Quantitative OCT-Raman spectral imaging for intra-operative detection of positive margins in breast conserving surgery

定量 OCT-拉曼光谱成像用于保乳手术中阳性切缘的术中检测

• 批准号: MR/Y008731/1
• 负责人: Ioan Notingher
• 金额: $ 245.69万
• 依托单位: University of Nottingham
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FY008731%2F1
• 关键词: Quantitative; OCT; Raman; spectral; imaging

Breast cancer is the most common cancer among women, with 55,000 new patients diagnosed each year in the UK. Breast conserving surgery is the most widely used procedure for cutting the cancer out. Surgery aims to remove the entire cancer with the smallest scar possible. To minimise the risks of the cancer returning, the surgeon cuts the cancer out including a margin of normal-looking tissue. However, at the time of surgery it is often difficult to know how much normal tissue to remove. Too wide a margin increases the risk of damage to nearby tissue and leads to a larger scar. Cutting too narrow margins may leave some cancer cells behind, which increases the risk of the cancer to re-grow. During the operation, surgeons have limited tools where the tumour ends, and mainly rely on their fingers to judge how much tissue to cut out. To confirm whether the whole cancer was cut out successfully, the removed tissue is transferred to the histology laboratory where it is cut into thin sections, stained with some special dies, and then observed under a microscope by a specialist histopathologist. However, this take long time (several days to one week) and therefore cannot be done during the surgery. If histopathology identifies cancer cells at the surface of the cut out tissue (positive margins), the patient is rescheduled for another surgery. Currently, one in five patients (~10,000 per year) undergoing breast conserving surgery in England needs a re-operation; this number is similar to other countries in Europe and the USA.The outcome of breast cancer surgery could be significantly improved, and the need of second operation reduced, if surgeons were able to check while the patients is in the operating room whether the entire cancer is out or not. In the last decade our team has developed a new imaging technique that can discriminate between healthy breast tissue and cancer. This technique, called Raman spectroscopy, measures molecular properties of breast tissue and detects changes related to cancer. By combining Raman spectroscopy with optical coherence tomography, a technique that can scan quickly the whole margins and identify high risk areas, we plan to develop a new instrument that could scan the surface of whole breast tissue specimen and build images that can identify even small regions of tumour, that often may not be felt by surgeons. Thus, this new instrument could be a very useful tool for surgeons as they could analyse the breast tissue cut during the surgery, while the patient is still under anaesthesia in the operating room. If any cancer cells are detected, they could on the spot remove additional tissue, and repeat this procedure until the whole cancer is out. In this project we want to build on our decade-long research and develop a first-generation instrument that can be used by surgeons in the operating room. To achieve this, we have assembled a team of scientists specialists in optics, microscopy and advance data processing, breast cancer surgeons and patients, to design a cost effective instrument that can be integrated in the operating room and then be adopted across the NHS. If successful, the new technology could lead to a step-change in breast cancer surgery by helping to maximise the chances for complete cancer removal in a single operation. We know that additional surgery causes huge emotional stress to patients, often leads to poorer cosmetic outcome, delays other treatment, require longer recovery times for patients, and increases costs to the NHS.

乳腺癌是女性中最常见的癌症，在英国每年有55，000名新患者被诊断出来。保乳手术是最广泛使用的切除癌症的手术。手术旨在以尽可能小的疤痕切除整个癌症。为了最大限度地减少癌症复发的风险，外科医生切除了癌症，包括正常组织的边缘。然而，在手术时，通常很难知道要切除多少正常组织。太宽的边缘会增加损伤附近组织的风险，并导致更大的疤痕。切得太窄可能会留下一些癌细胞，这会增加癌症重新生长的风险。在手术过程中，外科医生在肿瘤结束处的工具有限，主要依靠手指来判断要切除多少组织。为了确认整个癌症是否被成功切除，切除的组织被转移到组织学实验室，在那里它被切成薄片，用一些特殊的染料染色，然后在显微镜下由专业组织病理学家观察。然而，这需要很长时间（几天到一周），因此不能在手术期间完成。如果组织病理学在切除组织的表面识别出癌细胞（阳性边缘），则患者重新安排另一次手术。目前，在英国，五分之一（每年约10，000例）接受保乳手术的患者需要再次手术;这一数字与欧洲和美国的其他国家相似。如果外科医生能够在患者在手术室检查整个癌症是否已经切除，乳腺癌手术的结果可能会显着改善，并减少第二次手术的需要。在过去的十年中，我们的团队开发了一种新的成像技术，可以区分健康的乳腺组织和癌症。这种技术被称为拉曼光谱学，测量乳腺组织的分子特性，并检测与癌症相关的变化。通过将拉曼光谱与光学相干断层扫描技术相结合，这种技术可以快速扫描整个边缘并识别高风险区域，我们计划开发一种新的仪器，可以扫描整个乳房组织标本的表面，并建立图像，可以识别甚至是外科医生通常感觉不到的肿瘤小区域。因此，这种新仪器可能是外科医生非常有用的工具，因为他们可以在手术期间分析乳房组织切割，而患者仍在手术室中处于麻醉状态。如果检测到任何癌细胞，他们可以当场切除额外的组织，并重复此过程，直到整个癌症被清除。在这个项目中，我们希望建立在我们长达十年的研究基础上，开发出第一代手术器械，供外科医生在手术室使用。为了实现这一目标，我们组建了一个由光学，显微镜和高级数据处理专家，乳腺癌外科医生和患者组成的科学家团队，以设计一种具有成本效益的仪器，可以集成在手术室中，然后在NHS中采用。如果成功的话，这项新技术可能会通过帮助最大限度地提高在一次手术中完全切除癌症的机会，从而导致乳腺癌手术的一步变化。我们知道，额外的手术会给患者带来巨大的情绪压力，通常会导致更差的美容效果，延迟其他治疗，需要更长的患者恢复时间，并增加NHS的成本。