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Indocyanine green fluorescence image processing techniques for breast cancer macroscopic demarcation
Maria Leiloglou1,2, Martha S Kedrzycki3,4,5, Vadzim Chalau3,4
1Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK. maria.leiloglou16@imperial.ac.uk.
Scientific Reports
|May 21, 2022
Summary
Indocyanine green (ICG) fluorescence imaging helps surgeons identify tumor margins during breast conserving surgery (BCS). This technique accurately detects residual disease in surgical specimens, potentially reducing re-operations.
Area of Science:
- Surgical Oncology
- Medical Imaging
- Biophotonics
Background:
- Re-operation after breast conserving surgery (BCS) due to positive resection margins is a significant clinical challenge.
- Accurate visualization of tumor boundaries is crucial for complete tumor removal and improved patient outcomes.
Purpose of the Study:
- To evaluate the utility of indocyanine green (ICG) fluorescence imaging for precise tumor margin assessment in BCS.
- To develop and validate computational models for predicting tumor extent using ICG fluorescence and texture features.
Main Methods:
- Acquisition of ICG fluorescence and color images from 40 BCS patients across different surgical stages (in-situ, cavity, excised tumor, grossing).
- Development of logistic regression (LR) and support vector machine (SVM) models using ICG fluorescence intensity and texture features.
- Analysis of ICG fluorescence spectra in formalin-fixed tissues to assess dye stability.
Main Results:
- ICG fluorescence is retained in formalin-fixed tissues, enabling validation on grossing specimens.
- The trained LR model, combining fluorescence intensity and texture, achieved high accuracy (sensitivity 0.75±0.3, specificity 0.89±0.2) in identifying tumor extent on grossing images.
- The model demonstrated potential for predicting tumor presence in in-situ and post-excision surgical cavity images.
Conclusions:
- ICG fluorescence imaging is a viable tool for intraoperative tumor margin assessment in BCS.
- Computational analysis of ICG fluorescence provides accurate, pixel-level tumor delineation, potentially minimizing positive margins and the need for re-operation.
- The stability of ICG in formalin allows for post-operative validation, bridging the gap between surgical excision and histopathology.
