According to Duke University, researchers have developed a device which may give surgeons a quick and accurate read on whether they have removed all of the tumor cells during partial mastectomy for breast cancer. The early results of a study presented at the 2008 San Antonio Breast Cancer Symposium indicated the device can distinguish "immediately between normal and malignant breast tissue using a technology called optical spectral imaging."

"One of the risks of breast-conserving surgery, or partial mastectomy, is that many women -- up to 50 percent -- have to be brought back to the operating room at a later date because pathologists discover that we didn't have clean margins -- there may be cancer cells left in the tissue surrounding the tumor," says Lee Wilke, MD, a breast surgeon at Duke and an investigator on this study. "If we're able to further refine this new technology, we can get the results while the patient is still on the table, something we can't do with standard pathology," Wilke says. "Right now, we have women recovering from surgery who are told they need to come back."

The researchers presented data from 57 patients studied to date in a poster discussion session in San Antonio, TX. The study itself involved excised tissue in contact with the imaging device, and projected light into the tissue to determine whether margins are positive or negative for malignancy.
"The light is either scattered within the tissue or absorbed, and that activity is revealed in a colored map of the tissue surface on a computer screen, giving us information about the tissue's molecular composition; we use these images to decide whether the margin has cancer in it or not," says Nirmala Ramanujam, PhD, a biomedical engineer at Duke's Pratt School of Engineering, and lead investigator on this study. "We have already established in a number of previous studies that these markers of molecular composition are diagnostic of breast cancer."

The researchers say data can be generated within 15 minutes. The device is being tested in the operating room and compared with results from standard pathological studies. The research shows the device allows surgeons to find remaining cancer more frequently, and therefore reduces the number of times surgeons remove too much tissue.

"With this device, surgeons are able to remove positive margins with 80 percent accuracy on the first try -- as compared to 56 percent of the time without the device," Ramanujam says. "On the flip side, we were able to reduce the number of times a surgeon took too much tissue -- from 76 percent of the time to 33 percent of the time with the probe. This has big cosmetic implications for women undergoing partial mastectomy."

Wilke says 20 percent of women undergoing partial mastectomies in an academic medical setting may have to return for further surgery, and as many as 50 percent in community hospitals, where there may be no on-site pathologists. According to the release, surgeons aim to remove enough tissue so that they have two millimeters of clean tissue around the cancer, to reduce the chance for cancer recurrence. "What's really exciting about this is that if it works, it could be the answer to a huge unmet clinical need," Wilke says.

Adapted from a press release by Duke University.

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