title: Real-time Imaging of the Resection Bed Using a Handheld Probe to Reduce Incidence of Microscopic Positive Margins in Cancer Surgery.
abstract: Wide local excision (WLE) is a common surgical intervention for solid tumors such as those in melanoma, breast, pancreatic, and gastrointestinal cancer. However, adequate margin assessment during WLE remains a significant challenge, resulting in surgical reinterventions to achieve adequate local control. Currently, no label-free imaging method is available for surgeons to examine the resection bed in vivo for microscopic residual cancer. Optical coherence tomography (OCT) enables real-time high-resolution imaging of tissue microstructure. Previous studies have demonstrated that OCT analysis of excised tissue specimens can distinguish between normal and cancerous tissues by identifying the heterogeneous and disorganized microscopic tissue structures indicative of malignancy. In this translational study involving 35 patients, a handheld surgical OCT imaging probe was developed for in vivo use to assess margins both in the resection bed and on excised specimens for the microscopic presence of cancer. The image results from OCT showed structural differences between normal and cancerous tissue within the resection bed following WLE of the human breast. The ex vivo images were compared with standard postoperative histopathology to yield sensitivity of 91.7% [95% confidence interval (CI), 62.5%-100%] and specificity of 92.1% (95% CI, 78.4%-98%). This study demonstrates in vivo OCT imaging of the resection bed during WLE with the potential for real-time microscopic image-guided surgery.
authors.affiliation: Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Erickson-Bhatt
authors.affiliation: Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Nolan
authors.affiliation: Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Shemonski
authors.affiliation: Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Adie
authors.affiliation: Diagnostic Photonics, Inc., Chicago, Illinois.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Putney
authors.affiliation: Diagnostic Photonics, Inc., Chicago, Illinois.
authors.forename: Donald
authors.initials: D
authors.lastname: Darga
authors.affiliation: AdvancedMEMS, San Francisco, California.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: McCormick
authors.affiliation: Diagnostic Photonics, Inc., Chicago, Illinois.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cittadine
authors.affiliation: Diagnostic Photonics, Inc., Chicago, Illinois.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Zysk
authors.affiliation: Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Marina
authors.initials: M
authors.lastname: Marjanovic
authors.affiliation: Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chaney
authors.affiliation: Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Guillermo L
authors.initials: GL
authors.lastname: Monroy
authors.affiliation: Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Fredrick A
authors.initials: FA
authors.lastname: South
authors.affiliation: Carle Foundation Hospital, Urbana, Illinois.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cradock
authors.affiliation: Carle Foundation Hospital, Urbana, Illinois.
authors.forename: Z George
authors.initials: ZG
authors.lastname: Liu
authors.affiliation: Carle Foundation Hospital, Urbana, Illinois. Department of Surgery, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Magesh
authors.initials: M
authors.lastname: Sundaram
authors.affiliation: Carle Foundation Hospital, Urbana, Illinois. Department of Surgery, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois.
authors.forename: Partha S
authors.initials: PS
authors.lastname: Ray
authors.affiliation: Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois. Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois. Diagnostic Photonics, Inc., Chicago, Illinois. Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois. Carle Foundation Hospital, Urbana, Illinois. boppart@illinois.edu.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boppart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D003199:Computer Systems; D004867:Equipment Design; D005260:Female; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D041623:Tomography, Optical Coherence / Q000295:instrumentation / Q000379:methods*; D014741:Video Recording / Q000295:instrumentation / Q000379:methods