Fat/water ratios measured with diffuse reflectance spectroscopy to detect breast tumor boundaries
Fat/water ratios measured with diffuse reflectance spectroscopy to detect breast tumor boundaries
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DOI：
10.1007/s10549-015-3487-z
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发表时间：
2015-08-01
影响因子：
3.8
通讯作者：
Ruers, T. J. M.
中科院分区：
文献类型：
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作者：
de Boer, L. L.;Molenkamp, B. G.;Ruers, T. J. M.
在保乳手术（BCS）中识别肿瘤可能非常困难，目前还没有一种用于手术环境的可靠的边缘评估方法。因此，需要额外治疗的肿瘤阳性边缘直到组织病理学评价才被发现。利用漫反射光谱（DRS），可以在手术期间基于与组织形态和组成相关的光学参数来表征组织。在这里，我们调查的光学参数能够检测肿瘤的良性和肿瘤组织的混合物的区域，因此，哪些参数是最适合于术中边缘评估。DRS光谱（400-1600 nm）从来自良性、肿瘤边缘和肿瘤组织的16个离体乳房肿瘤切除术标本获得。一个乳房切除术标本与定制网格一起用于确认目的。与扩展近红外波长区域（类似于1000-1600 nm）中的脂肪和水吸收（F/W比）相关的光学参数提供了良性和肿瘤部位之间的最佳区分，导致100%的灵敏度和特异性（不包括边界部位）。每例患者，在87.5%的标本中，缩放的F/W比从大体良性组织向肿瘤逐渐降低。在一个测试用例中，基于边界组织的预定F/W比为0.58，DRS产生的手术切除平面几乎与2 mm的良性组织边缘重叠，2 mm是最广泛接受的阴性边缘定义。F/W比在肿瘤内部或外部的部位之间提供了极好的区分，并且能够在一个测试病例中检测到肿瘤的边界。这项工作显示了DRS在BCS期间指导外科医生的潜力。
Recognition of the tumor during breast-conserving surgery (BCS) can be very difficult and currently a robust method of margin assessment for the surgical setting is not available. As a result, tumor-positive margins, which require additional treatment, are not found until histopathologic evaluation. With diffuse reflectance spectroscopy (DRS), tissue can be characterized during surgery based on optical parameters that are related to the tissue morphology and composition. Here we investigate which optical parameters are able to detect tumor in an area with a mixture of benign and tumor tissue and hence which parameters are most suitable for intra-operative margin assessment. DRS spectra (400-1600 nm) were obtained from 16 ex vivo lumpectomy specimens from benign, tumor border, and tumor tissue. One mastectomy specimen was used with a custom-made grid for validation purposes. The optical parameter related to the absorption of fat and water (F/W-ratio) in the extended near-infrared wavelength region (similar to 1000-1600 nm) provided the best discrimination between benign and tumor sites resulting in a sensitivity and specificity of 100 % (excluding the border sites). Per patient, the scaled F/W-ratio gradually decreased from grossly benign tissue towards the tumor in 87.5 % of the specimens. In one test case, based on a predefined F/W-ratio for boundary tissue of 0.58, DRS produced a surgical resection plane that nearly overlapped with a 2-mm rim of benign tissue, 2 mm being the most widely accepted definition of a negative margin. The F/W-ratio provided excellent discrimination between sites clearly inside or outside the tumor and was able to detect the border of the tumor in one test case. This work shows the potential for DRS to guide the surgeon during BCS.