8/15/2011
Visualization of Breast Carcinoma
using Photoacoustic Imaging:
The ongoing Twente Experience
Srirang Manohar, PhD.
Biomedical Photonic Imaging Group
MIRA Institute,University of Twente
The Netherlands
CONTRIBUTIONS
Michelle Heijblom
Wenfeng Xia
Daniele Piras
Johan van Hespen
Wiendelt Steenbergen
Ton van Leeuwen (also AMC, Amsterdam)
Michelle Heijblom
Frank van den Engh - Radiology
Mariel Brinkhuis – Pathology
Joost Klaase - Surgery
Ronald Bezooijen - Radiology
Medisch Spectrum Twente
THE TWENTE PHOTOACOUSTIC MAMMOSCOPE (PAM I)
grouped
spread
S. Manohar et al Phys. Med. Biol. (2005) 50, 2543
1
8/15/2011
THE TWENTE PHOTOACOUSTIC MAMMOSCOPE (PAM I)
THE TWENTE PHOTOACOUSTIC MAMMOSCOPE (PAM I)
aperture to
accommodate
breast
ultrasound detector + electronics
light
delivery
system
+
scanning
system
laser
S. Manohar et al Phys. Med. Biol. (2005) 50, 2543
THE TWENTE PHOTOACOUSTIC MAMMOSCOPE
THE TWENTE PHOTOACOUSTIC MAMMOSCOPE (PAM I)
HbO 2
Hb
W a te r
B lo o d le ss D e rm is
-1
A b so rp tio n co e fficie n t [m m ]
100
aperture
for breast
ultrasound
detector
10
1064 nm, 10 ns, 10 Hz pulsed
light
 < 30 mJ/cm2
1
1 MHz unfocused US detector
array
0 .1
0 .0 1
B re a st tissu e (g la n d u la r)
B re a st tissu e (a d ip o se )
1 E -3
200
300
400
500
600
700
800
900 1000 1100 1200 1300
W a ve le n g th [n m ]
 Resolution 4 mm
 Electronic element scanning
 90 averages
55x55 mm2 region of interest
interface
electronics
scanning
system
compartment
 25 minutes scan duration
Transmission mode imaging
 Slight breast compression
 Cranio-Caudal view
Delay and Sum reconstruction
S. Manohar et al Phys. Med. Biol. (2005) 50, 2543
Compression
mechanism
2
8/15/2011
MALIGNANT
BIRADS V
Probably
malignant
BIRADS IV
Suspicious
PHASE I
Study time: 3 months
Study population: 5-10 patients
BIRADS 5
CASE I (P11-9): Infiltrating Ductal Carcinoma
X-ray mammogram
Asymmetry in breast appearance (L-R)
PHASE II
Study time: 18 months
Study population: TBD patients
BIRADS 4-5
High density region in RCC
Difficult to pin-point tumor region and
estimate size
Atypical microcalcifications
BIRADS III
Probably benign
BIRADS 5
Ultrasonogram
Center for Mammacare
Medisch Specrum Twente
Oldenzaal
BIRADS II
Benign
BIRADS I
Normal breast
Inhomogeneous mass diameter 30 mm with
microcalcifications
PHASE III
Study time: 3 months
Study population: 10-20 patients
BIRADS 1-2
Suggestive for a fibroadenoma
BIRADS 3
Second comparable but smaller lesion 8 ‘o’
clock
BENIGN
CASE I (P11-9): Infiltrating Ductal Carcinoma
CASE I (P11-9): Infiltrating Ductal Carcinoma
20 mm
3
8/15/2011
CASE I (P11-9): Infiltrating Ductal Carcinoma
CASE II (P10-1): Mixed Infiltrating Ductal Lobular Carcinoma
X-ray mammogram
Magnetic Resonance Image
Asymmetry in breast appearance (L-R)
Dense area away from the nipple;
architectural distortion; suspect
microcalcifications – BIRADS 4
Dense lesion close to nipple – BIRADS 5
Ultrasonogram
Single lesion inhomogeneous mass near
nipple; 18 mm
Suspect for malignancy – BIRADS 5
No sign of other atypical masses
Cranio
Caudal
12
Laser
Detector
4
8/15/2011
DISCUSSION
Histopathology
Macroscopically
 30 mm, diffusely marginated suspicious area
 Almost attached to skin of the nipple
Microscopically
 Mixed infiltrating lobular and ductal carcinoma,
 Grade II
Discussion:
PAM can visualize breast malignancies:
 with high lesion-to-background contrast – 2x to 5.5x
 sometimes even in relatively dense breasts
 at relatively large depths – 33 mm
Lesion size is slightly underestimated using current thresholding
methods
Outlook:
Measure on different types of lesions
 find photoaocustic malignancy markers
 estimate the effect of breast density on performance
Guide developments towards future generations of PAM
FINANCIAL SUPPORT
Research supported by:
AgentschapNL IOP-Photonic device project
HYMPACT
MIRA High-Tech Health Farm
5