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

Shipp, Dustin W.; Rakha, Emad A.; Koloydenko, Alexey A.; Macmillan, R. Douglas; Ellis, Ian O.; Notingher, Ioan


Dustin W. Shipp

Professor of Breast Cancer Pathology

Alexey A. Koloydenko

R. Douglas Macmillan


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 mm2 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 cm2). 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 mm2.
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.


Shipp, D. W., Rakha, E. A., Koloydenko, A. A., Macmillan, R. D., Ellis, I. O., & Notingher, I. (2018). Intra-operative spectroscopic assessment of surgical margins during breast conserving surgery. Breast Cancer Research, 20,

Journal Article Type Article
Acceptance Date Jun 4, 2018
Publication Date Jul 9, 2018
Deposit Date Jul 10, 2018
Publicly Available Date Jul 10, 2018
Journal Breast Cancer Research
Print ISSN 1465-5411
Electronic ISSN 1465-542X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 20
Keywords Auto-fluorescence, Breast cancer, Raman spectroscopy, Intra-operative margin evaluation
Public URL
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