Intraoperative Assessment of Final Margins with a Handheld Optical Imaging Probe During Breast-Conserving Surgery May Reduce the Reoperation Rate: Results of a Multicenter Study

Adam M. Zysk, Kai Chen, Edward Gabrielson, Lorraine Tafra, Evelyn A. May Gonzalez, Joseph K. Canner, Eric B. Schneider, Andrew J. Cittadine, P. Scott Carney, Stephen A. Boppart, Kimiko Tsuchiya, Kristen Sawyer, Lisa K. Jacobs

Research output: Contribution to journalArticle

Abstract

Background: A multicenter, prospective, blinded study was performed to test the feasibility of using a handheld optical imaging probe for the intraoperative assessment of final surgical margins during breast-conserving surgery (BCS) and to determine the potential impact on patient outcomes. Methods: Forty-six patients with early-stage breast cancer (one with bilateral disease) undergoing BCS at two study sites, the Johns Hopkins Hospital and Anne Arundel Medical Center, were enrolled in this study. During BCS, cavity-shaved margins were obtained and the final margins were examined ex vivo in the operating room with a probe incorporating optical coherence tomography (OCT) hardware and interferometric synthetic aperture microscopy (ISAM) image processing. Images were interpreted after BCS by three physicians blinded to final pathology-reported margin status. Individual and combined interpretations were assessed. Results were compared to conventional postoperative histopathology. Results: A total of 2,191 images were collected and interpreted from 229 shave margin specimens. Of the eight patients (17 %) with positive margins (0 mm), which included invasive and in situ diseases, the device identified all positive margins in five (63 %) of them; reoperation could potentially have been avoided in these patients. Among patients with pathologically negative margins (>0 mm), an estimated mean additional tissue volume of 10.7 ml (approximately 1 % of overall breast volume) would have been unnecessarily removed due to false positives. Conclusions: Intraoperative optical imaging of specimen margins with a handheld probe potentially eliminates the majority of reoperations.

Original languageEnglish (US)
Pages (from-to)3356-3362
Number of pages7
JournalAnnals of surgical oncology
Volume22
Issue number10
DOIs
StatePublished - Oct 29 2015

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ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Zysk, A. M., Chen, K., Gabrielson, E., Tafra, L., May Gonzalez, E. A., Canner, J. K., Schneider, E. B., Cittadine, A. J., Scott Carney, P., Boppart, S. A., Tsuchiya, K., Sawyer, K., & Jacobs, L. K. (2015). Intraoperative Assessment of Final Margins with a Handheld Optical Imaging Probe During Breast-Conserving Surgery May Reduce the Reoperation Rate: Results of a Multicenter Study. Annals of surgical oncology, 22(10), 3356-3362. https://doi.org/10.1245/s10434-015-4665-2