Breast conserving surgery is routinely offered for localized breast malignancies, but has a known problem of uncertainty about if the entire cancer has been removed. Today, approximately one third of all patients are recalled for a second re-excision because either residual cancer or DCIS was found on the specimen surface or within 1-2 mm of it, when analyzed in pathology in the days after the initial procedure. There is a need for an accurate surgeon assist device, which can determine the potential that the resected specimen is clear of cancer at the margins. This can be directly solved through a technological solution which is optimized for wide- field and volumetric scanning, coupled with computer-aided decision making. In this academic-industry partnership, wide-field optical scatter spectroscopic imaging is coupled to volumetric CT scanning of specimens, in a package which integrates a substantial pre-clinical experience by the PerkinElmer team, with substantial prototyping and clinical specimen imaging work of the Dartmouth team. Scatter imaging allows surface scanning through high-spatial frequency imaging of the tissue, which negates erroneous signals from blood, fluid or ink on the tissue surface, which is critically important for fast in situ imaging o large tissue fields. This will be coupled with fast volumetric CT imaging in integrated display software. The surface molecular- structural features are key to identifying potential cancer regions for the surgeon, as is the volumetric CT key to identifying the internal tracks of the cancer which were seen on mammography and can be used to help identify which faces of the specimen are closest to the internal lesion. The combined system will be completed in the first few years, and tested for training data sets on known tissue samples from the breast lesion tissue bank. Following validation, a prospective trial will be carried out on the system, to help determine the accuracy in margin identification. Taken together this will be one of the first comprehensive approaches to volumetric and surface scanning in a single package, and comes from two groups with substantial experience in the aspects of cancer imaging and system development.
Breast conserving surgery is routinely done but has a high subsequent 2nd surgery rate due to cancer being found in the margin of the tissue removed. In this proposal an optical scatting system will be combined with CT specimen imaging to allow wide field fast detection of cancer in the margins of surgical specimens. The grant will develop, test and validate the system as a surgeon's aid to decision making during the surgery.
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