Breast Cancer, a Hi-Tech Eye in the Operating Room to Improve Surgery

To develop a tool that, in real time and directly in the operating room, indicates to breast surgeons the presence of residual tumor cells, so that nothing escapes the scalpel. Objective: to improve conservative breast cancer surgery by reducing the need for new interventions and the risk of recurrence. This is the objective of the European project Spectra-Breast , led by the Irccs Maugeri of Pavia and just started.

This is an ambitious project, funded with three million euros by the European Innovation Council as part of the Pathfinder Open 2024 program and involving 5 other important scientific entities: the Polytechnic University of Milan and its spin-off Nireos, the Institute of Photonics and Nanotechnology (Ifn-Cnr), the Polytechnic University of Madrid and the company RiverD, in the Netherlands. Together, over the next four years, they will have to develop and adapt the necessary technologies, and test them in a first study on patients.

Improving Breast Cancer Conservative Surgery

Breast cancer affects over 50,000 women in Italy every year. In most cases, the diagnosis is early and, when possible, conservative surgery is performed: that is, only the small part (a quadrant, for example) of the breast where the disease has developed is removed; even when the entire gland is removed, the skin, areola and nipple are increasingly preserved. The removed tissue is then analyzed in the laboratory by the pathologist, who (among other things) must verify whether or not the resection margins contain tumor cells. In this case, it is necessary to operate on the patient again, to remove more breast tissue and ensure that the resection margins are clean. Recalls are a “not uncommon situation, with inconvenience for patients and costs for the health system,” as Fabio Corsi , head of the Breast Unit in Maugeri, points out.

A hi-tech eye

There is still no way to analyze the edges of the tissue removed in a few minutes during the operation itself, and this is why some (few) research centers are working on it. Like those of the European consortium Spectra-Breast, which will combine two different technologies, hyperspectral imaging and Raman spectroscopy: the first performs a reconnaissance and signals the suspicious parts, which are then analyzed in depth by the second. "In fact, it involves taking photographs of the tissue, but with very advanced optics - Carlo Morasso, coordinator of the project and head of the Nanomedicine and Molecular Imaging Laboratory at the IRCCS Maugeri, explains to Salute Seno - The image obtained will then be analyzed by an algorithm based on Artificial Intelligence, which in a few minutes will be able to signal the possible presence of tumor cells at the resection edges to the surgeon. Who, in that case, will be able to intervene immediately".

The three phases of the project

In a first phase, which will last about a year and a half, it will be necessary to perfect the two technologies, adapting them to this specific task. A second phase will follow in which the algorithm will be developed, which will have to learn to read the images to distinguish healthy cells from diseased ones. The third phase, in the last year, is dedicated to clinical validation and will be conducted at Maugeri on about one hundred patients.

“The analyses performed with these new technologies will be compared with those performed by pathologists,” Morasso continues. “It will be a sort of ‘competition’: our goal is for the automatic system to prove that it is as good as a human being. I would like to emphasize here that the analyses of the pathologist specialist will always continue to be indispensable. The advantage, in this case, will be to be able to give the surgeon immediate feedback that would otherwise be impossible. Each result, however, will still have to be confirmed in the laboratory.”

The “technological” consequences

The project also brings undoubted advantages in terms of the development of the technologies involved - from photonics to electronics, from robotics to artificial intelligence - with new applications that can be tested in a clinical setting and patented. In particular, the Politecnico di Milano will create both the combined optical instrument "turnkey" and a robotic arm that will guide the system over the tissue; the Ifn-Cnr will instead take care of the acquisition, integration and validation of the data, with the aim of bringing Raman technologies ever closer to clinical application.