectra had been included in the training dataset. Discussion: This preliminary study indicates that with further development and extension of the training dataset by inclusion of additional Raman spectra of histiocytes clusters and capsule, the AF-Raman may become a promising technique for intra-operative assessment of SLNs. Intra-operative detection of positive biopsies could avoid second surgery for axillary clearance.

• Journal Article Type: Article
• Acceptance Date: Apr 17, 2024
• Online Publication Date: May 20, 2024
• Publication Date: May 20, 2024
• Deposit Date: May 10, 2024
• Publicly Available Date: May 10, 2024
• Journal: Breast Cancer Research and Treatment
• Print ISSN: 0167-6806
• Electronic ISSN: 1573-7217
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1007/s10549-024-07349-z
• Keywords: Raman spectroscopy, auto-fluorescence imaging, spectral imaging, lymph node metastasis, breast cancer
• Public URL: https://nottingham-repository.worktribe.com/output/34631642
• Publisher URL: https://link.springer.com/article/10.1007/s10549-024-07349-z
• Additional Information: Received: 27 November 2023; Accepted: 17 April 2024; First Online: 20 May 2024; : ; : I Notingherand A Koloydenko hold a patent related to the AF-Raman technology. We declare no other conflict of interest, financial or non-financial.; : Ethical approval was obtained from East Midlands – Leicester South Research Ethics Committee (19/EM/0251).; : Informed consent was obtained from all individual participants included in the study.; : Consent to publish has been received from all participants.; : I Notingher holds a patent related to the AF-Raman technology. We declare no other conflict of interest, financial or non-financial.