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Abstract

Wide local excision (WLE) is a common surgical intervention for solid tumors such as those in melanoma, breast, pancreatic, and gastrointestinal cancer. However, adequate margin assessment during WLE remains a significant challenge, resulting in surgical reinterventions to achieve adequate local control. Currently, no label-free imaging method is available for surgeons to examine the resection bed in vivo for microscopic residual cancer. Optical coherence tomography (OCT) enables real-time high-resolution imaging of tissue microstructure. Previous studies have demonstrated that OCT analysis of excised tissue specimens can distinguish between normal and cancerous tissues by identifying the heterogeneous and disorganized microscopic tissue structures indicative of malignancy. In this translational study involving 35 patients, a handheld surgical OCT imaging probe was developed for in vivo use to assess margins both in the resection bed and on excised specimens for the microscopic presence of cancer. The image results from OCT showed structural differences between normal and cancerous tissue within the resection bed following WLE of the human breast. The ex vivo images were compared with standard postoperative histopathology to yield sensitivity of 91.7% [95% confidence interval (CI), 62.5%-100%] and specificity of 92.1% (95% CI, 78.4%-98%). This study demonstrates in vivo OCT imaging of the resection bed during WLE with the potential for real-time microscopic image-guided surgery. 

Author information

Erickson-Bhatt SJ1, Nolan RM1, Shemonski ND2, Adie SG1, Putney J3, Darga D3, McCormick DT4, Cittadine AJ3, Zysk AM3, Marjanovic M1, Chaney EJ1, Monroy GL5, South FA2, Cradock KA6, Liu ZG6, Sundaram M7, Ray PS7, Boppart SA8.

1Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.

2Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois.

3Diagnostic Photonics, Inc., Chicago, Illinois.

4AdvancedMEMS, San Francisco, California.

5Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois.

6Carle Foundation Hospital, Urbana, Illinois.

7Carle Foundation Hospital, Urbana, Illinois. Department of Surgery, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois.

8Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois. Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois. Diagnostic Photonics, Inc., Chicago, Illinois. Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois. Carle Foundation Hospital, Urbana, Illinois. boppart@illinois.edu.