Annals of Surgical Oncology

, Volume 22, Issue 10, pp 3356–3362

Intraoperative Assessment of Final Margins with a Handheld Optical Imaging Probe During Breast-Conserving Surgery May Reduce the Reoperation Rate: Results of a Multicenter Study

  • Adam M. Zysk
  • Kai Chen
  • Edward Gabrielson
  • Lorraine Tafra
  • Evelyn A. May Gonzalez
  • Joseph K. Canner
  • Eric B. Schneider
  • Andrew J. Cittadine
  • P. Scott Carney
  • Stephen A. Boppart
  • Kimiko Tsuchiya
  • Kristen Sawyer
  • Lisa K. Jacobs
Breast Oncology

Abstract

Background

A multicenter, prospective, blinded study was performed to test the feasibility of using a handheld optical imaging probe for the intraoperative assessment of final surgical margins during breast-conserving surgery (BCS) and to determine the potential impact on patient outcomes.

Methods

Forty-six patients with early-stage breast cancer (one with bilateral disease) undergoing BCS at two study sites, the Johns Hopkins Hospital and Anne Arundel Medical Center, were enrolled in this study. During BCS, cavity-shaved margins were obtained and the final margins were examined ex vivo in the operating room with a probe incorporating optical coherence tomography (OCT) hardware and interferometric synthetic aperture microscopy (ISAM) image processing. Images were interpreted after BCS by three physicians blinded to final pathology-reported margin status. Individual and combined interpretations were assessed. Results were compared to conventional postoperative histopathology.

Results

A total of 2,191 images were collected and interpreted from 229 shave margin specimens. Of the eight patients (17 %) with positive margins (0 mm), which included invasive and in situ diseases, the device identified all positive margins in five (63 %) of them; reoperation could potentially have been avoided in these patients. Among patients with pathologically negative margins (>0 mm), an estimated mean additional tissue volume of 10.7 ml (approximately 1 % of overall breast volume) would have been unnecessarily removed due to false positives.

Conclusions

Intraoperative optical imaging of specimen margins with a handheld probe potentially eliminates the majority of reoperations.

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Adam M. Zysk
    • 1
  • Kai Chen
    • 2
    • 3
  • Edward Gabrielson
    • 2
  • Lorraine Tafra
    • 4
  • Evelyn A. May Gonzalez
    • 2
  • Joseph K. Canner
    • 2
  • Eric B. Schneider
    • 2
  • Andrew J. Cittadine
    • 1
  • P. Scott Carney
    • 1
  • Stephen A. Boppart
    • 1
    • 5
  • Kimiko Tsuchiya
    • 2
  • Kristen Sawyer
    • 4
  • Lisa K. Jacobs
    • 2
  1. 1.Diagnostic Photonics, Inc.ChicagoUSA
  2. 2.The Johns Hopkins HospitalBaltimoreUSA
  3. 3.Sun Yat-sen Memorial HospitalGuangzhouPeople’s Republic of China
  4. 4.Anne Arundel Medical CenterAnnapolisUSA
  5. 5.University of Illinois at Urbana-ChampaignUrbanaUSA

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