Keller Matthew D, Majumder Shovan K, Kelley Mark C, Meszoely Ingrid M, Boulos Fouad I, Olivares Graciela M, Mahadevan-Jansen Anita
Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37235, USA.
Lasers Surg Med. 2010 Jan;42(1):15-23. doi: 10.1002/lsm.20865.
Most women with early stage breast cancer have the option of breast conserving therapy, which involves a partial mastectomy for removal of the primary tumor, usually followed by radiotherapy. The presence of tumor at or near the margin is strongly correlated with the risk of local tumor recurrence, so there is a need for a non-invasive, real-time tool to evaluate margin status. This study examined the use of autofluorescence and diffuse reflectance spectroscopy and spectral imaging to evaluate margin status intraoperatively.
Spectral measurements were taken from the surface of the tissue mass immediately following removal during partial mastectomies and/or from tissues immediately after sectioning by surgical pathology. A total of 145 normal spectra were obtained from 28 patients, and 34 tumor spectra were obtained from 12 patients.
After correlation with histopathology, a multivariate statistical algorithm classified the spectra as normal (negative margins) or tumor (positive margins) with 85% sensitivity and 96% specificity. A separate algorithm achieved 100% classification between neo-adjuvant chemotherapy-treated tissues and non-treated tissues. Fluorescence and reflectance-based spectral images were able to demarcate a calcified lesion on the surface of a resected specimen as well.
Fluorescence and reflectance spectroscopy could be a valuable tool for examining the superficial margin status of excised breast tumor specimens, particularly in the form of spectral imaging to examine entire margins in a single acquisition.
大多数早期乳腺癌女性患者可选择保乳治疗，该治疗包括切除原发肿瘤的部分乳房切除术，通常随后进行放射治疗。切缘处或其附近存在肿瘤与局部肿瘤复发风险密切相关，因此需要一种非侵入性的实时工具来评估切缘状态。本研究检测了自体荧光、漫反射光谱及光谱成像在术中评估切缘状态的应用。
在部分乳房切除术中切除组织块后立即从组织块表面进行光谱测量，和/或在手术病理切片后立即从组织进行光谱测量。从28例患者中获得了总共145条正常光谱，从12例患者中获得了34条肿瘤光谱。
与组织病理学相关分析后，一种多变量统计算法将光谱分类为正常（切缘阴性）或肿瘤（切缘阳性），敏感性为85%，特异性为96%。另一种算法在新辅助化疗治疗组织和未治疗组织之间实现了100%的分类。基于荧光和反射的光谱图像也能够在切除标本表面划定一个钙化病变。
荧光和反射光谱可能是检查切除的乳腺肿瘤标本表面切缘状态的有价值工具，特别是以光谱成像的形式在一次采集过程中检查整个切缘。
