BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia.
Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia.
Cancer Res. 2022 Nov 2;82(21):4093-4104. doi: 10.1158/0008-5472.CAN-22-0578.
Breast-conserving surgery (BCS) is commonly used for the treatment of early-stage breast cancer. Following BCS, approximately 20% to 30% of patients require reexcision because postoperative histopathology identifies cancer in the surgical margins of the excised specimen. Quantitative micro-elastography (QME) is an imaging technique that maps microscale tissue stiffness and has demonstrated a high diagnostic accuracy (96%) in detecting cancer in specimens excised during surgery. However, current QME methods, in common with most proposed intraoperative solutions, cannot image cancer directly in the patient, making their translation to clinical use challenging. In this proof-of-concept study, we aimed to determine whether a handheld QME probe, designed to interrogate the surgical cavity, can detect residual cancer directly in the breast cavity in vivo during BCS. In a first-in-human study, 21 BCS patients were scanned in vivo with the QME probe by five surgeons. For validation, protocols were developed to coregister in vivo QME with postoperative histopathology of the resected tissue to assess the capability of QME to identify residual cancer. In four cavity aspects presenting cancer and 21 cavity aspects presenting benign tissue, QME detected elevated stiffness in all four cancer cases, in contrast to low stiffness observed in 19 of the 21 benign cases. The results indicate that in vivo QME can identify residual cancer by directly imaging the surgical cavity, potentially providing a reliable intraoperative solution that can enable more complete cancer excision during BCS.
Optical imaging of microscale tissue stiffness enables the detection of residual breast cancer directly in the surgical cavity during breast-conserving surgery, which could potentially contribute to more complete cancer excision.
保乳手术（BCS）常用于治疗早期乳腺癌。BCS 后，约 20%至 30%的患者需要再次切除，因为术后组织病理学在切除标本的手术切缘处发现癌症。定量微弹性成像（QME）是一种成像技术，可绘制微尺度组织硬度图，在检测术中切除标本中的癌症方面具有很高的诊断准确性（96%）。然而，与大多数提出的术中解决方案一样，目前的 QME 方法无法直接在患者体内对癌症进行成像，这使得它们向临床应用的转化具有挑战性。在这项概念验证研究中，我们旨在确定一种设计用于探查手术腔的手持式 QME 探头是否可以在 BCS 期间直接在乳房腔内活体检测残留的癌症。在一项首次人体研究中，五位外科医生用 QME 探头对 21 名 BCS 患者进行了体内扫描。为了验证，制定了方案将体内 QME 与切除组织的术后组织病理学进行配准，以评估 QME 识别残留癌症的能力。在 4 个存在癌症的腔面和 21 个存在良性组织的腔面中，QME 在所有 4 个癌症病例中检测到了升高的硬度，而在 21 个良性病例中的 19 个观察到了低硬度。结果表明，体内 QME 可以通过直接对手术腔成像来识别残留的癌症，这可能提供一种可靠的术中解决方案，可在 BCS 期间实现更完全的癌症切除。
微尺度组织硬度的光学成像可在保乳手术期间直接在手术腔中检测残留的乳腺癌，这可能有助于更完全地切除癌症。
