High-resolution fiber optic microscopy with fluorescent contrast enhancement for the identification of axillary lymph node metastases in breast cancer: a pilot study

This prospective pilot study evaluates the potential of high-resolution fiber optic microscopy (HRFM) to identify lymph node metastases in breast cancer patients. 43 lymph nodes were collected from 14 consenting breast cancer patients. Proflavine dye was topically applied to lymph nodes ex vivo to allow visualization of nuclei. 242 images were collected at 105 sites with confirmed histopathologic diagnosis. Quantitative statistical features were calculated from images, assessed with one-way ANOVA, and were used to develop a classification algorithm with the goal of objectively discriminating between normal and metastatic tissue. A classification algorithm using mean image intensity and skewness achieved sensitivity of 79% (27/34) and specificity of 77% (55/71). This study demonstrates the technical feasibility and diagnostic potential of HRFM with fluorescent contrast in the ex vivo evaluation of lymph nodes from breast cancer patients.

[1]  P. Bult,et al.  Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. , 2010, Journal of the National Cancer Institute.

[2]  F. Penault-Llorca,et al.  Intraoperative Imprint Cytology Examination of Sentinel Lymph Nodes After Neoadjuvant Chemotherapy in Breast Cancer Patients , 2010, Annals of Surgical Oncology.

[3]  A. Degnim,et al.  Cost Modeling of Preoperative Axillary Ultrasound and Fine-Needle Aspiration to Guide Surgery for Invasive Breast Cancer , 2010, Annals of Surgical Oncology.

[4]  Manojit Pramanik,et al.  In vivo carbon nanotube-enhanced non-invasive photoacoustic mapping of the sentinel lymph node , 2009, Physics in medicine and biology.

[5]  Chulhong Kim,et al.  Noninvasive in vivo spectroscopic nanorod-contrast photoacoustic mapping of sentinel lymph nodes. , 2009, European journal of radiology.

[6]  Michael J Kallan,et al.  Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  Timothy J Muldoon,et al.  High-resolution imaging in Barrett's esophagus: a novel, low-cost endoscopic microscope. , 2008, Gastrointestinal endoscopy.

[8]  Timothy J Muldoon,et al.  Subcellular-resolution molecular imaging within living tissue by fiber microendoscopy. , 2007, Optics express.

[9]  S. Alvarez,et al.  Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. , 2006, AJR. American journal of roentgenology.

[10]  E. Cocker,et al.  Fiber-optic fluorescence imaging , 2005, Nature Methods.

[11]  A. Alessi,et al.  FDG-PET for axillary lymph node staging in primary breast cancer , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[12]  Kelly K. Hunt,et al.  Clinicopathologic Factors Predicting Involvement of Nonsentinel Axillary Nodes in Women With Breast Cancer , 2003, Annals of Surgical Oncology.

[13]  W. Kwan,et al.  Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  N. Sneige,et al.  Intraoperative touch imprint of sentinel lymph nodes in breast carcinoma patients , 2002, Cancer.

[15]  S. Kirk,et al.  Prospective evaluation of the morbidity of axillary clearance for breast cancer (Br J Surg 2001; 88: 114–7) , 2001, The British journal of surgery.

[16]  G. McGreal,et al.  Prospective evaluation of the morbidity of axillary clearance for breast cancer , 2001, The British journal of surgery.

[17]  N. Col,et al.  The learning curve for sentinel node biopsy in breast cancer: practical considerations. , 1999, Archives of surgery.

[18]  A. Luini,et al.  Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. , 1999, Journal of the National Cancer Institute.

[19]  R. Foster,et al.  The sentinel node in breast cancer--a multicenter validation study. , 1998, The New England journal of medicine.

[20]  A E Giuliano,et al.  Sentinel-lymph-node biopsy for breast cancer--not yet the standard of care. , 1998, The New England journal of medicine.

[21]  Umberto Veronesi,et al.  Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes , 1997, The Lancet.

[22]  T. Yeatman,et al.  Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. , 1996, JAMA.

[23]  A. Gmitro,et al.  Confocal microscopy through a fiber-optic imaging bundle. , 1993, Optics letters.

[24]  W. Denny,et al.  The genetic toxicology of acridines. , 1991, Mutation research.

[25]  D. Carter,et al.  Heterotopic epithelium in axillary lymph nodes: report of a case and review of the literature. , 1973, American journal of clinical pathology.

[26]  J. Engel,et al.  Axilla Surgery Severely Affects Quality of Life: Results of a 5-Year Prospective Study in Breast Cancer Patients , 2004, Breast Cancer Research and Treatment.