Precise measurement of an invasive breast cancer is crucial for pathological staging and subsequent patient management. Formalin fixation and histological processing may change tissue size, but there is no agreement on which state of the specimen, fresh or fixed, should be used for final tumor measurement. To determine the influence of fixation and processing on breast tumor size, a specific 1-dimensional measurement from 50 invasive breast tumors was recorded in fresh, fixed, and processed/mounted states. Tumors varied in maximum measured dimension from 4 to 20 mm and contained 10% to 90% estimated fibrous tissue (mean, 52.8%). In 96% of cases, there was no difference in measured size between fresh and fixed states. After final processing and mounting, a decrease in size from initial fresh measurement was noted in 40% of cases (mean difference, 2.4 mm; maximum difference, 7 mm). In 9 cases (18%), the measured size increased by a maximum of 3 mm (mean, 1.7 mm) after processing/mounting. Twenty-one cases (42%) showed no change in measurement during the entire fixation and processing protocol. Increases in measured size were attributed largely to tissue expansion during histological sectioning/mounting. One can arguably measure the size of an invasive breast cancer from either the fresh or fixed state without affecting accuracy, but caution should be exercised in relying solely on the microscopic measurements.
"Third, formalin fixation affects solid tissue measurements. Pritt and colleagues  observed 4% of breast cancer specimens decreased in size after overnight formalin fixation and that 40% shrank after processing and mounting. "
[Show abstract][Hide abstract] ABSTRACT: Background
Little information is available on the use of chest computed tomography (CT) to predict breast tumor size in breast cancer, despite the fact that chest CT examinations are being increasingly used. The purpose of this study was to evaluate the value of chest CT for predicting breast tumor size using pathology measurements as reference standards.
Tumor sizes (defined as greatest diameter) were retrospectively measured on the preoperative chest CT images of 285 patients with surgically proven unifocal, invasive breast carcinoma. Greatest tumor diameters as determined by chest CT and pathologic examinations were compared by linear regression and Spearman’s rho correlation analysis. Concordance between CT and pathology results was defined as a diameter difference of <5 mm. Subgroup analyses were also performed with respect to tumor size (<20 mm or ≥20 mm) and histological subtype (invasive ductal carcinoma(IDC) or non-IDC).
CT and pathology measured diameters were found to be linearly related (size at pathology = 1.086 × CT determined tumor size - 1.141; Spearman’s rho correlation coefficient = 0.84, P<0.001). Most tumors (n = 228, 80.0%) were concordant by chest CT and pathology, but 36 tumors (12.7%) were underestimated by CT (average underestimation, 11 mm; range, 6–36 mm) and 21 tumors (7.4%) were overestimated (average overestimation by CT, 10 mm; range, 6–19 mm). The concordance rate between the two sets of measurements was greater for tumor of <20 mm and for IDC (P<0.001 and P = 0.011, respectively).
Tumor size by chest CT is well correlated with pathology determined tumor size in breast cancer patients, and the diameters of the majority of tumors by chest CT and pathology differed by <5 mm. In addition, the concordance rate was higher for breast tumors of <20 mm and for tumors of the IDC histologic subtype.
World Journal of Surgical Oncology 06/2013; 11(1):130. DOI:10.1186/1477-7819-11-130 · 1.41 Impact Factor
"Four features commonly found in the composition of breast tissue have been identified and labeled, including a milk duct (D), blood vessels (V), adipose tissue (A), and connective tissue (C). As shrinkage due to tissue fixation and processing is typical of histological processing [27,28], with different tissues affected to different degrees , the histological image is used here to provide an understanding of the biological features, rather than to validate the geometrical distance and orientation of the features found in the OCT images, which were acquired in fresh tissue. "
[Show abstract][Hide abstract] ABSTRACT: We present a high-resolution three-dimensional position tracking method that allows an optical coherence tomography (OCT) needle probe to be scanned laterally by hand, providing the high degree of flexibility and freedom required in clinical usage. The method is based on a magnetic tracking system, which is augmented by cross-correlation-based resampling and a two-stage moving window average algorithm to improve upon the tracker's limited intrinsic spatial resolution, achieving 18 µm RMS position accuracy. A proof-of-principle system was developed, with successful image reconstruction demonstrated on phantoms and on ex vivo human breast tissue validated against histology. This freehand scanning method could contribute toward clinical implementation of OCT needle imaging.
"However, some geometrical distortion was observed, due to imaging artifacts in both the H&E preparation and OCT image acquisition . Tissue samples have been shown to undergo shrinkage and deformation during histological preparation, primarily during preparation of the paraffin block , , with different tissues affected to different degrees . Rotation and retraction of the OCT needle probe was also observed to cause a degree of drag on the tissue, giving rise to geometrical distortion. "
[Show abstract][Hide abstract] ABSTRACT: Optical coherence tomography (OCT) is a high-resolution imaging modality with the potential to provide in situ assessment to distinguish normal from cancerous tissue. However, limited image penetration depth has restricted its utility. This paper demonstrates the feasibility of an OCT needle probe to perform interstitial imaging deep below the tissue surface. The side-facing needle probe comprises miniaturized focusing optics consisting of no-core and GRIN fiber encased within either a 22- or 23-gauge needle. 3-D OCT volumetric data sets were acquired by rotating and retracting the probe during imaging. We present the first published image of a human breast cancer tumor margin, and of human axillary lymph nodes acquired with an OCT needle probe. Through accurate correlation with the histological gold standard, OCT is shown to enable a clear delineation of tumor boundary from surrounding adipose tissue, and identification of microarchitectural features.
IEEE Journal of Selected Topics in Quantum Electronics 05/2012; 18(3):1184-1191. DOI:10.1109/JSTQE.2011.2166757 · 2.83 Impact Factor
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