Wei Tse Yang: Optical Imaging of the Breast
A keynote presentation from SPIE Medical Imaging 2018.
"The range of different optical hardwares that are available in the clinic today have led to choices available to address specific clinical needs," says Wei Tse Yang of University of Texas in the opening remarks of her keynote presentation.
"The most promising application to date is in the breast," says Yang. Primarily because it is a superficial organ, and primarily because the remodeled vasculature changes in the cellular and extracellular domain, related to a malignant tissue and can be histologically characterized and be used to create suitable contrast when employing optical imaging.
Yang says the problems breast imaging radiologists face are threefold: The highest value-tasks in the breast-imaging chain today are the early detection of breast cancer, distinguishing benign from malignant tumors, and monitoring the effects of neoadjuvant chemotherapy (NAC).
Yang notes that the equation of Value equals = Patient Outcome over Cost is rapidly changing our healthcare landscape.
Yang discusses how Laser OptoAcoustic Ultrasound (OA/US) offers functional anatomical imaging of the breast. Diagnostic performance of OA/US compared with the internal grayscale US of this study device supports its potential for achieving higher specificity in the assessment of benign and malignant breast masses. OA/US may increase specificity in breast mass assessment, potentially reducing the number of false-positive examinations and biopsies of benign masses. Further study of OA/US feature analysis and refinement of interpretive strategies is warranted to define its role in clinical practice.
Yang also lists the advantages of 2D OA+US tomography; challenges of hand-held probe-based 2D optoacoustic tomography; and advantages of 3D OA+US tomography.
Yang also describes Diffuse Optical Spectroscopic Imaging (DOSI) -- non-invasive functional imaging modality that employs infrared light to measure breast tissue concentrations of oxygenated hemoglobin, deoxygenated hemoglobin, water, and lipid. She explains the correlation between baseline oxygen saturation and breast cancer response to NAC.
Preliminary results employing a hand-held probe for obtaining optical measurements of oxygen saturation in patients with varying tumor sizes, depths, and biologic subtypes undergoing NAC in a single center and multi-center setting are also presented.
According to Yang, The take-home nuggets of this presentation are that in order for new technologies to flourish, it's very important that we have our multi-disciplinary collaboration, and we wear our respective hats, whether it's in the wet lab, the dry lab, the clinical area, the imaging domain -- and the multi-disciplinary clinicians, whether they are surgeons or oncologists or radiation oncologists. Without the understanding of the biology, the equipment remains as it is, a piece of very funky, exciting technology. And without the technology, the biology remains as it is, and it is usually an insurmountable, daunting task.
"Cancers are highly intelligent," says Yang, "and they tend to always do a quick run whenever a new paradigm comes on board."
Wei Tse Yang, MBBS, FRCR is professor and chairman of the Department of Diagnostic Radiology and the Robert D. Moreton Distinguished Chair in Diagnostic Radiology at the University of Texas MD Anderson Cancer Center. She is Director of the Quantitative Image Analysis Core (QIAC) and the Imaging Response Assessment Team (IRAT) and is on the executive steering committee for the Center for Advanced Biomedical Imaging (CABI) at MD Anderson.
Yang championed the technique of Targeted Axillary Dissection (TAD), which ensures a false negative rate of less than 5 percent for SLND post NAC in breast cancer patients. She has authored more than 170 peer-reviewed articles along with co-authoring a textbook on breast imaging.