Nguyen Freddy T, Zysk Adam M, Chaney Eric J, Kotynek Jan G, Oliphant Uretz J, Bellafiore Frank J, Rowland Kendrith M, Johnson Patricia A, Boppart Stephen A
Departments of Chemistry, College of Medicine, and Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Illinois 61801, USA.
Cancer Res. 2009 Nov 15;69(22):8790-6. doi: 10.1158/0008-5472.CAN-08-4340.
As breast cancer screening rates increase, smaller and more numerous lesions are being identified earlier, leading to more breast-conserving surgical procedures. Achieving a clean surgical margin represents a technical challenge with important clinical implications. Optical coherence tomography (OCT) is introduced as an intraoperative high-resolution imaging technique that assesses surgical breast tumor margins by providing real-time microscopic images up to 2 mm beneath the tissue surface. In a study of 37 patients split between training and study groups, OCT images covering 1 cm(2) regions were acquired from surgical margins of lumpectomy specimens, registered with ink, and correlated with corresponding histologic sections. A 17-patient training set used to establish standard imaging protocols and OCT evaluation criteria showed that areas of higher scattering tissue with a heterogeneous pattern were indicative of tumor cells and tumor tissue in contrast to lower scattering adipocytes found in normal breast tissue. The remaining 20 patients were enrolled into the feasibility study. Of these lumpectomy specimens, 11 were identified with a positive or close surgical margin and 9 were identified with a negative margin under OCT. Based on histologic findings, 9 true positives, 9 true negatives, 2 false positives, and 0 false negatives were found, yielding a sensitivity of 100% and specificity of 82%. These results show the potential of OCT as a real-time method for intraoperative margin assessment in breast-conserving surgeries.
随着乳腺癌筛查率的提高，越来越多更小的病灶被更早地发现，从而导致更多的保乳手术。实现切缘阴性是一项具有重要临床意义的技术挑战。光学相干断层扫描（OCT）作为一种术中高分辨率成像技术被引入，它通过提供组织表面以下达2毫米的实时微观图像来评估乳腺肿瘤手术切缘。在一项对37例患者分为训练组和研究组的研究中，从乳房肿瘤切除标本的手术切缘获取覆盖1平方厘米区域的OCT图像，用墨水标记，并与相应的组织学切片进行对比。一个用于建立标准成像方案和OCT评估标准的17例患者训练集表明，与正常乳腺组织中低散射的脂肪细胞相比，具有异质模式的高散射组织区域指示肿瘤细胞和肿瘤组织。其余20例患者被纳入可行性研究。在这些乳房肿瘤切除标本中，OCT检查发现11例手术切缘阳性或接近阳性，9例切缘阴性。根据组织学结果，发现9例假阳性、9例假阴性、2例假阳性和0例假阴性，敏感性为100%，特异性为82%。这些结果显示了OCT作为保乳手术中术中切缘评估实时方法的潜力。
