Fig. 3.

Detection of grossly occult sub-millimeter red fluorescence tumor foci. A WL and fluorescence images of a slice containing no clinically obvious disease from a patient who received 30 mg/kg 5-ALA HCl. Biopsies were collected in an area of focal red PpIX fluorescence (Bx1) and an adjacent area lacking PpIX fluorescence (Bx2). B H&E-stained longitudinal section of the Bx1 biopsy identified in A, which was determined to contain invasive ductal carcinoma by a blinded pathologist (S.J.D.). The imaged surface of the biopsy is indicated by the arrowheads. The area of tumor near the imaged surface measured 0.71 mm². C H&E-stained longitudinal section of the Bx2 biopsy identified in A, which was determined to be negative for tumor by a blinded pathologist (S.J.D.). D White light and fluorescence images of slices of a lumpectomy from a patient who received 15 mg/kg 5-ALA HCl. A biopsy (Bx1) was collected from a small area of red fluorescence (inset digitally zoomed). E H&E-stained longitudinal section of the Bx1 identified in D, which was determined to contain DCIS > 2 mm below the imaged surface (arrowheads). Scale bar = 0.5 mm (A, D), 500 μm (B, C, E). WL, white light; FL, fluorescence; Bx, biopsy; IDC, invasive ductal carcinoma; DCIS, ductal carcinoma in situ