title: Quantitative automated image analysis system with automated debris filtering for the detection of breast carcinoma cells.
abstract: OBJECTIVE
  To develop an intraoperative method for margin status evaluation during breast conservation therapy (BCT) using an automated analysis of imprint cytology specimens.
  
  
  METHODS
  Imprint cytology samples were prospectively taken from 47 patients undergoing either BCT or breast reduction surgery. Touch preparations from BCT patients were taken on cut sections through the tumor to generate positive margin controls. For breast reduction patients, slide imprints were taken at cuts through the center of excised tissue. Analysis results from the presented technique were compared against standard pathologic diagnosis. Slides were stained with cytokeratin and Hoechst, imaged with an automated fluorescent microscope, and analyzed with a fast algorithm to automate discrimination between epithelial cells and noncellular debris.
  
  
  RESULTS
  The accuracy of the automated analysis was 95% for identifying invasive cancers compared against final pathologic diagnosis. The overall sensitivity was 87% while specificity was 100% (no false positives). This is comparable to the best reported results from manual examination of intraoperative imprint cytology slides while reducing the need for direct input from a cytopathologist.
  
  
  CONCLUSIONS
  This work demonstrates a proof of concept for developing a highly accurate and automated system for the intraoperative evaluation of margin status to guide surgical decisions and lower positive margin rates.
authors.affiliation: Department of Electrical and Computer Engineering, University of California San Diego, San Diego, CA 92161, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Martin
authors.forename: Sergio
authors.initials: S
authors.lastname: Sandoval
authors.forename: Casey N
authors.initials: CN
authors.lastname: Ta
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Ruidiaz
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Cortes-Mateos
authors.forename: Davorka
authors.initials: D
authors.lastname: Messmer
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Kummel
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Blair
authors.forename: Jessica
authors.initials: J
authors.lastname: Wang-Rodriguez
mesh_terms: D001331:Automation; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D003952:Diagnostic Imaging / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results