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