Abstract
The standard treatment for breast cancer is surgical removal mainly through breast-conserving surgery (BCS). We developed a new technique based on auto-fluorescence (AF) spectral imaging and Raman spectroscopy for fast intraoperative assessment of excision margins in BCS. A new wide-field AF imaging unit based on total internal reflection (TIR) was combined with a Raman spectroscopy microscope equipped with a 785 nm laser. The wavelength of the AF excitation was optimized to 365 nm in order to maximize the discrimination of adipose tissue. This approach allows for the non-adipose regions of tissue, which are at a higher risk of containing a tumor, to be targeted more efficiently by the Raman spectroscopy measurements. The integrated TIR-AF-Raman was tested on small tissue samples as well as fresh wide local excisions, delivering the analysis of the entire cruciate surface of BCS specimens (5.1 × 7.6 cm2) in less than 45 minutes and also providing information regarding the location of the tumor in the specimen. Full automation of the instrument and selection of a faster translation stage would allow for the measurement of BCS specimens within an intraoperative time scale (20 minutes). This study demonstrates that the TIR-AF Raman microscope represents a feasible step towards the development of a technique for intraoperative assessment of large WLE within intraoperative timescales.
Highlights
Each year, it is estimated that approximately 270,000 and 55,000 new cases of breast cancer are diagnosed in the USA and UK, respectively [1,2]
In this study we propose an alternative approach, in which Raman spectroscopy is combined with wide-field auto-fluorescence spectral imaging in order to speed up tissue analysis
The first type consisted of small breast tissue samples taken from mastectomies and wide local excisions (WLE)
Summary
It is estimated that approximately 270,000 and 55,000 new cases of breast cancer are diagnosed in the USA and UK, respectively [1,2]. One potential solution for reducing the number of re-excisions would be to use a technique that can assess the surgical margins intra-operatively (within a reasonable time frame; typically less than 20 minutes). [9] this method is laborious, it requires highly trained staff and it can lead to false results due to sampling errors and the high rate of histological artefacts induced when processing fatty samples [7,10]. For these reasons, the evaluation of surgical margins in breast specimens is often performed on permanent section [11]. A new approach for intraoperative assessment of margin that can overcome such limitations is urgently needed
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