High dynamic range dual-modal white light imaging system improves the accuracy of tumor bed sampling after neoadjuvant therapy for breast cancer

Abstract Background Accurate evaluation of residual cancer burden (RCB) remains challenging due to the lack of appropriate techniques for tumor bed sampling. Therefore, this study evaluated the application of white light imaging system in assisting pathologists differentiating the components and location of tumor bed in specimens. Methods The high dynamic range dual-mode white light imaging system (HDWIS) was developed to capture anti-glare reflection and high dynamic range (HDR) transmission images and was tested in sixty specimens of modified radical mastectomy after neoadjuvant therapy. We observed the differential transmittance among tumor tissue, fibrosis tissue and adipose tissue. The sensitivity and specificity of HDWIS were compared with x-ray or visual examination to determine whether HDWIS was superior in identifying tumor beds. Results We found tumor tissues had lower transmittance (0.12 ± 0.03) than fibers (0.15 ± 0.04) and fats (0.27 ± 0.07) (P < 0.01). HDWIS was more sensitive in identifying fiber and tumor tissues than cabinet X-ray and visual observation (P < 0.01). In addition, HDWIS could identify more fibrosis areas than the currently used Whole Slide Imaging (WSI) did in 12 samples (12/60). Conclusions We have determined that HDWIS can provide more in-depth tumor bed information than X-ray and visual examination do, which will help prevent the diagnostic error in tumor bed sampling.