Optical coherence tomography: the intraoperative assessment of lymph nodes in breast cancer.
Optical coherence tomography: the intraoperative assessment of lymph nodes in breast cancer.
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DOI：
10.1109/memb.2009.935722
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发表时间：
2010-03
期刊：
影响因子：
--
通讯作者：
Boppart SA
中科院分区：
文献类型：
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作者：
Nguyen FT;Zysk AM;Chaney EJ;Adie SG;Kotynek JG;Oliphant UJ;Bellafiore FJ;Rowland KM;Johnson PA;Boppart SA
在保乳手术中，从原发肿瘤部位引流的腋窝淋巴结被切除用于疾病分期。虽然在前哨淋巴结和淋巴结清扫术中经常切除大量的淋巴结，但只有相对较小比例的淋巴结被发现是转移性的，这一事实必须与潜在的并发症如水肿相权衡。在没有实时体内或原位术中成像工具来提供淋巴结的显微镜评估的情况下，术后石蜡切片组织病理学分析目前仍然是评估淋巴结状态的金标准。本文探讨了使用光学相干断层扫描（OCT），高分辨率实时显微光学成像技术，术中离体成像和评估腋窝淋巴结。对17例乳腺癌患者的正常（13例）、反应性（1例）和转移性（3例）淋巴结在术中进行OCT成像。这些初步临床研究已经确定了皮质相对于包膜的散射变化，可用于区分正常与反应性和转移性淋巴结。这些光散射变化与卵泡和生发中心中观察到的炎症和免疫学变化相关。这些结果表明，术中OCT有可能原位评估实时淋巴结状态，而无需物理切除和组织学处理标本以可视化显微镜特征。
During breast-conserving surgeries, axillary lymph nodes draining from the primary tumor site are removed for disease staging. Although a high number of lymph nodes are often resected during sentinel and lymph-node dissections, only a relatively small percentage of nodes are found to be metastatic, a fact that must be weighed against potential complications such as lymphedema. Without a real-time in vivo or in situ intraoperative imaging tool to provide a microscopic assessment of the nodes, postoperative paraffin section histopathological analysis currently remains the gold standard in assessing the status of lymph nodes. This paper investigates the use of optical coherence tomography (OCT), a high-resolution real-time microscopic optical-imaging technique, for the intraoperative ex vivo imaging and assessment of axillary lymph nodes. Normal (13), reactive (1), and metastatic (3) lymph nodes from 17 human patients with breast cancer were imaged intraoperatively with OCT. These preliminary clinical studies have identified scattering changes in the cortex, relative to the capsule, which can be used to differentiate normal from reactive and metastatic nodes. These optical scattering changes are correlated with inflammatory and immunological changes observed in the follicles and germinal centers. These results suggest that intraoperative OCT has the potential to assess the real-time node status in situ, without having to physically resect and histologically process specimens to visualize microscopic features.