The American Society of Breast Surgeons| Volume 198, ISSUE 4, P566-574, October 2009

Rapid noninvasive optical imaging of tissue composition in breast tumor margins



      In women undergoing breast conserving surgery (BCS), up to 60% can require re-excision. Our objective is to develop an optically based technology which can differentiate benign from malignant breast tissues intraoperatively through differences in tissue composition factors.


      A prospective study of optical imaging of BCS margins is being performed. Optical images are transformed into tissue composition maps with parameters of total hemoglobin concentration, b-carotene concentration and scattering. The predicted outcome is then compared to the margin-level pathology.


      Fifty-five margins from 48 patients have undergone assessment. Within 34 specimens with pathologically confirmed positive margins, the ratio map of b-carotene/scattering showed the most significant difference reflecting a decrease in adipose and an increase in cell density within malignant margins (p=.002). These differences were notable in both in-situ and invasive disease.


      We present a novel optical spectral imaging device that provides a rapid, non-destructive assay of the tissue composition of breast tumor margins.


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        • Barth Jr, R.J.
        • Gibson G.R.
        • Carney P.A.
        • et al.
        Detection of breast cancer on screening mammography allows patients to be treated with less-toxic therapy.
        AJR Am J Roentgenol. 2005; 184: 324-329
        • Dunne C.
        • Burke J.p.
        • Morrow M.
        • et al.
        Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ.
        J Clin Oncol. 2009; 27: 1615-1620
        • Poggi M.M.
        • Danforth D.N.
        • Sciuto L.C.
        • et al.
        Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial.
        Cancer. 2003; 98: 697-702
        • Fisher B.
        Highlights from recent National Surgical Adjuvant Breast and Bowel Project studies in the treatment and prevention of breast cancer.
        CA Cancer J Clin. 1999; 49: 159-177
        • Clarke M.
        • Collins R.
        • Darby S.
        • et al.
        Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15 year survival: an overview of the randomized trials.
        Lancet. 2005; 366: 2087-2106
        • Singletary S.E.
        Surgical margins in patients with early stage breast cancer treated with breast conservation therapy.
        Am J Surg. 2002; 184: 383-393
        • Carey L.A.
        • Perou C.M.
        • Livasy C.A.
        • et al.
        Race, breast cancer subtypes, and survival in the Carolina breast cancer study.
        JAMA. 2006; 295: 2492-2502
        • Cendan J.C.
        • Coco D.
        • Copeland E.M.
        Accuracy of intraoperative frozen-section analysis of breast cancer lumpectomy-bed margins.
        J Am Coll Surg. 2005; 201: 194-198
        • Creager A.J.
        • Shaw J.A.
        • Young P.R.
        • et al.
        Intraoperative evaluation of lumpectomy margins by imprint cytology with histologic correlation: a community hospital experience.
        Arch Pathol Lab Med. 2002; 126: 846-848
        • McLaughlin S.A.
        • Ochoa-Frongia L.M.
        • Patil S.M.
        • et al.
        Influence of frozen section analysis of sentinel lymph node and lumpectomy margin status on reoperation rates in patients undergoing breast conservation therapy.
        J Am Coll Surg. 2008; 206: 76-82
        • Cabioglu N.
        • Hunt K.K.
        • Sahin A.A.
        • et al.
        Role for intraoperative margin assessment in patients undergoing breast-conserving surgery.
        Ann Surg Oncol. 2007; 14: 1458-1471
        • Kurniawan E.D.
        • Wong M.H.
        • Windle I.
        • et al.
        Predictors of surgical margin status in breast-conserving surgery within a breast-screening program.
        Ann Surg Oncol. 2008; 15: 2542-2549
        • Olson T.P.
        • Harter J.
        • Muñoz A.
        • et al.
        Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence.
        Ann Surg Oncol. 2007; 14: 2953-2960
        • Balch G.C.
        • Mithani S.K.
        • Simpson J.F.
        • et al.
        Accuracy of intraoperative gross examination of surgical margin status in women undergoing partial mastectomy for breast malignancy.
        Am Surg. 2005; 71: 22-27
        • Méndez J.E.
        • Lamorte W.W.
        • de las Morenas A.
        • et al.
        Influence of breast cancer margin assessment method on the rates of positive margins and residual carcinoma.
        Am J Surg. 2006; 192: 538-540
        • Zhu C.
        • Palmer G.
        • Breslin T.
        • et al.
        Diagnosis of breast cancer using fluorescence and diffuse reflectance spectroscopy: a Monte Carlo-model-based approach.
        J Biomed Opt. 2008; 13: 034015
        • Volynskaya Z.
        • Haka A.S.
        • Bechtel K.L.
        • et al.
        Diagnosing breast cancer using diffuse reflectance spectroscopy and intrinsic fluorescence spectroscopy.
        J Biomed Opt. 2008; 13: 024012
        • Palmer G.M.
        • Ramanujam N.
        Monte Carlo-based inverse model for calculating tissue optical properties.
        Appl Opt. 2006; 45: 1062-1071
        • Palmer G.M.
        • Ramanujam N.
        Monte Carlo-based inverse model for calculating tissue optical properties.
        Appl Opt. 2006; 45: 1072-1078
        • Zhu C.
        • Palmer G.M.
        • Breslin T.M.
        • et al.
        Diagnosis of breast cancer using diffuse reflectance spectroscopy: Comparison of a Monte Carlo versus partial least squares analysis based on feature extraction technique.
        Lasers Surg Med. 2006; 38: 714-724
        • Huston T.L.
        • Pigalarga R.
        • Osborne M.P.
        • et al.
        The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery.
        Am J Surg. 2006; 192: 509-512
        • Mourant J.R.
        • Freyer J.P.
        • Hielscher A.H.
        • et al.
        Mechanisms of light scattering from biological cells relevant to non-invasive optical-tissue diagnostics.
        Appl Opt. 1998; 37: 3586-3593
        • Picard R.
        • Cook D.
        Cross-validation of regression models.
        J Am Stat Assoc. 1997; 387: 575-583
        • Keskek M.
        • Kothari M.
        • Ardehali B.
        • et al.
        Factors predisposing to cavity margin positivity following conservation surgery for breast cancer.
        Eur J Surg Oncol. 2004; 30: 1058-1064
        • O'Sullivan M.
        • Li T.
        • Freedman M.M.
        The effect of multiple reexcisions on the risk of local recurrence after breast conserving surgery.
        Ann Surg Oncol. 2007; 14: 3133-3140
        • Soucy G.
        • Bélanger J.
        • Leblanc G.
        • et al.
        Surgical margins in breast-conservation operations for invasive carcinoma: does neoadjuvant chemotherapy have an impact?.
        J Am Coll Surg. 2008; 206: 1116-1121
        • Brown J.Q.
        • Wilke L.G.
        • Geradts J.
        • et al.
        Quantitative optical spectroscopy: a robust tool for direct measurement of breast cancer vascular oxygenation and total hemoglobin content in vivo.
        Cancer Res. 2009; 69: 2919-2926
        • Brown J.Q.
        • Vishwanath K.
        • Palmer G.M.
        • et al.
        Advances in quantitative UV-visible spectroscopy for clinical and pre-clinical application in cancer.
        Curr Opin Biotechnol. 2009; 20: 119-131
        • Schwarz R.A.
        • Gao W.
        • Redden W.C.
        • et al.
        Noninvasive evaluation of oral lesions using depth-sensitive optical spectroscopy.
        Cancer. 2009; 115: 1669-1679
        • Tanamai W.
        • Chen C.
        • Siavoshi S.
        • et al.
        Diffuse optical spectroscopy measurements of healing in breast tissue after core biopsy: case study.
        J Biomed Opt. 2009; 14: 014024
        • Graham R.A.
        • Homer M.J.
        • Katz J.
        • et al.
        The pancake phenomenon contributes to the inaccuracy of margin assessment in patients with breast cancer.
        Am J Surg. 2002; 184: 89-93
        • Zavagno G.
        • Goldin E.
        • Mencarelli R.
        • et al.
        Role of resection margins in patients treated with breast conservation surgery.
        Cancer. 2008; 112: 1923-1931
        • Jacobs L.J.
        Positive margins: the challenge continues for breast surgeons.
        Ann Surg Oncol. 2008; 15: 1271-1272
        • Bani M.R.
        • Lux M.P.
        • Heusinger K.
        • et al.
        Factors correlating with re-excision after breast-conserving surgery.
        EJSO. 2009; 35: 32-37
        • Luini A.
        • Rososchansky J.
        • Gatti G.
        • et al.
        The surgical margin status after breast conserving surgery: discussion of an open issue.
        Breast Cancer Res Treat. 2009; 113: 397-402
        • Waljee J.F.
        • Hu E.S.
        • Newman L.A.
        • et al.
        Predictors of re-excision among women undergoing breast conserving surgery for cancer.
        Ann Surg Oncol. 2008; 15: 1297-1303
        • Weber W.P.
        • Engelberger S.
        • Viehl C.T.
        • et al.
        Accuracy of frozen section analysis versus specimen radiography during breast-conserving surgery for nonpalpable lesions.
        World J Surg. 2008; 32: 2599-2606
        • Jacobson A.F.
        • Asad J.
        • Boolbol S.K.
        • et al.
        Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision?.
        Am J Surg. 2008; 196: 556-558
        • Cao D.
        • Lin C.
        • Woo S.H.
        • et al.
        Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcision.
        Am J Surg Pathol. 2005; 29: 1625-1632