Miniature spectral imaging device for wide-field quantitative functional imaging of the morphological landscape of breast tumor margins

Compact fiber-free parallel-plane multi-wavelength diffuse optical tomography system for breast imaging

To facilitate the clinical applicability of the diffuse optical inspection device, a compact multi-wavelength diffuse optical tomography system for breast imaging (compact-DOTB) with a fiber-free parallel-plane structure was designed and fabricated for acquiring three-dimensional optical properties of the breast in continuous-wave mode. The source array consists of 56 surface-mounted micro light-emitting diodes (LEDs), each integrating three wavelengths (660, 750, and 840 nm). The detector array is arranged with 56 miniaturized surface-mounted optical sensors, each encapsulating a high-sensitivity photodiode (PD) and a low-noise current amplifier with a gain of 24×. The system provides 3,136 pairs of source-detector measurements at each wavelength, and the fiber-free design largely ensures consistency between source/detection channels while effectively reducing the complexity of system operation and maintenance. We have evaluated the compact-DOTB system's characteristics and demonstrated its performance in terms of reconstruction positioning accuracy and recovery contrast with breast-sized phantom experiments. Furthermore, the breast cancer patient studies have been carried out, and the quantitative results indicate that the compact-DOTB system is able to observe the changes in the functional tissue components of the breast after receiving the neoadjuvant chemotherapy (NAC), demonstrating the great potential of the proposed compact system for clinical applications, while its cost and ease of operation are competitive with the existing breast-DOT devices.

Quantitative assessment of distant recurrence risk in early stage breast cancer using a nonlinear combination of pathological, clinical and imaging variables

Use of genomic assays to determine distant recurrence risk in patients with early stage breast cancer has expanded and is now included in the American Joint Committee on Cancer staging manual. Algorithmic alternatives using standard clinical and pathology information may provide equivalent benefit in settings where genomic tests, such as OncotypeDx, are unavailable. We developed an artificial neural network (ANN) model to nonlinearly estimate risk of distant cancer recurrence. In addition to clinical and pathological variables, we enhanced our model using intraoperatively determined global mammographic breast density (MBD) and local breast density (LBD). LBD was measured with optical spectral imaging capable of sensing regional concentrations of tissue constituents. A cohort of 56 ER+ patients with an OncotypeDx score was evaluated. We demonstrated that combining MBD/LBD measurements with clinical and pathological variables improves distant recurrence risk prediction accuracy, with high correlation (r = 0.98) to the OncotypeDx recurrence score.

Methods of extraction of optical properties from diffuse reflectance measurements of ex-vivo human colon tissue using thin film silicon photodetector arrays

Spatially resolved diffuse reflectance spectroscopy (SRDRS) is a promising technique for characterization of colon tissue. Herein, two methods for extracting the reduced scattering and absorption coefficients ( μ s ' ( λ ) and μ a ( λ ) ) from SRDRS data using lookup tables of simulated diffuse reflectance are reported. Experimental measurements of liquid tissue phantoms performed with a custom multi-pixel silicon SRDRS sensor spanning the 450 - 750 nm wavelength range were used to evaluate the extraction methods, demonstrating that the combined use of spatial and spectral data reduces extraction error compared to use of spectral data alone. Additionally, SRDRS measurements of normal and tumor ex-vivo human colon tissue are presented along with μ s ' ( λ ) and μ a ( λ ) extracted from these measurements.

Intra-operative spectroscopic assessment of surgical margins during breast conserving surgery

Background

In over 20% of breast conserving operations, postoperative pathological assessment of the excised tissue reveals positive margins, requiring additional surgery. Current techniques for intra-operative assessment of tumor margins are insufficient in accuracy or resolution to reliably detect small tumors. There is a distinct need for a fast technique to accurately identify tumors smaller than 1 mm² in large tissue surfaces within 30 min.

Methods

Multi-modal spectral histopathology (MSH), a multimodal imaging technique combining tissue auto-fluorescence and Raman spectroscopy was used to detect microscopic residual tumor at the surface of the excised breast tissue. New algorithms were developed to optimally utilize auto-fluorescence images to guide Raman measurements and achieve the required detection accuracy over large tissue surfaces (up to 4 × 6.5 cm²). Algorithms were trained on 91 breast tissue samples from 65 patients.

Results

Independent tests on 121 samples from 107 patients - including 51 fresh, whole excision specimens - detected breast carcinoma on the tissue surface with 95% sensitivity and 82% specificity. One surface of each uncut excision specimen was measured in 12–24 min. The combination of high spatial-resolution auto-fluorescence with specific diagnosis by Raman spectroscopy allows reliable detection even for invasive carcinoma or ductal carcinoma in situ smaller than 1 mm².

Conclusions

This study provides evidence that this multimodal approach could provide an objective tool for intra-operative assessment of breast conserving surgery margins, reducing the risk for unnecessary second operations.

Electronic supplementary material

The online version of this article (10.1186/s13058-018-1002-2) contains supplementary material, which is available to authorized users.

Multiscale nonlinear microscopy and widefield white light imaging enables rapid histological imaging of surgical specimen margins

The ability to histologically assess surgical specimens in real-time is a long-standing challenge in cancer surgery, including applications such as breast conserving therapy (BCT). Up to 40% of women treated with BCT for breast cancer require a repeat surgery due to postoperative histological findings of close or positive surgical margins using conventional formalin fixed paraffin embedded histology. Imaging technologies such as nonlinear microscopy (NLM), combined with exogenous fluorophores can rapidly provide virtual H&E imaging of surgical specimens without requiring microtome sectioning, facilitating intraoperative assessment of margin status. However, the large volume of typical surgical excisions combined with the need for rapid assessment, make comprehensive cellular resolution margin assessment during surgery challenging. To address this limitation, we developed a multiscale, real-time microscope with variable magnification NLM and real-time, co-registered position display using a widefield white light imaging system. Margin assessment can be performed rapidly under operator guidance to image specific regions of interest located using widefield imaging. Using simulated surgical margins dissected from human breast excisions, we demonstrate that multi-centimeter margins can be comprehensively imaged at cellular resolution, enabling intraoperative margin assessment. These methods are consistent with pathology assessment performed using frozen section analysis (FSA), however NLM enables faster and more comprehensive assessment of surgical specimens because imaging can be performed without freezing and cryo-sectioning. Therefore, NLM methods have the potential to be applied to a wide range of intra-operative applications.

Quantitative characterization of turbidity by radiative transfer based reflectance imaging

A new and noncontact approach of multispectral reflectance imaging has been developed to inversely determine the absorption coefficient of μ _a , the scattering coefficient of μ_s and the anisotropy factor g of a turbid target from one measured reflectance image. The incident beam was profiled with a diffuse reflectance standard for deriving both measured and calculated reflectance images. A GPU implemented Monte Carlo code was developed to determine the parameters with a conjugate gradient descent algorithm and the existence of unique solutions was shown. We noninvasively determined embedded region thickness in heterogeneous targets and estimated in vivo optical parameters of nevi from 4 patients between 500 and 950nm for melanoma diagnosis to demonstrate the potentials of quantitative reflectance imaging.

Automated detection of breast cancer in resected specimens with fluorescence lifetime imaging

Re-excision rates for breast cancer lumpectomy procedures are currently nearly 25% due to surgeons relying on inaccurate or incomplete methods of evaluating specimen margins. The objective of this study was to determine if cancer could be automatically detected in breast specimens from mastectomy and lumpectomy procedures by a classification algorithm that incorporated parameters derived from fluorescence lifetime imaging (FLIm). This study generated a database of co-registered histologic sections and FLIm data from breast cancer specimens (N  =  20) and a support vector machine (SVM) classification algorithm able to automatically detect cancerous, fibrous, and adipose breast tissue. Classification accuracies were greater than 97% for automated detection of cancerous, fibrous, and adipose tissue from breast cancer specimens. The classification worked equally well for specimens scanned by hand or with a mechanical stage, demonstrating that the system could be used during surgery or on excised specimens. The ability of this technique to simply discriminate between cancerous and normal breast tissue, in particular to distinguish fibrous breast tissue from tumor, which is notoriously challenging for optical techniques, leads to the conclusion that FLIm has great potential to assess breast cancer margins. Identification of positive margins before waiting for complete histologic analysis could significantly reduce breast cancer re-excision rates.

Evaluating feasibility of an automated 3-dimensional scanner using Raman spectroscopy for intraoperative breast margin assessment

Breast conserving surgery is the preferred treatment for women diagnosed with early stage invasive breast cancer. To ensure successful breast conserving surgeries, efficient tumour margin resection is required for minimizing tumour recurrence. Currently surgeons rely on touch preparation cytology or frozen section analysis to assess tumour margin status intraoperatively. These techniques have suboptimal accuracy and are time-consuming. Tumour margin status is eventually confirmed using postoperative histopathology that takes several days. Thus, there is a need for a real-time, accurate, automated guidance tool that can be used during tumour resection intraoperatively to assure complete tumour removal in a single procedure. In this paper, we evaluate feasibility of a 3-dimensional scanner that relies on Raman Spectroscopy to assess the entire margins of a resected specimen within clinically feasible time. We initially tested this device on a phantom sample that simulated positive tumour margins. This device first scans the margins of the sample and then depicts the margin status in relation to an automatically reconstructed image of the phantom sample. The device was further investigated on breast tissues excised from prophylactic mastectomy specimens. Our findings demonstrate immense potential of this device for automated breast tumour margin assessment to minimise repeat invasive surgeries.

Flexible silicon sensors for diffuse reflectance spectroscopy of tissue

Diffuse reflectance spectroscopy (DRS) is being used in exploratory clinical applications such as cancer margin assessment on excised tissue. However, when interrogating nonplanar tissue anomalies can arise from non-uniform pressure. Herein is reported the design, fabrication, and test of flexible, thin film silicon photodetectors (PDs) bonded to a flexible substrate designed for use in conformal DRS. The PDs have dark currents and responsivities comparable to conventional Si PDs, and were characterized while flat and while flexed at multiple radii of curvature using liquid phantoms mimicking adipose and malignant breast tissue. The DRS and nearest neighbor crosstalk results were compared with Monte Carlo simulations, showing good agreement between simulation and experiment.