Fluorescence for image and spectrum guided breast-conserving surgery
File(s)
Author(s)
Leiloglou, Maria
Type
Thesis
Abstract
Breast conserving surgery (BCS) in combination with adjuvant therapies is the preferred course of treatment for patients with early stage breast cancer. In BCS only the tumour along with a rim of heathy tissue is resected while the rest of the breast tissue is preserved. Although BCS offers favourable cosmetic results and less post-operative complications, it has been associated with a high risk of re-operation. Re-operation is necessary to prevent cancer recurrence in cases where tumour is inadvertently not fully resected but negatively impacts patient’s physio/psychology and financially burdens healthcare.
Despite the plethora of technologies aiming to tackle this challenge which are currently used in clinical practice or are under development, no universally accepted solution exists. Out of these technologies, fluorescence intensity and hyperspectral imaging are investigated in this thesis as the potential solution.
The focus of the experimental work is on the development and clinical testing of an imaging prototype that exploits the fluorescence of externally administered contrast agents to guide the tumour resection in BCS and help the surgeons to remove the entirety of the tumour. This prototype was firstly tested and iteratively developed in the lab to ensure it fulfils the pre-requisites for clinical translation. Moreover, the feasibility of performing in-vivo fluorescence imaging with this prototype without impeding clinical workflow was investigated in a clinical study recruiting ten BCS patients. Upon establishing feasibility, a second clinical study was contacted with forty overall recruited patients. The aim of this study was to investigate the optimal contrast agent injection time and validate the method in freshly excised breast and formalin-fixed specimen grossing specimens in the histopathology lab. Finally, with the aim to improve the tumour detection accuracy of the technique, the potential combination of fluorescence intensity and hyperspectral imaging in a single prototype was investigated in the lab.
Despite the plethora of technologies aiming to tackle this challenge which are currently used in clinical practice or are under development, no universally accepted solution exists. Out of these technologies, fluorescence intensity and hyperspectral imaging are investigated in this thesis as the potential solution.
The focus of the experimental work is on the development and clinical testing of an imaging prototype that exploits the fluorescence of externally administered contrast agents to guide the tumour resection in BCS and help the surgeons to remove the entirety of the tumour. This prototype was firstly tested and iteratively developed in the lab to ensure it fulfils the pre-requisites for clinical translation. Moreover, the feasibility of performing in-vivo fluorescence imaging with this prototype without impeding clinical workflow was investigated in a clinical study recruiting ten BCS patients. Upon establishing feasibility, a second clinical study was contacted with forty overall recruited patients. The aim of this study was to investigate the optimal contrast agent injection time and validate the method in freshly excised breast and formalin-fixed specimen grossing specimens in the histopathology lab. Finally, with the aim to improve the tumour detection accuracy of the technique, the potential combination of fluorescence intensity and hyperspectral imaging in a single prototype was investigated in the lab.
Version
Open Access
Date Issued
2021-12
Date Awarded
2022-10
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Darzi, Ara
Elson, Daniel
Mayer, Erik
Sponsor
National Institute for Health Research (Great Britain)
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)