title: Spectrally encoded confocal microscopy for diagnosing breast cancer in excision and margin specimens.
abstract: A large percentage of breast cancer patients treated with breast conserving surgery need to undergo multiple surgeries due to positive margins found during post-operative margin assessment. Carcinomas could be removed completely during the initial surgery and additional surgery avoided if positive margins can be determined intraoperatively. Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technology that has a potential to rapidly image the entire surgical margin at subcellular resolution and accurately determine margin status intraoperatively. In this study, in order to test the feasibility of using SECM for intraoperative margin assessment, we have evaluated the diagnostic accuracy of SECM for detecting various types of breast cancers. Forty-six surgically removed breast specimens were imaged with an SECM system. Side-by-side comparison between SECM and histologic images showed that SECM images can visualize key histomorphologic patterns of normal/benign and malignant breast tissues. Small (500 μm × 500 μm) spatially registered SECM and histologic images (n=124 for each) were diagnosed independently by three pathologists with expertise in breast pathology. Diagnostic accuracy of SECM for determining malignant tissues was high, average sensitivity of 0.91, specificity of 0.93, positive predictive value of 0.95, and negative predictive value of 0.87. Intra-observer agreement and inter-observer agreement for SECM were also high, 0.87 and 0.84, respectively. Results from this study suggest that SECM may be developed into an intraoperative margin assessment tool for guiding breast cancer excisions.
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Elena F
authors.initials: EF
authors.lastname: Brachtel
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Nicole B
authors.initials: NB
authors.lastname: Johnson
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Amelia E
authors.initials: AE
authors.lastname: Huck
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Travis L
authors.initials: TL
authors.lastname: Rice-Stitt
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.|Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Vangel
authors.affiliation: Gillette Center for Women's Cancers and Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.|Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.|Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Tearney
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Dongkyun
authors.initials: D
authors.lastname: Kang
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D018613:Microscopy, Confocal / Q000379:methods*; D015588:Observer Variation; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity