Real-time, intraoperative detection of residual breast cancer in lumpectomy cavity walls using a novel cathepsin-activated fluorescent imaging system

Barbara L. Smith, Michele A. Gadd, Conor R. Lanahan, Upahvan Rai, Rong Tang, Travis Rice-Stitt, Andrea L. Merrill, David B. Strasfeld, Jorge M. Ferrer, Elena F. Brachtel, Michelle C. Specht

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Purpose: Obtaining tumor-free surgical margins is critical to prevent recurrence in breast-conserving surgery but it remains challenging. We assessed the LUM Imaging System for real-time, intraoperative detection of residual tumor. Methods: Lumpectomy cavity walls and excised specimens of breast cancer lumpectomy patients were assessed with the LUM Imaging System (Lumicell, Inc., Wellesley MA) with and without intravenous LUM015, a cathepsin-activatable fluorescent agent. Fluorescence at potential sites of residual tumor was evaluated with a sterile hand-held probe, displayed on a monitor and correlated with histopathology. Results: Background autofluorescence was assessed in excised specimens from 9 patients who did not receive LUM015. In vivo lumpectomy cavities and excised specimens were then imaged in 15 women undergoing breast cancer surgery who received no LUM015, 0.5, or 1 mg/kg LUM015 (5 women per dose). Among these, 11 patients had invasive carcinoma with ductal carcinoma in situ (DCIS) and 4 had only DCIS. Image acquisition took 1 s for each 2.6-cm-diameter surface. No significant background normal breast fluorescence was identified. Elevated fluorescent signal was seen from invasive cancers and DCIS. Mean tumor-to-normal signal ratios were 4.70 ± 1.23 at 0.5 mg/kg and 4.22 ± 0.9 at 1.0 mg/kg (p = 0.54). Tumor was distinguished from normal tissue in pre-and postmenopausal women and readings were not affected by breast density. Some benign tissues produced fluorescent signal with LUM015. Conclusion: The LUM Imaging System allows rapid identification of residual tumor in the lumpectomy cavity of breast cancer patients and may reduce rates of positive margins.

Original languageEnglish (US)
Pages (from-to)413-420
Number of pages8
JournalBreast Cancer Research and Treatment
Volume171
Issue number2
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

Keywords

  • Breast cancer
  • Image-guided surgery
  • Intraoperative tumor detection
  • Lumpectomy surgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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