Quantitative Micro-Elastography Enables In Vivo Detection of Residual Cancer in the Surgical Cavity during Breast-Conserving Surgery

Author:

Gong Peijun12ORCID,Chin Synn Lynn3ORCID,Allen Wes M.12ORCID,Ballal Helen3ORCID,Anstie James D.12ORCID,Chin Lixin12ORCID,Ismail Hina M.12ORCID,Zilkens Renate14ORCID,Lakhiani Devina D.12ORCID,McCarthy Matthew5ORCID,Fang Qi12ORCID,Firth Daniel12ORCID,Newman Kyle12ORCID,Thomas Caleb12ORCID,Li Jiayue126ORCID,Sanderson Rowan W.12ORCID,Foo Ken Y.12ORCID,Yeomans Chris7ORCID,Dessauvagie Benjamin F.78ORCID,Latham Bruce79ORCID,Saunders Christobel M.3410ORCID,Kennedy Brendan F.126ORCID

Affiliation:

1. 1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia.

2. 2Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia.

3. 3Breast Centre, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.

4. 4Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia.

5. 5OncoRes Medical, Perth, Western Australia, Australia.

6. 6Australian Research Council Centre for Personalised Therapeutics Technologies, Melbourne, Victoria, Australia.

7. 7PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.

8. 8Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia.

9. 9The University of Notre Dame, Fremantle, Western Australia, Australia.

10. 10Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia.

Abstract

Abstract 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. Significance: 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.

Funder

Australian Research Council

Publisher

American Association for Cancer Research (AACR)

Subject

Cancer Research,Oncology

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