Clinical feasibility of optical coherence micro-elastography for imaging tumor margins in breast-conserving surgery

Wes M Allen; Ken Y Foo; Renate Zilkens; Kelsey M Kennedy; Qi Fang; Lixin Chin; Benjamin F Dessauvagie; Bruce Latham; Christobel M Saunders; Brendan F Kennedy

doi:10.1364/BOE.9.006331

Clinical feasibility of optical coherence micro-elastography for imaging tumor margins in breast-conserving surgery

Biomed Opt Express. 2018 Nov 19;9(12):6331-6349. doi: 10.1364/BOE.9.006331. eCollection 2018 Dec 1.

Authors

Wes M Allen^{1

2}, Ken Y Foo^{1

2}, Renate Zilkens^{1

3}, Kelsey M Kennedy^{1

2

4}, Qi Fang^{1

2}, Lixin Chin^{1

2}, Benjamin F Dessauvagie^{5

6}, Bruce Latham⁵, Christobel M Saunders^{3

7

8}, Brendan F Kennedy^{1

2}

Affiliations

¹ BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia.
² Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia.
³ Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia.
⁴ Current address: Department of Biomedical Engineering, Columbia University, 622 W 168th St, New York, NY 10025, USA.
⁵ PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia.
⁶ Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia.
⁷ Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia.
⁸ Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia, 6000, Australia.

Abstract

It has been demonstrated that optical coherence micro-elastography (OCME) provides additional contrast of tumor compared to optical coherence tomography (OCT) alone. Previous studies, however, have predominantly been performed on mastectomy specimens. Such specimens typically differ substantially in composition and geometry from the more clinically relevant wide-local excision (WLE) specimens excised during breast-conserving surgery. As a result, it remains unclear if the mechanical contrast observed is maintained in WLE specimens. In this manuscript, we begin to address this issue by performing a feasibility study of OCME on 17 freshly excised, intact WLE specimens. In addition, we present two developments required to sustain the progression of OCME towards intraoperative deployment. First, to enable the rapid visualization of en face images required for intraoperative assessment, we describe an automated segmentation algorithm to fuse en face micro-elastograms with OCT images to provide dual contrast images. Secondly, to validate contrast in micro-elastograms, we present a method that enables co-registration of en face images with histology of WLE specimens, sectioned in the orthogonal plane, without any modification to the standard clinical workflow. We present a summary of the observations across the 17 specimens imaged in addition to representative micro-elastograms and OCT images demonstrating contrast in a number of tumor margins, including those involved by invasive ductal carcinoma, mucinous carcinoma, and solid-papillary carcinoma. The results presented here demonstrate the potential of OCME for imaging tumor margins.