SignificanceDuring breast-conserving surgeries, it is essential to evaluate the resection margins (edges of breast specimen) to determine whether the tumor has been removed completely. In current surgical practice, there are no methods available to aid in accurate real-time margin evaluation.AimIn this study, we investigated the diagnostic accuracy of diffuse reflectance spectroscopy (DRS) combined with tissue classification models in discriminating tumorous tissue from healthy tissue up to 2 mm in depth on the actual resection margin of in vivo breast tissue.ApproachWe collected an extensive dataset of DRS measurements on ex vivo breast tissue and in vivo breast tissue, which we used to develop different classification models for tissue classification. Next, these models were used in vivo to evaluate the performance of DRS for tissue discrimination during breast conserving surgery. We investigated which training strategy yielded optimum results for the classification model with the highest performance.ResultsWe achieved a Matthews correlation coefficient of 0.76, a sensitivity of 96.7% (95% CI 95.6% to 98.2%), a specificity of 90.6% (95% CI 86.3% to 97.9%) and an area under the curve of 0.98 by training the optimum model on a combination of ex vivo and in vivo DRS data.ConclusionsDRS allows real-time margin assessment with a high sensitivity and specificity during breast-conserving surgeries.
Achieving adequate resection margins during breast-conserving surgery is crucial for minimizing the risk of tumor recurrence in patients with breast cancer but remains challenging due to the lack of intraoperative feedback. Here, we evaluated the use of hyperspectral imaging to discriminate healthy tissue from tumor tissue in lumpectomy specimens of 121 patients. A dataset on tissue slices was used to develop and evaluate three convolutional neural networks. Subsequently, these networks were fine-tuned with lumpectomy data to predict the tissue percentages on the lumpectomy resection surface. We achieved a MCC of 0.92 on the tissue slices and an RMSE of 9% on the lumpectomy resection surface.
Diffuse reflectance spectroscopy (DRS) has already been successfully used for tissue discrimination during colorectal cancer surgery. In clinical practice, however, tissue often consists of several layers. Therefore, a novel multi-output convolutional neural network (CNN) was designed to classify multiple layers of colorectal cancer tissue simultaneously. DRS data was acquired with an array of six fibers with different fiber distances to sample at multiple depths. After training a 2D CNN with the DRS data as input, the first, second, and third tissue layers could be classified with mean accuracies of 0.90, 0.71, and 0.62, respectively.
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