Seeing the invisible: How technology is transforming breast-conserving surgery for Arizonans

Sommer Gunia, DO

Submitted photo/Joseph James

We can now visualize tissue structure down to just 2 millimeters, into ducts, vessels and glands, right there in the operating room. What traditionally required up to 10 days of waiting for pathology results can now be assessed immediately, enabling better decision-making while the patient is still in the operating room.”

As a breast surgeon, one of the hardest conversations I have with patients is telling them we didn’t get all of the cancer during surgery — and that we’ll need to go back in. It’s an outcome that happens in about 20% of breast-conserving surgeries across the country.

Even when we do everything right, cancer cells can hide at the margins, and we often don’t find out until days later when pathology results come back. It’s discouraging, not just for the patient, but for the whole care team.

A new imaging tool called Optical Coherence Tomography is changing the way surgeons approach breast-conserving surgery. This advanced technology provides the ability to view breast tissue at the microscopic level during surgery, offering real-time feedback on whether cancerous tissue remains.

We can now visualize tissue structure down to just 2 millimeters, into ducts, vessels and glands, right there in the operating room. What traditionally required up to 10 days of waiting for pathology results can now be assessed immediately, enabling better decision-making while the patient is still in the operating room.

One of my patients, Jean D., a 69-year-old woman from Scottsdale, came in understandably anxious after discovering a lump during a routine mammogram. She had heard about women needing second surgeries and was concerned about the same outcome. After discussing her options, she felt comfortable going into surgery knowing that I use this advanced imaging technology in the OR.

Jean’s surgery was successful the first time, and she was able to proceed to radiation without delay. Today, she’s back to hiking and enjoying life.

That’s the goal for every patient. Breast cancer treatment should be effective without unnecessary disruption to someone’s life. Traditional tools like X-rays, ultrasounds and MRIs have limitations in the operating room. This advanced technology provides cross-sectional, 3D images with a resolution 10 times greater than conventional imaging and 100 times higher than MRI.

Approved by the FDA in 2021, OCT is being used across different tissue types, but its application in breast-conserving surgery is particularly impactful. By giving surgeons real-time insights into tissue margins, we are empowered to make better decisions in the moment that lead to better outcomes while offering patients greater confidence in their care.

Healing isn’t just about removing disease. It’s about helping people feel whole again. With innovations like OCT imaging, we’re one step closer to making that possible for every patient, every time.

Editor’s note: Sommer Gunia, DO is a breast surgeon with HonorHealth Cancer Care and Comprehensive Breast Center of Arizona in Scottsdale. Please send your comments to AzOpinions@iniusa.org. We are committed to publishing a wide variety of reader opinions, as long as they meet our Civility Guidelines.