SENOSI Confocal Microscopy: A New and Innovating Way to Detect Positive Margins in Non-Palpable Breast Cancer?

Abstract

In Switzerland, breast cancer is the leading cancer among women, with breast-conserving surgery (BCS) being the preferred treatment for small tumors. The margin status post-surgery is a critical predictor of local recurrence. Achieving negative margins remains a challenge, leading to re-excision in 20-30% of cases. Traditional methods like intraoperative examination palpation and radiography have limitations in assessing excised margins. This study introduces the Histolog^® Scanner, a confocal microscopy tool, as a potential solution. It provides real-time images of tissue architecture, allowing for rapid and accurate assessment of excised margins. Our research compared the Histolog^® Scanner with standard per-operative radiography in patients with non palpable breast cancer. Preliminary results indicate that the Histolog^® Scanner offers a reliable and time-efficient method for margin assessment, suggesting its potential for clinical integration.

Keywords: breast cancer; confocal microscopy; margins; surgery.

Figure 1

Histolog Scanner confocal imaging device (top) and full surgical specimen (unsliced) placed on the device for imaging (bottom).

Figure 2

Diagram presenting the observational workflow implemented for the study.

Figure 3

Distribution of breast cancer types identified by the final pathology assessment in study participants.

Figure 4

Detection performance and associated confidence intervals for individual techniques of the study.

Figure 5

High-magnification Histolog images of a normal lumpectomy margin presenting healthy tissue with vessels (V) and fatty tissue (F). Scale bar is 100 µm.

Figure 6

Study case with a DCIS-positive margin. (A) Radiography of the surgical specimen. Several microcalcifications can be seen in the center and in the upper-left quadrant. Some of them (*) are close to the surface of the margin (purple dashed line). The graphical insert shows the area within the white frame at higher magnification. (B) Low-magnification HS image of the surface of the cancer-positive margin corresponding to the specimen area with the purple dash line in the radiography figure. Areas delimited with red annotations are DCIS lesions. Graphical insert shows a DCIS lesion (#) at higher magnification, corresponding to the area within the back frame.

Figure 7

Bar plot displaying the number of intraoperative recuts recommended by individual techniques (radiography, HS surgeon, HS pathologist, and the standard-of-care (SoC)).

Figure 8

Mean time of utilization of the Histolog Scanner vs. radiography. The brackets, the cross (×), and the bar (-) represent the standard deviation, mean, and the medial of the collected values, respectively.