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Breast Cancer Research and Treatment
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Open Access 20-05-2024 | Breast Cancer | Research

Intraoperative spectroscopic evaluation of sentinel lymph nodes in breast cancer surgery

Authors: Surekha Barkur, Radu A. Boitor, Raluca Mihai, Navarasi S. Raja Gopal, Samuel Leeney, Alexey A. Koloydenko, Hazem Khout, Emad Rakha, Ioan Notingher

Published in: Breast Cancer Research and Treatment | Issue 1/2024

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Abstract

Background and objectives

Sentinel lymph node (SLN) biopsy is a standard procedure for patients with breast cancer and normal axilla on imaging. Positive SLNs on histological examination can lead to a subsequent surgery for axillary lymph node clearance (ALNC). Here we report a non-destructive technique based on autofluorescence (AF) imaging and Raman spectroscopy for intra-operative assessment of SLNs excised in breast cancer surgery.

Methods

A microscope integrating AF imaging and Raman spectroscopy modules was built to allow scanning of lymph node biopsy samples. During AF-Raman measurements, AF imaging determined optimal sampling locations for Raman spectroscopy measurements. After optimisation of the AF image analysis and training of classification models based on data from 85 samples, the AF-Raman technique was tested on an independent set of 81 lymph nodes comprising 58 fixed and 23 fresh specimens. The sensitivity and specificity of AF-Raman were calculated using post-operative histology as a standard of reference.

Results

The independent test set contained 66 negative lymph nodes and 15 positive lymph nodes according to the reference standard, collected from 78 patients. For this set of specimens, the area under the receiver operating characteristic (ROC) curve for the AF-Raman technique was 0.93 [0.83–0.98]. AF-Raman was then operated in a regime that maximised detection specificity, producing a 94% detection accuracy: 80% sensitivity and 97% specificity. The main confounders for SLN metastasis were areas rich in histiocytes clusters, for which only few Raman spectra had been included in the training dataset.

Discussion

This preliminary study indicates that with further development and extension of the training dataset by inclusion of additional Raman spectra of histiocytes clusters and capsule, the AF-Raman may become a promising technique for intra-operative assessment of SLNs. Intra-operative detection of positive biopsies could avoid second surgery for axillary clearance.
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Metadata
Title
Intraoperative spectroscopic evaluation of sentinel lymph nodes in breast cancer surgery
Authors
Surekha Barkur
Radu A. Boitor
Raluca Mihai
Navarasi S. Raja Gopal
Samuel Leeney
Alexey A. Koloydenko
Hazem Khout
Emad Rakha
Ioan Notingher
Publication date
20-05-2024
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2024
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-024-07349-z

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