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First author Dr. Maddalena T. Tilli, confocal microscope with digital photo of breast biopsy tissue, and Dr. Priscilla A. Furth (Professor at Lombardi Comprehensive Cancer Center Georgetown University and Dr. Tilli’s mentor)

Although it’s all too easy to become immune to claims of “latest, greatest, better, best” in today’s rapidly changing world of medical technology, the fact remains that much of what has been discovered and refined over the past couple of decades has indeed been revolutionary in terms of patient care and outcomes.

Adding to the growing list of improvements in oncology diagnosis and treatment, researchers at Georgetown University believe their recent work with a sophisticated microscope that allows a three-dimensional analysis of tissue samples in “real time” has the potential to positively impact the rapid diagnosis of breast cancer. Furthermore, the investigators believe the technology could also impact outcomes by rapidly confirming doctors have reached clear margins during surgery to excise cancerous cells.

Dr. Priscilla Furth, professor of oncology at Georgetown University who sees patients at the Lombardi Comprehensive Cancer Center, said the technology has the potential to benefit not only breast cancer patients but could also be useful in diagnosing and treating other forms of cancer with a bit of additional tweaking. Already, the technology is limitedly available in clinical practice for diagnosing melanoma.

Like all microscopes, Furth said, this one uses reflected light to form an image. However, the microscope uses a different wavelength — near-infrared light - to instantly produce an image that clearly shows the difference in the types of cells present.

“The microscope uses confocal technology to be able to focus on a specific section within intact tissue,” explained Furth. “The light is reflected back from the tissue components, and a digital image is created.”

She added the black-and-white image is clear enough to see cellular and tissue structure but noted future lines of development should focus on improving the resolution of the images.

“But the present work demonstrates that it is feasible to distinguish between normal tissue and cancer,” she stressed.

Tissue is obtained through normal needle biopsy. To highlight the cell’s nucleus, a diluted solution of acetic acid is employed to induce chromatin condensation, which changes the reflectance pattern.

Furth said the user can then “essentially section through the tissue optically.” One great advantage, she added, is the “real time” nature of this virtual sectioning, which means the diagnostic test could theoretically be performed at the bedside. Furth said the entire procedure only takes about 10 minutes.

For patients, this could alleviate the stress of worrying for days while awaiting news of their biopsy lab report. Additionally, it is quite common to have to order a repeat biopsy if collected samples don’t yield a clear answer. With the new technology, any need for additional tissue samples would be known within minutes while the patient is still onsite.

The benefit of this rapid technology doesn’t end in the mammography suite, however. Furth said perhaps the biggest benefit is to those women who do receive a diagnosis of cancer.

“In the operating room, it’s potentially an even greater advantage because you could histologically check the surgical margins before closing,” she noted.

From a payer and health system perspective, Furth said she believes this technology is actually quite cost-efficient and could pay for itself over time. The savings come from eliminating the need to do another round of biopsy collection or additional surgery by letting physicians know they have what they need at the point of patient care.

However, Furth said she didn’t have a sense of when the microscope might become widely available, although she believes with directed work it could be in the commercial marketplace within just a few years.

“This is a technology that is quite realizable,” she said. “The real issues are financial,” she added, saying it would require a company willing to invest money into improving software and heightening the capabilities of the microscope lens to move to the next step.

“The basic technology works, but it will have to be optimized for different tissues,” Furth continued of the potential to expand use beyond melanoma and breast cancer.

She added that a manufacturer would not have to go back to the drawing board to make the technology feasible to detect other forms of cancer, but the exact wavelength of light used would vary depending on what tissue is being viewed. Therefore, the machine would need to be made more flexible in order to attain the broadest clinical application.

“We have to demonstrate this is useful so demand will be there,” she added of studies such as hers, which was published last fall in the Journal of Biomedical Optics.

For those on the front lines of detecting and fighting cancer, any breakthrough that is “better, safer, faster” has to be viewed with interest.



Caption: First author Dr. Maddalena T. Tilli (Post-doctoral Fellow at Lombardi Comprehensive Cancer Center Georgetown University), confocal microscope with digital photo of breast biopsy tissue, and Dr. Priscilla A. Furth (Professor at Lombardi Comprehensive Cancer Center Georgetown University and Dr. Tilli’s mentor)



March 2008

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