Diana Gore is 44 years old and minutes away from surgery to remove the cancer in her breast. The mother of three daughters from Clinton, N.C., is trying to control a flood of emotions.
"Fear. Will this be it?" she says in the pre-op room. "Will it be gone when we're finished here, or will we come back later on and say, 'Oh, you know, there's a little more left there, we've got to go back,'" Gore says.
Inside the operating room, Gore's surgeon, Dr. Lee Wilke of Duke University Medical Center, wonders the same thing.
"I'm removing a tumor, and I have nothing that tells me that I've removed the whole tumor," she says.
It's one of the great frustrations in the fight against breast cancer. Every year, tens of thousands of U.S. women are forced to endure a second, even a third lumpectomy to remove all their breast cancer. In many hospitals, four out of 10 women are returning to the operating room for a second surgery, Wilke says.
But researchers at Duke University Medical Center are working on an experimental device that might help reduce that risk: a device used in the operating room that can help surgeons know whether they've removed the tumor once and for all, thereby saving patients from yet another surgery weeks later.
The device uses a special imaging technique to differentiate between normal breast tissue and cancerous tissue.
In the operating room, Wilke removes Gore's tumor and hands it to a team of technicians a few feet away who then place it inside a small case to be tested later. The surface area of the tumor, down to about a tenth of an inch, is then bombarded with beams of light.
"And what that's telling us about is basically the blood vessels that are present in the tissue -- the amount of fat that's present in the tissue, or the density of the cells that's present in the tissue," said Quincy Brown , an engineer who is helping to develop the experimental device at Duke.
Detecting Cancerous Breast Tissue
Each one of the variables offers a clue to the presence of cancer on the surface of the tumor. The results are then plotted on a colored map of the tumor. If the surface areas read "blue," it suggests the edges or margins are safe and cancer-free. Those that appear "red" on the map suggests the specific margins where there is likely to be cancer. That is likely to mean more cancer remains in the patient and that more tissue needs to be removed.
Results from 57 breast cancer patients were announced at this year's San Antonia Breast Cancer Symposium.
"The device is showing us, with an 85 percent sensitivity, the areas we would need to remove," Wilke says. "If I had removed those areas, the patient wouldn't need to be going back to the operating room."
Researchers think they can do even better by refining the technique. But it will likely take two more years of work and testing on many more tumors from patients like Gore.
It's now 90 minutes since the end of her surgery, and Gore is heading home. "I'm glad it's over," she says.
With a device now in development, researchers say that thousands more women each year might soon be able to make their first breast cancer surgery their only breast cancer surgery.