Although the incidence of positive resection margins in breast-conserving surgery has decreased, both incomplete resection and unnecessary large resections still occur. This is especially the case in the surgical treatment of ductal carcinoma in situ (DCIS). Diffuse reflectance spectroscopy (DRS), an optical technology based on light tissue interactions, can potentially characterize tissue during surgery thereby guiding the surgeon intraoperatively. DRS has shown to be able to discriminate pure healthy breast tissue from pure invasive carcinoma (IC) but limited research has been done on (1) the actual optical characteristics of DCIS and (2) the ability of DRS to characterize measurements that are a mixture of tissue types. In this study, DRS spectra were acquired from 107 breast specimens from 107 patients with proven IC and/or DCIS (1488 measurement locations). With a generalized estimating equation model, the differences between the DRS spectra of locations with DCIS and IC and only healthy tissue were compared to see if there were significant differences between these spectra. Subsequently, different classification models were developed to be able to predict if the DRS spectrum of a measurement location represented a measurement location with “healthy” or “malignant” tissue. In the development and testing of the models, different definitions for “healthy” and “malignant” were used. This allowed varying the level of homogeneity in the train and test data. It was found that the optical characteristics of IC and DCIS were similar. Regarding the classification of tissue with a mixture of tissue types, it was found that using mixed measurement locations in the development of the classification models did not tremendously improve the accuracy of the classification of other measurement locations with a mixture of tissue types. The evaluated classification models were able to classify measurement locations with > 5% malignant cells with a Matthews correlation coefficient of 0.41 or 0.40. Some models showed better sensitivity whereas others had better specificity. The results suggest that DRS has the potential to detect malignant tissue, including DCIS, in healthy breast tissue and could thus be helpful for surgical guidance.

中文翻译：

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用于手术指导的浸润癌和导管原位癌的光学组织测量

尽管保乳手术中切缘阳性的发生率有所下降，但不完全切除和不必要的大切除仍然存在。在导管原位癌 (DCIS) 的手术治疗中尤其如此。漫反射光谱 (DRS) 是一种基于光组织相互作用的光学技术，可以潜在地在手术过程中表征组织，从而在术中指导外科医生。DRS 已显示能够区分纯健康乳腺组织和纯浸润性癌 (IC)，但对 (1) DCIS 的实际光学特性和 (2) DRS 表征混合测量的能力的研究有限组织类型。在这项研究中，DRS 光谱是从 107 名已证实 IC 和/或 DCIS（1488 个测量位置）的患者的 107 个乳房标本中获取的。使用广义估计方程模型，比较DCIS和IC位置与仅健康组织的DRS光谱之间的差异，以查看这些光谱之间是否存在显着差异。随后，开发了不同的分类模型，以便能够预测测量位置的 DRS 光谱是否代表具有“健康”或“恶性”组织的测量位置。在模型的开发和测试中，对“健康”和“恶性”使用了不同的定义。这允许改变训练和测试数据的同质性​​水平。发现IC和DCIS的光学特性相似。关于具有混合组织类型的组织的分类，发现在分类模型的开发中使用混合测量位置并没有极大地提高具有混合组织类型的其他测量位置的分类的准确性。评估的分类模型能够对具有 > 5% 恶性细胞的测量位置进行分类，马修斯相关系数为 0.41 或 0.40。一些模型显示出更好的敏感性，而其他模型则具有更好的特异性。结果表明，DRS 有可能检测健康乳房组织中的恶性组织，包括 DCIS，因此可能有助于手术指导。发现在分类模型的开发中使用混合测量位置并没有极大地提高具有混合组织类型的其他测量位置的分类准确度。评估的分类模型能够对具有 > 5% 恶性细胞的测量位置进行分类，马修斯相关系数为 0.41 或 0.40。一些模型显示出更好的敏感性，而其他模型则具有更好的特异性。结果表明，DRS 有可能检测健康乳房组织中的恶性组织，包括 DCIS，因此可能有助于手术指导。发现在分类模型的开发中使用混合测量位置并没有极大地提高具有混合组织类型的其他测量位置的分类准确度。评估的分类模型能够对具有 > 5% 恶性细胞的测量位置进行分类，马修斯相关系数为 0.41 或 0.40。一些模型显示出更好的敏感性，而其他模型则具有更好的特异性。结果表明，DRS 有可能检测健康乳房组织中的恶性组织，包括 DCIS，因此可能有助于手术指导。5% 恶性细胞，马修斯相关系数为 0.41 或 0.40。一些模型显示出更好的敏感性，而其他模型则具有更好的特异性。结果表明，DRS 有可能检测健康乳房组织中的恶性组织，包括 DCIS，因此可能有助于手术指导。5% 恶性细胞，马修斯相关系数为 0.41 或 0.40。一些模型显示出更好的敏感性，而其他模型则具有更好的特异性。结果表明，DRS 有可能检测健康乳房组织中的恶性组织，包括 DCIS，因此可能有助于手术指导。