Abstract
.Intraoperative assessment of breast surgical margins will be of value for reducing the rate of re-excision surgeries for lumpectomy patients. While frozen-section histology is used for intraoperative guidance of certain cancers, it provides limited sampling of the margin surface (typically of the margin) and is inferior to gold-standard histology, especially for fatty tissues that do not freeze well, such as breast specimens. Microscopy with ultraviolet surface excitation (MUSE) is a nondestructive superficial optical-sectioning technique that has the potential to enable rapid, high-resolution examination of excised margin surfaces. Here, a MUSE system is developed with fully automated sample translation to image fresh tissue surfaces over large areas and at multiple levels of defocus, at a rate of . Surface extraction is used to improve the comprehensiveness of surface imaging, and 3-D deconvolution is used to improve resolution and contrast. In addition, an improved fluorescent analog of conventional H&E staining is developed to label fresh tissues within for MUSE imaging. We compare the image quality of our MUSE system with both frozen-section and conventional H&E histology, demonstrating the feasibility to provide microscopic visualization of breast margin surfaces at speeds that are relevant for intraoperative use.
Highlights
Lumpectomy is a breast-conserving procedure used to surgically remove breast carcinoma along with a margin of normal tissue surrounding the tumor
Comprehensive pathology of the margin surfaces of freshly excised breast specimens has been achieved through the use of a UV-excited two-color fluorescent analog of H&E in conjunction with a fully automated Microscopy with ultraviolet surface excitation (MUSE) system that enables 3-D deconvolution and surface extraction to improve image resolution, contrast, and comprehensiveness
MUSE is a nondestructive and comprehensive surface-imaging technique, unlike slide-based formalin-fixed paraffin-embedded (FFPE) histology, which requires destructive tissue sectioning with severe limitations concerning sampling extent
Summary
Lumpectomy is a breast-conserving procedure used to surgically remove breast carcinoma along with a margin of normal tissue surrounding the tumor. Studies have shown that patients with invasive breast cancer, treated with lumpectomy and local breast irradiation, exhibit no significant difference in survival compared with those undergoing mastectomy, provided that the entire tumor is removed during lumpectomy surgery.[1,2] if postoperative histopathology reveals the presence of carcinoma at the surgical margin, re-excision procedures, including completion mastectomies, are often performed to minimize the possibility of local recurrence.[3] Reoperation after lumpectomy can result in the delay of adjuvant treatments with increased risks of recurrence,[4] emotional trauma,[5] as well as an increased economic burden for both the healthcare system and patients. The rate of reoperation after lumpectomy has been calculated to be at least 20% according to recent studies.[3,6,7] there is an acknowledged need for reliable intraoperative methods to assess the surgical margins of freshly resected lumpectomy specimens (Fig. 1)
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