High-speed Intraoperative Assessment of Breast Tumor Margins by Multimodal Ultrasound and Photoacoustic Tomography.
High-speed Intraoperative Assessment of Breast Tumor Margins by Multimodal Ultrasound and Photoacoustic Tomography.
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DOI：
10.1002/mds3.10018
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发表时间：
2018-06-01
期刊：
影响因子：
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通讯作者：
Cheng, Ji-Xin
中科院分区：
文献类型：
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作者：
Li, Rui;Lan, Lu;Cheng, Ji-Xin
传统的乳房肿瘤边缘评估方法需要较长的周转时间，这可能导致接受乳房肿瘤切除术的患者再次手术。光声断层扫描（PAT）已被证明可以可视化小动物和人类乳房的脂肪组织。在这里，我们展示了一种定制的多模态超声和PAT系统，用于术中乳房肿瘤边缘评估，使用来自66名患者的新鲜乳房肿瘤切除术标本。该系统可在10分钟内提供整个切除组织的边缘状态。经三位研究者主观解读，结果与术后组织学交叉相关时，敏感性为85.7%[95%置信区间（CI）， 42.0% ~ 99.2%]，特异性为84.6% (95% CI, 53.7% ~ 97.3%)，敏感性为71.4% (95% CI, 30.3% ~ 94.9%)，特异性为92.3% (95% CI, 62.1% ~ 99.6%)，敏感性为100% (95% CI, 56.1% ~ 100%)，特异性为53.9% （95% CI, 26.1% ~ 79.6%）。此外，基于机器学习的算法被用于挑战性导管原位癌组织的边缘评估，获得了85.5% （95% CI, 75.2% - 92.2%）的灵敏度和90% （95% CI, 79.9% - 95.5%）的特异性。这些结果表明，使用多模态超声和PAT作为一种快速准确的术中乳腺肿瘤边缘评估方法的潜力。
Conventional methods for breast tumor margins assessment need a long turnaround time, which may lead to re-operation for patients undergoing lumpectomy surgeries. Photoacoustic tomography (PAT) has been shown to visualize adipose tissue in small animals and human breast. Here, we demonstrate a customized multimodal ultrasound and PAT system for intraoperative breast tumor margins assessment using fresh lumpectomy specimens from 66 patients. The system provides the margin status of the entire excised tissue within 10 minutes. By subjective reading of three researchers, the results show 85.7% [95% confidence interval (CI), 42.0% - 99.2%] sensitivity and 84.6% (95% CI, 53.7% - 97.3%) specificity, 71.4% (95% CI, 30.3% - 94.9%) sensitivity and 92.3% (95% CI, 62.1% - 99.6%) specificity, and 100% (95% CI, 56.1% - 100%) sensitivity and 53.9% (95% CI, 26.1% - 79.6%) specificity respectively when cross-correlated with post-operational histology. Furthermore, a machine learning-based algorithm is deployed for margin assessment in the challenging ductal carcinoma in situ tissues, and achieved 85.5% (95% CI, 75.2% - 92.2%) sensitivity and 90% (95% CI, 79.9% - 95.5%) specificity. Such results present the potential of using mutlimodal ultrasound and PAT as a high-speed and accurate method for intraoperative breast tumor margins evaluation.