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Evaluating Receptor-Specific Fresh Specimen Staining for Tumor Margin Detection in Clinical Breast Specimens
Brook K Byrd1, Wendy A Wells2, Rendall R Strawbridge1
1Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.
Molecular Imaging and Biology
|June 23, 2023
Summary
Dual-stain difference imaging (DDSI) shows promise for identifying breast cancer margins during surgery. This technique accurately distinguished tumor tissue, potentially reducing the need for repeat surgeries.
Area of Science:
- Oncology
- Medical Imaging
- Surgical Pathology
Background:
- Accurate identification of tumor margins in breast-conserving surgery is crucial to minimize repeat operations.
- Dual-stain difference imaging (DDSI) is an emerging technique utilizing fluorescent probes to differentiate tissue types.
- Previous preclinical studies indicated promising diagnostic performance for DDSI.
Purpose of the Study:
- To evaluate the diagnostic performance of HER2-targeted DDSI in identifying tumor margins in human breast specimens.
- To assess the feasibility of rapid, receptor-specific staining during surgical procedures.
Main Methods:
- Eleven human mastectomy specimens were analyzed using a HER2-targeted DDSI protocol shortly after resection.
- Specimens were stained with dual fluorescent probes, imaged, and then fixed for conventional histological analysis (hematoxylin and eosin, and anti-HER2 immunohistochemistry).
- Diagnostic performance was quantified using receiver operator characteristic curves and area under the curve (AUC) analysis.
Main Results:
- In 8 of 11 evaluable specimens, DDSI achieved high AUC values (0.90 ± 0.07 for tumor-to-adipose and 0.81 ± 0.15 for tumor-to-glandular tissue).
- DDSI performance significantly outperformed images from the targeted probe alone.
- Diagnostic performance did not correlate with HER2 expression levels, indicating utility even in tumors with low HER2 expression.
Conclusions:
- This pilot clinical study demonstrates that HER2-targeted DDSI is a promising technique for rapid, intraoperative margin assessment in breast cancer surgery.
- The findings are consistent with prior preclinical research, supporting the potential of DDSI to improve surgical outcomes and reduce re-excision rates.
