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Convergence and Technologies

Diagnostic Accuracy of Quantitative Micro-Elastography for Margin Assessment in Breast-Conserving Surgery

Kelsey M. Kennedy, Renate Zilkens, Wes M. Allen, Ken Y. Foo, Qi Fang, Lixin Chin, Rowan W. Sanderson, James Anstie, Philip Wijesinghe, Andrea Curatolo, Hsern Ern I. Tan, Narelle Morin, Bindu Kunjuraman, Chris Yeomans, Synn Lynn Chin, Helen DeJong, Katharine Giles, Benjamin F. Dessauvagie, Bruce Latham, Christobel M. Saunders and Brendan F. Kennedy
Kelsey M. Kennedy
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
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Renate Zilkens
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
2School of Medicine, The University of Western Australia, Perth, Australia.
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Wes M. Allen
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
3Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia.
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Ken Y. Foo
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
3Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia.
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  • ORCID record for Ken Y. Foo
Qi Fang
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
3Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia.
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Lixin Chin
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
3Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia.
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Rowan W. Sanderson
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
3Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia.
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James Anstie
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
3Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia.
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Philip Wijesinghe
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
3Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia.
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Andrea Curatolo
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
3Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia.
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Hsern Ern I. Tan
2School of Medicine, The University of Western Australia, Perth, Australia.
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Narelle Morin
4Sonowest, Perth, Australia.
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Bindu Kunjuraman
5Breast Centre, Fiona Stanley Hospital, Murdoch, Australia.
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Chris Yeomans
6PathWest, Fiona Stanley Hospital, Murdoch, Australia.
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Synn Lynn Chin
5Breast Centre, Fiona Stanley Hospital, Murdoch, Australia.
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Helen DeJong
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
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Katharine Giles
7OncoRes Medical, Perth, Australia.
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Benjamin F. Dessauvagie
2School of Medicine, The University of Western Australia, Perth, Australia.
6PathWest, Fiona Stanley Hospital, Murdoch, Australia.
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Bruce Latham
6PathWest, Fiona Stanley Hospital, Murdoch, Australia.
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Christobel M. Saunders
2School of Medicine, The University of Western Australia, Perth, Australia.
5Breast Centre, Fiona Stanley Hospital, Murdoch, Australia.
8Breast Clinic, Royal Perth Hospital, Perth, Australia.
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Brendan F. Kennedy
1BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.
3Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia.
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  • For correspondence: brendan.kennedy@uwa.edu.au
DOI: 10.1158/0008-5472.CAN-19-1240 Published April 2020
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Abstract

Inadequate margins in breast-conserving surgery (BCS) are associated with an increased likelihood of local recurrence of breast cancer. Currently, approximately 20% of BCS patients require repeat surgery due to inadequate margins at the initial operation. Implementation of an accurate, intraoperative margin assessment tool may reduce this re-excision rate. This study determined, for the first time, the diagnostic accuracy of quantitative micro-elastography (QME), an optical coherence tomography (OCT)–based elastography technique that produces images of tissue microscale elasticity, for detecting tumor within 1 mm of the margins of BCS specimens. Simultaneous OCT and QME were performed on the margins of intact, freshly excised specimens from 83 patients undergoing BCS and on dissected specimens from 7 patients undergoing mastectomy. The resulting three-dimensional images (45 × 45 × 1 mm) were coregistered with postoperative histology to determine tissue types present in each scan. Data from 12 BCS patients and the 7 mastectomy patients served to build a set of images for reader training. One hundred and fifty-four subimages (10 × 10 × 1 mm) from the remaining 71 BCS patients were included in a blinded reader study, which resulted in 69.0% sensitivity and 79.0% specificity using OCT images, versus 92.9% sensitivity and 96.4% specificity using elasticity images. The quantitative nature of QME also facilitated development of an automated reader, which resulted in 100.0% sensitivity and 97.7% specificity. These results demonstrate high accuracy of QME for detecting tumor within 1 mm of the margin and the potential for this technique to improve outcomes in BCS.

Significance: An optical imaging technology probes breast tissue elasticity to provide accurate assessment of tumor margin involvement in breast-conserving surgery.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Research Online (http://cancerres.aacrjournals.org/).

  • Cancer Res 2020;80:1773–83

  • Received April 20, 2019.
  • Revision received August 9, 2019.
  • Accepted February 14, 2020.
  • Published first April 15, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Research: 80 (8)
April 2020
Volume 80, Issue 8
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Diagnostic Accuracy of Quantitative Micro-Elastography for Margin Assessment in Breast-Conserving Surgery
Kelsey M. Kennedy, Renate Zilkens, Wes M. Allen, Ken Y. Foo, Qi Fang, Lixin Chin, Rowan W. Sanderson, James Anstie, Philip Wijesinghe, Andrea Curatolo, Hsern Ern I. Tan, Narelle Morin, Bindu Kunjuraman, Chris Yeomans, Synn Lynn Chin, Helen DeJong, Katharine Giles, Benjamin F. Dessauvagie, Bruce Latham, Christobel M. Saunders and Brendan F. Kennedy
Cancer Res April 15 2020 (80) (8) 1773-1783; DOI: 10.1158/0008-5472.CAN-19-1240

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Diagnostic Accuracy of Quantitative Micro-Elastography for Margin Assessment in Breast-Conserving Surgery
Kelsey M. Kennedy, Renate Zilkens, Wes M. Allen, Ken Y. Foo, Qi Fang, Lixin Chin, Rowan W. Sanderson, James Anstie, Philip Wijesinghe, Andrea Curatolo, Hsern Ern I. Tan, Narelle Morin, Bindu Kunjuraman, Chris Yeomans, Synn Lynn Chin, Helen DeJong, Katharine Giles, Benjamin F. Dessauvagie, Bruce Latham, Christobel M. Saunders and Brendan F. Kennedy
Cancer Res April 15 2020 (80) (8) 1773-1783; DOI: 10.1158/0008-5472.CAN-19-1240
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