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

Abstract

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.

Citation

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, https://doi.org/10.1186/s13058-018-1002-2

• 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
• DOI: https://doi.org/10.1186/s13058-018-1002-2
• Keywords: Auto-fluorescence, Breast cancer, Raman spectroscopy, Intra-operative margin evaluation
• Public URL: https://nottingham-repository.worktribe.com/output/945738
• Publisher URL: https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-018-1002-2