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Open Access Research article

High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

Timothy E Doyle1*, Rachel E Factor2, Christina L Ellefson3, Kristina M Sorensen4, Brady J Ambrose5, Jeffrey B Goodrich5, Vern P Hart5, Scott C Jensen5, Hemang Patel6 and Leigh A Neumayer3

Author Affiliations

1 Department of Physics, Utah Valley University, Orem, UT 84058, USA

2 Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA

3 Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA

4 Department of Mathematics and Statistics, Utah State University, Logan, UT 84322, USA

5 Department of Physics, Utah State University, Logan, UT 84322, USA

6 Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, USA

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BMC Cancer 2011, 11:444  doi:10.1186/1471-2407-11-444

Published: 12 October 2011

Abstract

Background

In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz) can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery.

Methods

Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values.

Results

The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each pathology type from the other four using a multivariate analysis. The results yielded specificities and sensitivities of 85% and 86% for lobular carcinomas, 85% and 74% for ductal carcinomas, 100% and 61% for benign pathologies, 84% and 100% for fat necrosis and adenomas, and 98% and 80% for normal tissue.

Conclusions

Results from high-frequency ultrasonic measurements of human breast tissue specimens indicate that characteristics in the ultrasonic attenuation, spectra, and cepstra can be used to differentiate between normal, benign, and malignant breast pathologies.