Diagnostic accuracy of quantitative micro-elastography for margin assessment in breast-conserving surgery

Kelsey M Kennedy, Renate Zilkens, Wes M Allen, Ken Y Foo, Qi Fang, Lixin Chin, Rowan W Sanderson, James Anstie, Philip Wijesinghe, Andrea Curatolo, Hsern Ern I Tan, Narelle Morin, Bindu Kunjuraman, Chris Yeomans, Synn Lynn Chin, Helen DeJong, Katharine Giles, Benjamin F Dessauvagie, Bruce Latham, Christobel M SaundersBrendan F Kennedy

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Inadequate margins in breast-conserving surgery (BCS) are associated with an increased likelihood of local recurrence of breast cancer. Currently, approximately 20% of BCS patients require repeat surgery due to inadequate margins at the initial operation. Implementation of an accurate, intraoperative margin assessment tool may reduce this re-excision rate. This study determined, for the first time, the diagnostic accuracy of quantitative micro-elastography (QME), an optical coherence tomography (OCT)-based elastography technique that produces images of tissue microscale elasticity, for detecting tumor within 1 mm of the margins of BCS specimens. Simultaneous OCT and QME were performed on the margins of intact, freshly excised specimens from 83 patients undergoing BCS and on dissected specimens from 7 patients undergoing mastectomy. The resulting three-dimensional images (45 × 45 × 1 mm) were coregistered with postoperative histology to determine tissue types present in each scan. Data from 12 BCS patients and the 7 mastectomy patients served to build a set of images for reader training. One hundred and fifty-four subimages (10 × 10 × 1 mm) from the remaining 71 BCS patients were included in a blinded reader study, which resulted in 69.0% sensitivity and 79.0% specificity using OCT images, versus 92.9% sensitivity and 96.4% specificity using elasticity images. The quantitative nature of QME also facilitated development of an automated reader, which resulted in 100.0% sensitivity and 97.7% specificity. These results demonstrate high accuracy of QME for detecting tumor within 1 mm of the margin and the potential for this technique to improve outcomes in BCS.

Significance: An optical imaging technology probes breast tissue elasticity to provide accurate assessment of tumor margin involvement in breast-conserving surgery.

Original languageEnglish
Pages (from-to)1773-1783
Number of pages11
JournalCancer Research
Issue number8
Early online date15 Apr 2020
Publication statusPublished - Apr 2020


  • Breast-conserving surgery
  • Surgical guidance
  • Tumor margins
  • Elastography


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