多模态光学相干断层扫描术中对保乳手术中肿瘤边缘和手术边缘的评估。

IF 1.1 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
D A Vorontsov, E V Gubarkova, M A Sirotkina, A A Sovetsky, A A Plekhanov, S S Kuznetsov, D A Davydova, A Yu Bogomolova, V Y Zaitsev, S V Gamayunov, A Y Vorontsov, V A Sobolevskiy, N D Gladkova
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引用次数: 2

摘要

本研究的目的:我们比较了传统结构OCT模式下的多模态光学相干断层扫描(MM OCT)和OCT弹性成像(OCE)模式在解决两项临床重要任务中的有效性:(1)在乳腺癌(BC)保乳手术(BСS)中检测手术边缘的肿瘤细胞群;(2)识别乳房肿瘤边缘。所得结果与相应的组织学切片相关联。材料和方法:本研究对25例行乳房肿瘤切除术(BCS)的BC患者和25例术后肿瘤样本(确定肿瘤边缘)进行了100例手术边缘样本(上、下、内侧和外侧-每位患者共4例样本)。采用MM OCT方法,我们通过视觉和数值评估肿瘤和非肿瘤乳腺组织的散射(OCT信号穿透的水平和深度)和弹性(刚度值或杨氏模量(kPa))特性,并将所得值与术后组织学检查结果进行比较。结果:在4例手术切缘样本(100例)中,我们使用OCE方法在距离可见肿瘤边缘约5mm处识别出组织学证实的肿瘤细胞组(“阳性”切缘)。在所有这些情况下,识别的区域都大于0.5 mm,刚度大于400kpa。然而,结构OCT不能识别这些肿瘤组,也不能与周围的纤维组织区分。在肿瘤向非肿瘤组织过渡的区域,结构OCT图像仅在肿瘤边缘与脂肪组织相邻时检测到肿瘤边缘,而在肿瘤边缘与非肿瘤纤维组织相邻时未检测到肿瘤边缘。高刚度值(超过400kpa)和高对比度的OCE图像显示肿瘤边缘清晰,脂肪和纤维组织均可见。结论:本研究证明了MM OCT,特别是其OCE模式,作为BCS术中肿瘤边缘和手术边缘实时评估方法的潜力。与结构性OCT图像相比,OCE图像显示不同类型乳腺组织(脂肪组织、纤维间质、透明化间质、肿瘤细胞簇)之间的对比度更高,并且更准确地识别肿瘤边界和检测手术边缘的小群肿瘤细胞。根据乳腺癌患者手术切缘清洁的标准临床指南,提出一种术中MM OCT检查切缘状态的算法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Multimodal Optical Coherence Tomography for Intraoperative Evaluation of Tumor Margins and Surgical Margins in Breast-Conserving Surgery.

Multimodal Optical Coherence Tomography for Intraoperative Evaluation of Tumor Margins and Surgical Margins in Breast-Conserving Surgery.

Multimodal Optical Coherence Tomography for Intraoperative Evaluation of Tumor Margins and Surgical Margins in Breast-Conserving Surgery.

Multimodal Optical Coherence Tomography for Intraoperative Evaluation of Tumor Margins and Surgical Margins in Breast-Conserving Surgery.

The aim of the study: We compare the effectiveness of multimodal optical coherence tomography (MM OCT) in the traditional structural OCT mode and the OCT elastography (OCE) mode in addressing two clinically important tasks: (1) detecting groups of tumor cells at surgical margins during breast-сonserving surgery (BСS) in breast cancer (BC) and (2) identifying breast tumor margins. The obtained results were correlated with corresponding histological sections.

Materials and methods: The study was performed on 100 surgical margin samples (top, bottom, medial, and lateral - four samples from each patient in total) obtained from 25 patients with BC who underwent BCS (lumpectomy), and on 25 postoperative tumor samples (to determine tumor margins). With MM OCT method, we visually and numerically assessed the scattering (level and depth of OCT signal penetration) and elastic (stiffness values, or Young's modulus (kPa)) properties of the tumor and non-tumor breast tissue and the obtained values were compared with the results of postoperative histological examination.

Results: In 4 surgical margin samples (out of 100), with the OCE method we identified groups of histologically confirmed tumor cells ("positive" resection margins) at the distance of about 5 mm from the visible tumor margin. The identified zones were larger than 0.5 mm with stiffness of more than 400 kPa in all these cases. However, the structural OCT could not identify these groups of tumors and they were not distinguishable from the surrounding fibrous tissue.In the areas of tumor into non-tumor tissue transition, structural OCT images detected tumor margins only if they were adjacent to adipose tissue and did not detect them if there were adjacent to non-tumor fibrous tissue. OCE images with high stiffness values (more than 400 kPa) and high contrast showed a clear tumor margin with both adipose and fibrous tissue.

Conclusion: The study demonstarets the potential of MM OCT, particularly its OCE mode, as a real-time method for intraoperative tumor margin and surgical margin assessment in BCS. OCE images compared to structural OCT images visualize higher contrast between different types of breast tissue (adipose tissue, fibrous stroma, hyalinized stroma, tumor cell clusters), as well as more accurate identification of the tumor border and detection of small groups of tumor cells at surgical margins. An algorithm for intraoperative MM OCT examination of the state of the resection margin is proposed in accordance with standard clinical guidelines for achieving clean surgical margins in breast cancer patients.

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来源期刊
Sovremennye Tehnologii v Medicine
Sovremennye Tehnologii v Medicine MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
1.80
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发文量
38
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