Multimodality Optical Imaging System for Intraoperative Detection of Tumor Positive Margins

摘要

Patients with invasive lobular carcinoma undergoing breast conserving surgery have a particularly high risk of tumor-positive excision margins, which is usually caused by the larger and non-uniform spreading of cancer foci. Surgical removal of invasive lobular carcinoma is not fully successful in controlling breast cancer because a small number of tumor cells can be left at the surgical area, and the cancer recurrence probability is very high. Intraoperative assessment of margins using usually techniques is minimal in reducing the positive margins rate. Therefore, a technology capable of highlighting the presence of the positive margins could provide very useful information for surgery guidance and therefore could potentially eliminate cancer recurrence. The margin is defined as the distance from the tumor to the cut surface of the specimen. This technology, based on a multimodality imaging approach combining reflectance spectral imaging with structural optical coherence tomography imaging, will provide the surgeon with real-time feedback with the exact location and amount of tissue that has to be removed. The proposed approach for breast cancer surgical guidance would allow efficient detection of positive margins and will decrease the need for secondary surgeries and recurrences of cancers. Positive surgical margins and ipsilateral breast tumor recurrence are predictors of systemic recurrence and disease-specific survival after breast conserving surgery. Very efficient cancer localization during surgery is the only way to remove cancer in its entirety. A high sensitivity and specificity dualmodality imaging platform will provide the surgeon with real-time information about cancer spreading, allowing for complete removal of cancer foci, which otherwise cannot be identified with current clinical instrumentation. Therefore, this technology will have a high impact on cancer recurrence and will significantly reduce both emotional and hospitalization costs.