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. 2024 May 24;1(2):umae015.
doi: 10.1093/radadv/umae015. eCollection 2024 Jul.

Cerenkov luminescence imaging and flexible autoradiography for specimen margin assessment during breast-conserving cancer surgery

Aaditya Sinha  1   2 , Zhane Peterson  1   2 , Belul Shifa  1   2 , Hannah Jeffery  1   2 , Patriek Jurrius  1   2 , Sarah Allen  1   2 , Eugene Lee  2 , Mohammed Azmat  2 , Rachel Barrass  2 , Damion Bailey  2 , Jessica Johnson  2 , Kathryn Adamson  2 , Vasileios Karydakis  2 , Elina Shaari  2 , Mangesh Thorat  2 , Hisham Hamed  2 , Georgina Bitsakou  2 , Sarah Pinder  1   2 , Padma Menon  2 , Wen Ng  2 , Gary Cook  1   2 , John Joemon  2 , Armidita Jacob  2 , Sofia Pereira  2 , Jocelyn Thomas  2 , Ruheana Begum  2 , Karim El-Boghdadly  1   2 , Mieke Van Hemelrijck  1   2 , Ashutosh Kothari  1   2 , Arnie Purushotham  1   2
Affiliations

Cerenkov luminescence imaging and flexible autoradiography for specimen margin assessment during breast-conserving cancer surgery

Aaditya Sinha et al. Radiol Adv. .

Abstract

Background: Among women with breast cancer who undergo breast-conserving surgery (BCS), 20% to 25% require further surgery because of close or involved margins. Improved techniques are needed to assess resection margins.

Purpose: The study aims were to assess the feasibility of the combined techniques of Cerenkov luminescence imaging-flexible autoradiography (CLI-FAR) to assess excision specimen margins in women undergoing BCS and to determine the diagnostic performance of intraoperative CLI-FAR imaging with postoperative histopathology as the reference standard.

Materials and methods: Women undergoing BCS were recruited prospectively at a single center over 13 months. Patients were injected with 250 MBq ± 10 MBq of 18F-fluorodeoxyglucose, 145 minutes before surgery; the excised specimens were imaged intraoperatively. The surgically excised tumor was initially imaged using conventional x-ray, and margins suspected to be involved by tumor were then imaged using CLI-FAR. CLI-FAR imaging was performed using the LightPath system (Lightpoint), an in vitro diagnostic device designed to identify and locate positron-emitting radionuclides. Any suspicious margin underwent an immediate reexcision in the form of cavity shavings. Sensitivity, specificity, and positive and negative predictive values while considering histopathological assessment as the golden standard were used to assess the performance of CLI-FAR.

Results: In all, 54 specimens were imaged in 52 patients, with a total of 104 margins reviewed using CLI-FAR. The results showed a specificity of 97.8% (89/91; 95% confidence interval [CI], 95.0-100.6), sensitivity of 76.9% (10/13; 95% CI, 68.3-85.0), positive predictive value of 83.3% (10/12; 95% CI, 76.2-90.5), and negative predictive value of 96.7% (89/92; 95% CI, 93.3-100.2). In all, 8 patients had 10 positive margins on CLI-FAR imaging and were treated accordingly. CLI-FAR imaging reduced the reexcision rate by 69% (17.3/25).

Conclusion: CLI-FAR imaging is a promising technique for intraoperative margin assessment in women undergoing BCS for invasive breast cancer.

Keywords: Cerenkov luminescence; breast cancer; breast-conserving surgery; flexible autoradiography; intra-operative novel imaging.

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Conflict of interest statement

Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials. The authors have no relevant financial or nonfinancial interests to disclose. The authors have no conflicts of interest to declare. For the purposes of open access, the authors have applied Creative Commons Attribution (CC BY) license to any Accepted Author Manuscript version arising from this submission.

Figures

Figure 1.
Figure 1.
Imaging technology. (A) The LightPath System (Lightpoint Medical), (B) Cerenkov luminescence imaging (CLI), (C) flexible autoradiography (FAR) imaging: 3-μm Mylar sheet placed between scintillator and specimen. The specimen releasing beta particles is detected using an ultrasensitive camera for each imaging modality. Copyright granted by Lightpoint Medical for image in Figure 1A.
Figure 2.
Figure 2.
Patient and specimen flow. Abbreviations: M = number of margins; n = number of patients; s = number of samples.
Figure 3.
Figure 3.
A specimen in which the margins were deemed positive by Cerenkov luminescence imaging (CLI) and negative by intraoperative x-ray. (A) Intraoperative x-ray. (B) White light image. (C) CLI image as seen at the time of interpretation. The green region of interest shows radioactivity on a positive margin. The illuminated spot on the specimen seen above the radioactivity is either contamination or chemiluminescence.
Figure 4.
Figure 4.
(A) Specimen wrapped in a scintillator, image in black and white. (B) Intraoperative x-ray of the specimen. (C) The flexible autoradiography (FAR) image with a region of interest drawn in green where activity was seen. (D) Cerenkov luminescence imaging (CLI) image of with a region of interest drawn in green where activity was seen.
See this image and copyright information in PMC

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