Elisabetta Rizzo

Introduction: Nationally, 25% to 50% of patients undergoing lumpectomy for local management of breast cancer require a secondary excision because of the persistence of residual tumor. Intraoperative assessment of specimen margins by frozen-section analysis is not widely adopted in breast-conserving surgery. Here, a new approach to wide-field optical imaging of breast pathology in situ was tested to determine whether the system could accurately discriminate cancer from benign tissues before routine pathological processing.Methods: Spatial frequency domain imaging was used to quantify near-infrared optical parameters at the surface of 47 lumpectomy tissue specimens. Spatial frequency and wavelength-dependent reflectance spectra were parameterized with matched simulations of light transport. Spectral images were co-registered to histopathology in adjacent, stained sections of the tissue, cut in the geometry imaged in situ. A supervised classifier and feature-selection algorithm were implemented to automate discrimination of breast pathologies and to rank the contribution of each parameter to a diagnosis.Results: Spectral parameters distinguished all pathology subtypes with 82% accuracy and benign from malignant pathologies with 88% accuracy, high specificity, and reasonable sensitivity. Although spectral absorption and scattering features were essential components of the discriminant classifier, scattering exhibited lower variance and contributed most to tissue-type separation. The scattering slope was sensitive to stromal and epithelial distributions measured with quantitative immunohistochemistry.Conclusions: SFDI is a new quantitative imaging technique that renders a specific tissue-type diagnosis. Its combination of planar sampling and frequency-dependent depth sensing is clinically pragmatic and appropriate for breast surgical-margin assessment. This study is the first to apply SFDI to pathology discrimination in surgical breast tissues. It represents an important step toward imaging surgical specimens immediately ex vivo to reduce the high rate of secondary excisions associated with breast lumpectomy procedures. © 2013 Laughney et al.; licensee BioMed Central Ltd.

According to some neurocognitive studies, autistic people do not have a theory of mind (ToM); this means that they are unable to interpret the thoughts, beliefs and intentions of others just by observing their behaviour and/or listening to what they say and how they say it. By contrast, researchers from phenomenology claim that autistic people experience issues in earlier forms of intersubjectivity and that in some cases a ToM may be used to compensate for issues in empathy. My purpose is to present both the ToM account, along with its internal accounts (theory-theory, simulation theory, theory of mind mechanism), and an overview of phenomenology, followed by the presentation of some of the phenomenological counterarguments to ToM. Finally, I argue that both the neurocognitive approach and the phenomenological view seem to assume that issues reside in autistic people only and do not take into account the communication gap between autistic people and non-autistic people. As recent studies claim, autistic people are able to understand other autistic people, while they experience difficulties in communication when involved in intersubjective relations with non-autistic people. This mismatch between the two groups has been labelled the double empathy problem, and I propose that ToM and phenomenology may offer their support to this new perspective.

Despite the belief that autism is an empathy disorder, autistics declare their ability to empathize. To explore this experiential vision, we present the alternative explanation for social impairments in autism offered by the Intense World Theory (IWT) and substantiate it through the phenomenological analysis of empathy as an experienced phenomenon. According to IWT, autistics are characterized by hyper-emotionality and therefore their detachment is not the sign of a disrupted empathy, but a strategy to face a world of overwhelming stimuli. Taking the phenomenological account of empathy as a tendency to minimize the emotional and conceptual space dividing embodied and conscious subjects, our purpose is to explain that although autistics seem to expand this space, they may still be considered empathetic.