Rationale and Objectives
This study aimed to assess whether different breast cancer subspecialty physicians
can be trained to distinguish non-suspicious from suspicious areas of post-lumpectomy
specimen margin in patients with breast cancer using optical coherence tomography
(OCT) images (a near-infrared based imaging technique) with final histology as the
reference standard.
Materials and Methods
This institutional review board-exempt, Health Insurance Portability and Accountability
Act-compliant study was performed on 63 surgically excised breast specimens from 35
female patients, creating a 90-case atlas containing both non-suspicious and suspicious
areas for cancer. OCT images of the specimens were performed, providing 6.5–15 µm
resolution with tissue visualization 1–2 mm subsurface. From the 90-case atlas, 40
cases were chosen for training and 40 were randomly selected for reader assessment.
Three breast imaging radiologists, two pathologists, two breast surgeons, and one
non-clinical reader were trained and assessed for ability to distinguish non-suspicious
from suspicious findings blinded to clinical data and corresponding histology slides.
Duration of training and assessment, sensitivity, specificity, positive predictive
value, negative predictive value, and the area under the curve for each reader were
calculated as well as averages by subspecialty.
Results
The average training time was 3.4 hours (standard deviation, 1.2). The average assessment
time was 1.9 hours (standard deviation, 0.7). The overall average reader sensitivity,
specificity, and accuracy for detecting suspicious findings with histologic confirmation
of cancer at the surgical margin for all eight readers were 80%, 87%, and 87%, respectively.
Radiologists demonstrated the highest average among the disciplines, 85%, 93%, and
94%, followed by pathologists, 79%, 90%, and 84%, and surgeons, 76%, 84%, and 82%
respectively.
Conclusions
With relatively short training (3.4 hours), readers from different medical specialties
were able to distinguish suspicious from non-suspicious OCT imaging findings in ex
vivo breast tissue as confirmed by histology. These results support the potential
of OCT as a real-time intraoperative tool for post-lumpectomy specimen margin assessment.
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Article info
Publication history
Published online: November 22, 2017
Accepted:
September 18,
2017
Received in revised form:
September 12,
2017
Received:
June 7,
2017
Identification
Copyright
© 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
