Abstract
.High re-excision rates in breast-conserving surgery call for a new intraoperative approach to the lumpectomy margin evaluation problem. The unique intraoperative imaging system, presented here, demonstrated the capability of photoacoustic tomography (PAT) to deliver optical sensitivity and specificity, along with over 2-cm imaging depth, in a clinical setting. The system enabled the evaluation of tumor extent, shape, morphology, and position within lumpectomy specimens measuring up to 11 cm in diameter. The investigation included all major breast cancer-related lesions, such as invasive ductal carcinoma (IDC), multifocal IDC, ductal carcinoma in situ and combinations of these variants. Coregistration with established ultrasound (US) technology, as well as comparison to specimen radiography, validated the performance of PAT, which appeared to facilitate better tumor visualization. Contrary to expected PA contrast mechanisms, PAT images of hemoglobin distribution correlated poorly with US-determined tumor location, while hypointense regions in lipid-weighted PAT images were in better agreement with US.
Highlights
The past few decades have witnessed the introduction of advanced imaging methods, regular screening programs, and therapies causing breast cancer survival rates to improve significantly; it still remains as the most common cancer to affect women, excluding basal cell carcinoma
In current clinical practice, the procedure often fails, resulting in a positive margin being reported by pathology at a later time and leading to a national (Canadian) re-excision rate of 23%
The selected z-slices are separated by 1 mm and depict the graphite spoke inclusions as Downloaded From: https://www.spiedigitallibrary.org/journals/Journal-of-Biomedical-Optics on 08 Nov 2021 Terms of Use: https://www.spiedigitallibrary.org/terms-of-use hyperintense on the intraoperative photoacoustic screening (iPAS) scan
Summary
The past few decades have witnessed the introduction of advanced imaging methods, regular screening programs, and therapies causing breast cancer survival rates to improve significantly; it still remains as the most common cancer to affect women, excluding basal cell carcinoma. The goal is to remove all malignant tissues from the breast surrounded by a continuous envelope of normal tissues. This healthy tissue layer is referred to as a negative margin.[2] Currently, selection of the width of a lumpectomy margin to minimize cancer recurrence is a topic of debate. To minimize the risk of cancer recurrence, such a finding usually leads to the need for a second surgery. This situation has a negative impact on hospital resources and patients, by delaying adjuvant therapy, elevating stress levels, and degrading cosmetic outcome.
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