Real-time peri-operative microcalcification detection in superficial breast tissues

Surgical management of ductal carcinoma in situ (DCIS), particularly in cases involving suspicious morphology and orientation of microcalcifications, remains a primary treatment option. However, the lack of real-time technical assistance in the form of an intraoperative surgical tool for detection of microcalcifications in the resection margins presents a significant challenge. In the context of breast conserving surgery, ex-vivo imaging of excised breast tissues slices from 12 patients was conducted. By employing a cross-polarized multispectral microcamera setup for tissue visualization an imaging depth of up to 2 mm was achieved. The microcamera provides the clinician with a clear color image with magnification allowing features down to 50 μm to be seen on the resection surface. Mammography images were used for accurate cross-correlation, enabling the identification of microcalcifications in the microcamera images. Detection efficacy of microcalcifications in microcamera images was notably influenced by both calcification clustering and distribution depth within the tissue. Calcifications within the 2 mm range were detected through their distinct optical manifestations in relation to the adjacent tissues. Four independent reviewers-two medical and two technical-achieved an average sensitivity of 77.8%, specificity of 80.0%, and overall accuracy of 79.0%. This study demonstrates the potential of an integrated microcamera and cross-polarized setup for non-invasive, real-time detection of microcalcifications in superficial breast tissues. By focusing on the superficial 2 mm, this approach shows promising results and offers substantial opportunities for future research and clinical applications.