1. 1 Electrical Impedance Tomography with Tomosynthesis for Breast Cancer Detection Jonathan Newell Rensselaer Polytechnic Institute With: David Isaacson Gary J. Saulnier Tzu-Jen Kao Greg Boverman Richard Moore* Daniel Kopans* And: Rujuta KulkarniChandana Tamma David ArdreyNeha Pol With: David Isaacson Gary J. Saulnier Tzu-Jen Kao Greg Boverman Richard Moore* Daniel Kopans* And: Rujuta KulkarniChandana Tamma David ArdreyNeha Pol *Massachusetts General Hospital

2. 2 EIT electrodes added to mammography machine.  1 : 2 : 4 : 2 : 1 is the ratio of the mesh thicknesses.  Only the center layer, III, is displayed in the results.  1 : 2 : 4 : 2 : 1 is the ratio of the mesh thicknesses.  Only the center layer, III, is displayed in the results.

3. 3 EIT Instrumentation ACT 4 with Tomosynthesis unitRadiolucent electrode array

4. 4 Co-registration of EIT and Tomo Images To find the electrode position, display the slice containing the electrodes. Superimpose the mesh grid with correct scale. Slice 15 of 91 Then select the desired tomosynthesis layer. Slice 50 of 91 HS_14R Normal

5. 5 Admittance Loci: format for summaries of EIS data Results of in-vitro studies of excised breast tissue. Jossinet & Schmitt 1999

6. 6 120 EIS plots for a normal breast ( HS14_Right )

7. 7 HS25_L: Invasive Ductal Carcinoma ROI 1 ROI 2

8. 8 Linear Correlation Measure – LCM Y YmYm compute for each voxel LCM Image 700 0

9. 9 LCM Image of invasive ductal CA (HS25_L) Gray scale image of LCM 700 0

10. 10 HS21_R: Fibroadenoma in the upper box ROI 1 ROI 2

11. 11 LCM Image of fibroadenoma (HS21_R) Gray scale image of LCM 350 0

12. 12 HS10_L: Invasive Ductal CA “ Proliferation is worrisome ” ROI 1 ROI 2

13. 13 LCM Image of invasive ductal CA (HS10_L) Gray scale image of LCM 1300 0

14. 14 LCM for 11 normal breasts There are 120 EIS plots for layer 3 in each patient. The distribution of the LCM parameter in these plots is shown. 300 0

15. 15 LCM for the regions of interest in 4 patients The distributions of the LCM for the regions of interest identified. Note the LCM values are much larger for voxels associated with the malignant lesions. Hyalinized Fibroadenoma Invasive ductal carcinoma Normal

16. 16 LCM on the same scale for a normal subject, a fibroadenoma and two carcinomas Normal Breast Fibroadenoma Invasive Ductal Carcinoma Invasive Ductal Carcinoma

17. 17 Conclusions  We have discovered a quantitative parameter derived from the admittance spectra that is markedly different in malignancy from normal breast tissues.  This parameter is location-specific to the tumor.  We need to study more patients with more benign lesions and tumors in order to evaluate the clinical potential of this parameter to improve the sensitivity and specificity of breast cancer screening.  We will present additional details about our system and its results in four posters at this meeting. See Kao, Boverman, Kulkarni and Tamma.  We have discovered a quantitative parameter derived from the admittance spectra that is markedly different in malignancy from normal breast tissues.  This parameter is location-specific to the tumor.  We need to study more patients with more benign lesions and tumors in order to evaluate the clinical potential of this parameter to improve the sensitivity and specificity of breast cancer screening.  We will present additional details about our system and its results in four posters at this meeting. See Kao, Boverman, Kulkarni and Tamma.

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19. 19 Clinical details of the four patients. Patient #Pathology report, Grade, EIS spectra and LCM value HS14_R Screening patient, normal breast, No biopsy report All EIS plots have good curvature. LCM < 137 for all regions. Maximum value of LCM: 137. HS21_R Hyalinized Fibroadenoma, no evidence of malignancy Most EIS Plots have good curvature. LCM < 328 for the tumor region. LCM < 200 for most other regions Maximum value of LCM: 328. HS25_L Invasive ductal carcinoma, Ductal carcinoma in-situ A few cylindrical to irregular tan-yellow soft tissue cores ranging from 0.3 to 1.2 cm in length and averaging 0.1 cm in diameter. Grade: 3/3 EIS plots on bottom right corner are abnormal. LCM > 400 for the tumor region. Maximum value of LCM: 709. HS10_L Invasive ductal carcinoma, (Proliferation is worrisome) Ductal carcinoma in-situ Atypical ductal hyperplasia Tumor size: 1..1 x 0.9 x 0.7 cm and two satellite nodules, 0.14 cm and < 0.1 cm. Grade:3/3 Most EIS plots are close to a straight line. LCM > 400 for most plots. Maximum value of LCM: 1230.

20. 20 Summary of first 38 patients accrued  Total patient studied: 37-7 = 30  First 7 patients were needed to develop correct operational procedures.  19 breasts are underwent biopsy  7 of these were reported as CA  4 breasts of these were located outside of the electrode region.  3 CA breasts are OK for analysis  Total patient studied: 37-7 = 30  First 7 patients were needed to develop correct operational procedures.  19 breasts are underwent biopsy  7 of these were reported as CA  4 breasts of these were located outside of the electrode region.  3 CA breasts are OK for analysis

21. 21 Threshold for Parameter, Straightness image  After preliminary study, we can set a threshold for normal or abnormal EIS plot.  400 will be the first guess with these patient data.  The previous image will be show again with full scale set to 700.  After preliminary study, we can set a threshold for normal or abnormal EIS plot.  400 will be the first guess with these patient data.  The previous image will be show again with full scale set to 700.