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Lesion Discrimination in Young Women by Functional Optical Tomography
The objective of this application is to test the feasibility of functional optical tomography as an imaging modality to non-invasively distinguish benign from neoplastic tumors in young women (age 25 to 44) presenting with a palpable breast mass. Presently there is no reliable imaging method to make this distinction non-invasively, leading to the requirement for excisional biopsies to definitively rule out malignancy. This conservative approach leads to numerous, oftentimes unnecessary surgical procedures, with low yield of detection of malignancy due to the predominance of fibroadenomas in this population. This supports a role for the proposed technology in order to avoid unnecessary surgical excisions.
Optical tomography employs near infrared wavelengths to probe the optical properties of tissue and is capable of providing three-dimensional spatial maps of changes in blood volume and oxygenation in the entire volume of the breast (up to ~1,500 cc). We have demonstrated the capability of detecting neoplastic lesions based on alterations in physiologic response to autonomic stimuli (e.g., deep breathing, breath hold, temperature change, etc.), a consequence of dysfunctional regulatory mechanisms in microvasculature formed by angiogenesis.
The goal of the proposed study is to substantiate our hypothesis that optical tomography is capable of distinguishing with high specificity early stage neoplasms from benign breast lesions in young women. To explore this capability, we plan to perform optical tomographic breast measurements on 50 women aged 25-44. Criteria for inclusion are presence of a palpable mass on clinical breast exam and planned excisional biopsy. Optical measurements will be performed prior to surgical intervention. The acquired raw data and reconstructed images will be analyzed for dynamic signatures in the hemoglobin signal that are indicative for neovascularization. A priori knowledge of the lesion location is expected to increase the sensitivity and specificity of our analysis. The pathological diagnosis of surgically resected biopsy specimen will be the standard for analyzing the accuracy of the optical diagnosis.
The potential benefits of optically discriminating benign from neoplastic processes include a significantly reduced number of avoidable surgical interventions, decreasing surgical risks to the patient. In addition, cosmetic problems such as scarring and breast disfiguration will be minimized, decreasing morbidity and improving quality of life.
For a young woman (in the age range 25-44) who is found to have a breast lump, there is presently no definitive noninvasive diagnostic test which can discriminate a benign mass from a cancerous tumor. As a result, many such patients are subjected to surgical biopsies of the lump in order to establish the diagnosis. Because benign masses far outnumber malignant tumors in this population of women, the majority of these surgical procedures could be avoided if an accurate noninvasive diagnostic test were available. We are proposing the use of optical tomography as a technique which is capable of distinguishing cancerous from benign lumps, based on the unique interaction of near-infrared light with human tissues.
Optical tomography uses near-infrared light, which is capable of penetrating tissue up to several centimeters, to create volumetric images that show variations in blood content and oxygenation in the breast. Studies have already shown that this technique is capable of locating and imaging breast tumors, based on the fact that the blood vessels supplying a cancerous tumor are structurally and functionally malformed compared to vessels in healthy tissue.
The aim of the proposed research is to validate our hypothesis that optical techniques can distinguish between cancerous and benign lumps. We plan to perform optical measurements on 50 young women, aged 25-44, who are seen in clinic for a breast lump and who plan to have surgery to biopsy the tumor. An optical measurement will be performed prior to surgery, an image of the woman’s breast will be reconstructed from the data collected, and based on patterns in blood concentration and oxygen saturation an assessment will be made as to the benign or malignant nature of the lump. We will use results of the pathology of the biopsy tissue as a standard for analyzing the accuracy of the optical measurements.
A potential benefit of our approach is a significantly decreased number of unnecessary surgeries on young women who are discovered to have a breast lump. Besides reducing health care cost this will decrease anxiety, expose these women to fewer surgical risks, and will minimize cosmetic problems such as breast disfiguration and scarring resulting from surgery.