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Imaging breast cancer morphology using probe-based confocal laser endomicroscopy: towards a real-time intraoperative imaging tool for cavity scanning

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Abstract

Current techniques for assessing the adequacy of tumour excision during breast conserving surgery do not provide real-time direct cytopathological assessment of the internal cavity walls within the breast. This study investigates the ability of probe-based confocal laser endomicroscopy (pCLE), an emerging imaging tool, to image the morphology of neoplastic and non-neoplastic breast tissues, and determines the ability of histopathologists and surgeons to differentiate these images. Freshly excised tumour samples and adjacent non-diseased sections from 50 consenting patients were stained with 0.01 % acriflavine hydrochloride and imaged using pCLE. All discernible pCLE features were cross-examined with conventional histopathology. Following pattern recognition training, 17 histopathologists and surgeons with no pCLE experience interpreted 50 pCLE images independently whilst blinded to histopathology results. Three-hundred and fifty pCLE image mosaics were analysed. Consistent with histopathology findings, the glandular structures, adipocytes and collagen fibres of normal breast were readily visible on pCLE images. These were distinguishable from the morphological architecture exhibited by invasive and non-invasive carcinoma. The mean accuracy of pCLE image interpretation for histopathologists and surgeons was 94 and 92 %, respectively. Overall, inter-observer agreement for histopathologists was ‘almost perfect’, κ = 0.82; and ‘substantial’ for surgeons, κ = 0.74. pCLE morphological features of neoplastic and non-neoplastic breast tissues are readily visualized and distinguishable with high accuracy by both histopathologists and surgeons. Further research is required to investigate a potential role for the use of pCLE intraoperatively for in situ detection of residual cancerous foci, thereby guiding operating decision-making based on real-time breast cavity scanning.

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Authors and Affiliations

  1. The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK

    Tou Pin Chang, Daniel R. Leff, Michael R. Hughes, Guang-Zhong Yang & Ara Darzi

  2. Imperial Breast Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK

    Daniel R. Leff, Sami Shousha, Dimitri J. Hadjiminas & Rathi Ramakrishnan

  3. Academic Surgical Unit, St Mary’s Hospital, 10th Floor, QEQM Wing, London, W21NY, UK

    Tou Pin Chang, Daniel R. Leff & Ara Darzi

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  1. Tou Pin Chang
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  2. Daniel R. Leff
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Tou Pin Chang, Daniel R Leff, Sami Shousha, Dimitri J Hadjiminas, Rathi Ramakrishnan, Michael Hughes, Guang-Zhong Yang and Ara Darzi have no conflicts of interest or financial ties to declare.

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Chang, T., Leff, D.R., Shousha, S. et al. Imaging breast cancer morphology using probe-based confocal laser endomicroscopy: towards a real-time intraoperative imaging tool for cavity scanning. Breast Cancer Res Treat 153, 299–310 (2015). https://doi.org/10.1007/s10549-015-3543-8

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