Optoacoustic characterization of breast conserving surgery specimens - A pilot study

Utility of photoacoustic patterns in intra-operative margin assessment of breast cancer post neoadjuvant chemotherapy

Purpose

To evaluate the feasibility and accuracy of ultrasound-guided photoacoustic tomography (US-PA) for intraoperative margin assessment in breast-conserving surgery (BCS) following neoadjuvant chemotherapy (NACT).

Methods

This study, approved by the local Institutional Review Board, included 21 women with histologically confirmed breast cancer referred for BCS post-NACT. Data from 4 participants were used for training while 17 participants were analyzed. US-PA imaging was performed using the MSOT inVision 512-ECHO system, capturing chromophores like lipids, collagen, and hemoglobin up to a 5 mm depth. Imaging results were compared to histopathological findings, and diagnostic accuracy was calculated.

Results

US-PA imaging demonstrated a high diagnostic accuracy of 89.0 %, with a sensitivity and negative predictive value (NPV) of 100 %, specificity of 86.9 %, and positive predictive value (PPV) of 59.4 %. Excellent inter-observer agreement (kappa = 1) was observed. No laser-induced tissue damage was noted. The average scan time per specimen was approximately 20 minutes. False positives (n = 11) were primarily due to post-therapy fibrotic changes and extremely close tumor extensions (<2 mm).

Conclusion

US-PA provided clear visualization of tissue components, accurately correlating with histopathology. The method's high NPV minimizes the risk of re-operations and locoregional recurrence. Although the PPV was lower, it did not impact clinical management as surgeons typically excise wider margins in such cases. The study highlighted US-PA's potential as a promising tool for intraoperative margin assessment in BCS post-NACT, offering a rapid, accurate, and safe method. Further studies with larger sample sizes are needed to confirm these findings and enhance quantitative assessment methods.

Photoacoustic Tomography Appearance of Fat Necrosis: A First-in-Human Demonstration of Biochemical Signatures along with Histological Correlation

A 50-year-old woman with no past medical history presented with a left anterior chest wall mass that was clinically soft, mobile, and non-tender. A targeted ultrasound (US) showed findings suggestive of a lipoma. However, focal “mass-like” nodules seen within the inferior portion suggested malignant transformation of a lipomatous lesion called for cross sectional imaging, such as MRI or invasive biopsy or excision for histological confirmation. A T1-weighted image demonstrated a large lipoma that has a central fat-containing region surrounded by an irregular hypointense rim in the inferior portion, confirming the benignity of the lipoma. An ultrasound-guided photoacoustic imaging (PA) of the excised specimen to derive the biochemical distribution demonstrated the “mass-like” hypoechoic regions on US as fat-containing, suggestive of benignity of lesion, rather than fat-replacing suggestive of malignancy. The case showed the potential of PA as an adjunct to US in improving the diagnostic confidence in lesion characterization.

Biochemical "decoding" of breast ultrasound images with optoacoustic tomography fusion: First-in-human display of lipid and collagen signals on breast ultrasound

To date, studies which utilized ultrasound (US) and optoacoustic tomography (OT) fusion (US-OT) in biochemical differentiation of malignant and benign breast conditions have relied on limited biochemical data such as oxyhaemoglobin (OH) and deoxyhaemoglobin (DH) only. There has been no data of the largest biochemical components of breast fibroglandular tissue: lipid and collagen. Here, the authors believe the ability to image collagen and lipids within the breast tissue could serve as an important milestone in breast US-OT imaging with many potential downstream clinical applications. Hence, we would like to present the first-in-human US-OT demonstration of lipid and collagen differentiation in an excised breast tissue from a 38-year-old female.

Safety of use of the ENDOSWIR near-infrared optical imaging device on human tissues: prospective blind study

Cancer surgery requires removing the tumor tissue in necessary and sufficient quantities. Spectral optical imaging in the short-wave infrared (900-1700 nm) could provide an intraoperative guidance to the surgeon based on the absorption of the tissues without contrast agent. Our objective was to ensure the safety of our ENDOSWIR device on human tissues. Histological analysis of fresh human tonsils exposed to the SWIR light or not was compared and showed no histological differences. This demonstrates the safety of using the SWIR device on human tissues and allows us to initiate a clinical study for the resection of tumors intraoperatively.

An Excitation-Reception Collinear Probe for Ultrasonic, Photoacoustic, and Thermoacoustic Tri-Modal Volumetric Imaging

Imaging systems that integrate multiple modalities can reveal complementary anatomic and functional information as they exploit different contrast mechanisms, which have shown great application potential and advantages in preclinical studies. A portable and easy-to-use imaging probe will be more conducive to transfer to clinical practice. Here, we present a tri-modal ultrasonic (US), photoacoustic (PA), and thermoacoustic (TA) imaging system with an excitation-reception collinear probe. The acoustic field, light field, and electric field of the probe were designed to be coaxial, realizing homogeneous illumination and high-sensitivity detection at the same detection position. US images can provide detailed information about structures, PA images can delineate the morphology of blood vessels in tissues, and TA images can reveal dielectric properties of the tissues. Moreover, phantoms and in vivo human finger experiments were performed by the tri-modal imaging system to demonstrate its performance. The results show that the tri-modal imaging system with the proposed probe has the ability to detect small breast tumors with a radius of only 2.5 mm and visualize the anatomical structure of the finger in three dimensions. Our work confirms that the tri-modal imaging system equipped with a collinear probe can be applied to a variety of different scenarios, which lays a solid foundation for the application of the tri-modality system in clinical trials.

Spherical-matching hyperbolic-array photoacoustic computed tomography

Linear-array photoacoustic computed tomography (LA-PACT), for its flexibility and simplicity, has great potential in providing anatomical and functional information of tissues. However, the limited coverage view impedes the LA-PACT obtaining high-quality images. In this study, a photoacoustic tomographic system with a hyperbolic-array transducer was developed for stereoscopic PA imaging of carotid artery. The hyperbolic-array PACT increases the receiving sensitivity for PA signal detection due to its transducer's geometric structure matching with the spherical wave. The control phantom experiment shows that the proposed system can expand the angular coverage of ∼1/3 more than that of the LA-PACT system, and the volumetric PA images of rat's carotid artery demonstrates the potential of the system for carotid artery imaging. Furthermore, volumetric imaging of the human forearm verifies that the system has significant capability in human imaging, which indicates that it has bright prospect for assisting diagnosis in the vascular disease.

Exploring the diagnostic value of photoacoustic imaging for breast cancer: the identification of regional photoacoustic signal differences of breast tumors

We examined 14 benign and 26 malignant breast nodules by a handheld dual-modal PA/US imaging system and analyzed the data using the quantitative and semi-quantitative method. The PA signal spatial density and PA scores of different regions of the benign and malignant nodules were compared, and the diagnostic performances of two diagnostic methods based on PA parameters were evaluated. For both quantitative and semi-quantitative results, significant differences in the distributions of PA signals in different regions of benign and malignant breast lesions were identified. The PA parameters showed good performance in diagnosing breast cancer, indicating the potential of PAI in clinical utilization.

Biophotonic technologies for assessment of breast tumor surgical margins-A review

Breast conserving surgery (BCS) offering similar surgical outcomes as mastectomy while retaining breast cosmesis is becoming increasingly popular for the management of early stage breast cancers. However, its association with reoperation rates of 20% to 40% following incomplete tumor removal warrants the need for a fast and accurate intraoperative surgical margin assessment tool that offers cellular, structural and molecular information of the whole specimen surface to a clinically relevant depth. Biophotonic technologies are evolving to qualify as such an intraoperative tool for clinical assessment of breast cancer surgical margins at the microscopic and macroscopic scale. Herein, we review the current research in the application of biophotonic technologies such as photoacoustic imaging, Raman spectroscopy, multimodal multiphoton imaging, diffuse optical imaging and fluorescence imaging using medically approved dyes for breast cancer detection and/or tumor subtype differentiation toward intraoperative assessment of surgical margins in BCS specimens, and possible challenges in their route to clinical translation.