Imaging of lumpectomy surface with large field-of-view confocal laser scanning microscope ‘Histolog®​ Scanner’ for breast margin assessment in comparison with intraoperative imaging

Background Breast-conserving surgery (BCS) intends to completely remove breast cancer. However, about 20% of patients undergo several procedures to achieve acceptable cancer-negative margins with physical, psychological, and economic consequences. The Histolog^®​ Scanner (SamanTree Medical SA, Lausanne, Switzerland) is a large field-of-view confocal laser-scanning-microscope which allows intraoperative margin assessment to reduce re-operation rates (ROR).

Materials and Methods The study included 40 consecutive patients undergoing BCS. The margin assessment was performed according to standard-of-care (SOC, ultrasound, surgical inspection, specimen radiography). The specimen was imaged intraoperatively using the Histolog^®​ Scanner (HLS) with an observational review at the end of the surgery. Final histopathological assessment served as the reference.

Results The study population included 26 patients with DCIS (65%), 5 with ILC (12.5%), 8 patients with IDC, 1 patient with a combination. Clinical routine resulted in 13/40 patients with positive margins identified by final histopathological assessment – 11 with DCIS involved in their margin. Following a short familiarization on HLS images, surgeons were able to detect positive margins in 4/13 patients (30%) that were missed by the SOC. In addition, a retrospective analysis of the HLS images revealed that cancer lesions were detectable in 9/13 patients (70%) with positive margins.

Conclusions Surgeons were able to detect positive margins that were missed by the SOC, resulting in a potential 30% reduction of the re-operation rate. An additional retrospective analysis of the images indicated that cancer lesions can be found in HLS images of more patients bringing the perspective of a 70% reduction of the ROR.

Publication History

Article published online:
21 June 2022