Unacceptably large percentage (20-40%) of breast cancer lumpectomy patients are required to undergo multiple surgeries when positive margins are found upon post-operative histologic assessment. If the margin status can be determined during surgery, surgeon can resect additional tissues to achieve tumor-free margin, which will reduce the need for additional surgeries. Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technology that has a potential to image the entire surgical margin within a short procedural time. Previously, SECM was shown to rapidly image a large area (10 mm by 10 mm) of human esophageal tissue within a short procedural time (15 seconds). When used in lumpectomy, SECM will be able to image the entire margin surface of ~30 cm2 in around 7.5 minutes. SECM images will then be used to determine margin status intra-operatively. In this paper, we present results from a study of testing accuracy of SECM for diagnosing malignant breast tissues. We have imaged freshly-excised breast specimens (N=46) with SECM. SECM images clearly visualized histomorphologic features associated with normal/benign and malignant breast tissues in a similar manner to histologic images. Diagnostic accuracy was tested by comparing SECM diagnoses made by three junior pathologists with corresponding histologic diagnoses made by a senior pathologist. SECM sensitivity and specificity were high, 0.91 and 0.93, respectively. Intra-observer agreement and inter-observer agreement were also high, 0.87 and 0.84, respectively. Results from this study showed that SECM has a potential to accurately determine margin status during breast cancer lumpectomy.
Elena F. Brachtel, Nicole B. Johnson, Amelia E. Huck, Travis L. Rice-Stitt, Mark G. Vangel, Barbara L. Smith, Guillermo J. Tearney M.D., and DongKyun Kang, "Spectrally encoded confocal microscopy (SECM) for rapid assessment of breast excision specimens
(Conference Presentation)," Proc. SPIE 9703, Optical Biopsy XIV: Toward Real-Time Spectroscopic Imaging and Diagnosis, 97030C (Presented at SPIE BiOS: February 15, 2016; Published: 26 April 2016); https://doi.org/10.1117/12.2209699.4848650666001.
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