Fig. 2.

Fluorescence imaging of 5-ALA-induced PpIX fluorescence in grossly obvious and grossly occult carcinoma. A Representative white light (top row) and fluorescence (bottom row) images of grossly obvious disease in sectioned lumpectomy specimens (a) and a clinically positive sentinel lymph node (c). The pathologist’s assistant (V.S., M.S., F.M.) demarcated tumor border (blue line) identified the grossly obvious tumor in the sectioned specimens. The surgeon (A.M.E., W.L.L.) identified the lymph node as grossly obvious for disease. B Representative white light (top row) and fluorescence (bottom row) images of grossly occult disease at the surface of an excised lumpectomy (a), in grossly sectioned specimens (b, c) and a sentinel lymph node (d) from patients with invasive ductal carcinoma with (a, d) or without (b, c) a DCIS component administered 15 mg/kg (b, c) or 30 mg/kg (a, d) 5-ALA HCl. Images represent tissue that was identified by the surgeon (A.M.E., W.L.L.) (a, d) or pathologist’s assistant (V.S., M.S., F.M.) (b, c) as grossly negative for the presence of cancer. (a) DCIS identified by fluorescence imaging at the lumpectomy margin. (b, c) Invasive carcinoma identified by fluorescence imaging on slices outside the grossly demarcated tumor. (d) Invasive carcinoma macro-metastases identified by fluorescence imaging in an excised sentinel lymph node. Scale bars = 5 mm