A morphological imaging scanner reached 95.2 percent accuracy in assessing breast-conserving surgery margins compared with 81 percent for macroscopic examination, according to a recent study.
Confocal laser scanning microscopy has been investigated as a method for intraoperative margin assessment in breast-conserving surgery, where achieving negative margins is important to reduce the need for re-excision. Conventional intraoperative techniques, including macroscopic inspection, specimen radiography, and frozen section analysis, each have practical and interpretive limitations. The morphological imaging scanner, a wide-field confocal device, has been designed to allow rapid examination of fresh lumpectomy specimens in this setting.
In this retrospective observational study, published in The American Journal of Surgical Pathology, conducted at the Montpellier Cancer Institute, the morphological imaging scanner was incorporated into the pathology laboratory workflow for intraoperative evaluation of lumpectomy specimens. The study population included 20 patients with invasive breast carcinoma, resulting in analysis of 21 tumors. Pathologists trained in device operation and image interpretation used both macroscopic examination and morphological imaging to assess margins. These assessments were compared with the final pathology reports generated from formalin-fixed paraffin-embedded sections.
The scanner images and macroscopic examination produced concordant decisions in 76.2 percent of specimens. In 19 percent of cases, morphological imaging indicated the need for additional intraoperative re-excision. These findings were confirmed by the final pathology reports. The device allowed visualization of invasive and in situ carcinoma as well as benign lesions. In some cases, benign lesions such as fibrocystic changes, columnar cell hyperplasia, or papillomas were difficult to distinguish from carcinoma in the scanned images. The additional procedure time associated with device use was approximately 10 minutes.
In this series, no delayed reoperations were required except in cases where mastectomy was recommended after intraoperative re-excisions continued to demonstrate positive margins.
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