Abstract
Successful breast conserving surgery consists of complete removal of the tumor while sparing healthy surrounding tissue. Despite currently available imaging and margin assessment tools, recognizing tumor tissue at a resection margin during surgery is challenging. Diffuse reflectance spectroscopy (DRS), which uses light for tissue characterization, can potentially guide surgeons to prevent tumor positive margins. However, inter-patient variation and changes in tissue physiology occurring during the resection might hamper this light-based technology. Here we investigate how inter-patient variation and tissue status (in vivo vs ex vivo) affect the performance of the DRS optical parameters. In vivo and ex vivo measurements of 45 breast cancer patients were obtained and quantified with an analytical model to acquire the optical parameters. The optical parameter representing the ratio between fat and water provided the best discrimination between normal and tumor tissue, with an area under the receiver operating characteristic curve of 0.94. There was no substantial influence of other patient factors such as menopausal status on optical measurements. Contrary to expectations, normalization of the optical parameters did not improve the discriminative power. Furthermore, measurements taken in vivo were not significantly different from the measurements taken ex vivo. These findings indicate that DRS is a robust technology for the detection of tumor tissue during breast conserving surgery.
Highlights
There is an unmet clinical need for intra-operative detection of tumor deposits on resection margins during breast conserving surgery
In this study, we investigated the usability of optical spectroscopy for margin assessment during breast conserving surgery by evaluating the discriminative power of optical parameters for tissue differentiation between normal breast tissue and tumor tissue
We took in consideration confounding factors such as menopausal status, previous treatments, verification method and tissue status that might have an influence on the optical parameters
Summary
There is an unmet clinical need for intra-operative detection of tumor deposits on resection margins during breast conserving surgery. Leaving tumor tissue behind during surgery will increase the chance of developing local recurrence, and for this reason, in patients with tumor positive resection margins additional measures such as re-excision or boost radiation therapy may be indicated. Like intra-operative ultrasound, decrease the number of positive resection margins but still lack sensitivity for small tumor deposits [2]. A recently introduced margin evaluation tool is the MarginProbe (DUNE Medical Devices, Paoli, PA, United States), which uses radiofrequency spectroscopy for positive resection margin detection. This technology is under evaluation for more widespread intraoperative use during breast conserving surgery (BCS). First results indicate that with this device the number of re-excisions decreases larger volumes of tissue are resected [3, 4]
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