Multimodal optical coherence tomography of breast tissue in clarifying diagnostics of early forms of breast cancer: analysis of clinical cases

Efficient multimodal diagnostics of tumor type and intraoperative assessment of resection margins purity are the main indicators for reducing the risk of local recurrence after organ-preserving surgery (OPS) in patients with early breast cancer. The use of new high-resolution imaging techniques, an integrated approach to data analysis and numerical image processing will improve the overall efficiency of diagnostics and surgical treatment of tumors at early stages. The objective of the presented clinical observations was to demonstrate the advantages of an integrated approach to breast cancer diagnostics, which includes, in addition to standard ultrasound elastography, tissue examination by multimodal optical coherence tomography (OCT) in the modes of visualizing the structure and calculating tissue stiffness.

We demonstrate clinical examples of two malignant breast tumors with a similar diagnosis of “invasive cancer of a nonspecific type, moderate malignancy, T1–2N0M0”. The patients underwent preoperative standard ultrasound examination and subsequent OPS with additional intraoperative multimodal OCT in the modes of structural OCT with visualization of the attenuation coefficient and OCT-elastography with calculation of Young modulus in kilopascals. The examples of a tumor that was erroneously classified as benign according to the results of preoperative compression ultrasound elastography and another tumor that was correctly classified as malignant are considering. Post-operative tissue examination using multimodal OCT allowed us to establish that both cases demonstrate features of malignancy: quantitative processing of structural OCT images of the mammary gland tissues revealed a decrease in the attenuation coefficient of the OCT signal (<4 mm^–1) in both cases, which is typical for tumor tissue; stiffness maps constructed from the OCT data demonstrated high stiffness values (>400  kPa), which indicated the presence of tumor cells / tissue in both cases, which was confirmed by histological examination. It has been established that, compared with ultrasound elastography and structural OCT, OCT-elastography method allows more accurate determination of malignant tumors and clear visualization of the boundary between non-tumor and tumor tissues of the mammary gland.

Multimodal OCT with complex calculation of the OCT signal attenuation coefficient and stiffness values  has a certain potential for improving the intraoperative assessment of tumor structure features and determining the resection margins of breast cancer in OPS.

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