Diagnostic accuracy of quantitative micro-elastography for margin assessment in breast-conserving surgery
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Inadequate margins in breast-conserving surgery (BCS) are associated with an increased likelihood of local recurrence of breast cancer. Currently, approximately 20% of BCS patients require repeat surgery due to inadequate margins at the initial operation. Implementation of an accurate, intraoperative margin assessment tool may reduce this re-excision rate. This study determined, for the first time, the diagnostic accuracy of quantitative micro-elastography (QME), an optical coherence tomography (OCT)-based elastography technique that produces images of tissue microscale elasticity, for detecting tumor within 1 mm of the margins of BCS specimens. Simultaneous OCT and QME were performed on the margins of intact, freshly excised specimens from 83 patients undergoing BCS and on dissected specimens from 7 patients undergoing mastectomy. The resulting three-dimensional images (45 × 45 × 1 mm) were coregistered with postoperative histology to determine tissue types present in each scan. Data from 12 BCS patients and the 7 mastectomy patients served to build a set of images for reader training. One hundred and fifty-four subimages (10 × 10 × 1 mm) from the remaining 71 BCS patients were included in a blinded reader study, which resulted in 69.0% sensitivity and 79.0% specificity using OCT images, versus 92.9% sensitivity and 96.4% specificity using elasticity images. The quantitative nature of QME also facilitated development of an automated reader, which resulted in 100.0% sensitivity and 97.7% specificity. These results demonstrate high accuracy of QME for detecting tumor within 1 mm of the margin and the potential for this technique to improve outcomes in BCS. Significance : An optical imaging technology probes breast tissue elasticity to provide accurate assessment of tumor margin involvement in breast-conserving surgery.
Kennedy , K M , Zilkens , R , Allen , W M , Foo , K Y , Fang , Q , Chin , L , Sanderson , R W , Anstie , J , Wijesinghe , P , Curatolo , A , Tan , H E I , Morin , N , Kunjuraman , B , Yeomans , C , Chin , S L , DeJong , H , Giles , K , Dessauvagie , B F , Latham , B , Saunders , C M & Kennedy , B F 2020 , ' Diagnostic accuracy of quantitative micro-elastography for margin assessment in breast-conserving surgery ' , Cancer Research , vol. 80 , no. 8 , pp. 1773-1783 . https://doi.org/10.1158/0008-5472.CAN-19-1240
Copyright © 2020 American Association for Cancer Research. This work has been made available online in accordance with publisher policies or with permission. Permission for further reuse of this content should be sought from the publisher or the rights holder. This is the author created accepted manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at https://doi.org/10.1158/0008-5472.CAN-19-1240
DescriptionFunding: OncoRes Medical; Department of Health, Australia; Cancer Council Western Australia; Australian Research Council.
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