Spectrally Encoded Confocal Microscopy for Guiding Lumpectomy

Complete removal of breast cancer during a single breastconserving lumpectomy procedure is often challenging due to the lack of adequate intraoperative tools to accurately determine the margin status. About one-third of lumpectomy patients are found to have positive margins upon final histologic analysis, which usually is reported within a week after surgery. These patients are then required to undergo additional surgeries, which increases the patient morbidity, cosmetic challenges, and healthcare cost. Spectrally encoded confocal microscopy (SECM) is a high-speed confocal microscopy technique [1] that can visualize cellular and subcellular features of an unstained fresh tissue. SECM is 10–100 times faster than conventional confocal microscopes and has been demonstrated to image an entire endoscopic mucosal resection (EMR) esophageal tissue (10mm by 10mm) within 15 seconds [2]. The high imaging speed of SECM may make it possible to rapidly image the margins of entire lumpectomy specimens to comprehensively determine margin status without sampling error. Real-time feedback regarding the margin status could enable the surgeon to achievemore thorough tumor removal in a single surgery and will significantly reduce the need for additional surgeries.The aim of this preliminary studywas to test SECM for visualizing breast cancers with various morphologic features.