Image-guided core needle biopsy plays a central role in the diagnosis and management of a wide range of breast lesions. After collection, tissue cylinders are transported from a biopsy suite to a pathology laboratory for analysis. The existing workflow for microscopic diagnosis of tissue specimens precludes the option of using histologic data to inform clinical decision-making at the time of biopsy. Here, we introduce stimulated Raman histology (SRH), a rapid label-free optical imaging method that enables microscopic imaging of unprocessed breast biopsy specimens in the biopsy suite within minutes of sample collection. SRH has been thoroughly validated for use in the detection and diagnosis of brain tumors but its use has not been validated in breast lesions. In our study, we collected core needle biopsy specimens and allocated a 2mm portion of the tissue sample for SRH imaging. Each specimen was imaged with SRH and subsequently fixed in formalin, embedded, stained and sectioned in a conventional manner. A board-certified breast pathologist first analyzed the diagnostic features of the imaged specimens with SRH and then with conventional H&E-stained sections. In a pilot series of six patients, we found that SRH could differentiate between lesions that can mimic cancer such as a radial scar from neoplastic ones like invasive ductal carcinoma. SRH also demonstrated histologic differences between a benign tumor like a fibroadenoma and a malignant tumor like an invasive ductal carcinoma. We also observed diagnostic differences amongst benign processes such as radial scar and pseudoangiomatous stromal hyperplasia. Importantly, we showed that SRH is non-consumptive and the imaged tissue can be used for downstream histologic and immunohistochemical analysis. Our data provide proof of concept that SRH can reveal the diagnostic features of tissue collected in breast core needle biopsies, supporting further validation of this technology. Ultimately, we envision the use of SRH to create new, efficient workflows for managing patients with breast lesions, especially those in which fine needle aspiration is of limited value, and where rapid diagnosis of tissue biopsies could streamline care and increase patient satisfaction.

Citation Format: Daniel Avram Orringer, Thomas Chen, Steve Pastore, Farbod Darvishian, Hildegard Toth, Freya Schnabel. Rapid beside diagnosis of breast core needle biopsies using stimulated raman histology [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-20.