Detection of margin positivity in breast cancer using fluorescence and diffuse reflectance imaging

Accurate intraoperative assessment of surgical margins during breast-conserving surgery remains challenging due to tissue heterogeneity and the presence of small, scattered malignant foci. This prospective study evaluated the effectiveness of a multimodal imaging approach combining fluorescence imaging and diffuse reflectance spectroscopy (DRS) for detecting tumour involvement at surgical margins. Sixty female patients with a preoperative diagnosis of breast carcinoma were included. Immediately after surgical excision, multispectral images of resected specimens were acquired using a handheld imaging device. Measurements were obtained at wavelengths of 375 nm, 545 nm, 575 nm, and 610 nm and analyzed using proprietary software. Spectral readings from histologically confirmed malignant tissues were compared with those from histologically verified normal margins and benign lesions. A total of 510 multispectral images were obtained from 356 tissue locations, including 111 malignant lesions, 327 normal margins, and 72 benign lesions. The system demonstrated limited ability to differentiate benign from normal tissue (sensitivity 30.63%, specificity 63.96%). However, when distinguishing malignant from normal tissue at histologically confirmed margins (basal, inferior, lateral, medial, and superior), sensitivity ranged from 70.37% to 74.51%, while specificity ranged from 90.74% to 98%. Multimodal imaging using fluorescence and DRS demonstrates high specificity for detecting malignant tissue at surgical margins and shows promise as a practical, label-free intraoperative adjunct for margin assessment during breast-conserving surgery.