Abstract
Abstract Background: The goal of breast cancer surgery is to remove all cancer with a minimum of normal tissue, but the absence of full 3-dimensional information on the surgical specimen makes this difficult to achieve. Method: Micro CT is a high resolution, X-ray, 3D imaging method, used principally in material science and industry but little used in medicine. Results: We imaged and analyzed 173 partial mastectomies by Micro-CT (129 ductal carcinomas, 14 lobular carcinomas, 28 DCIS). Imaging was simple and rapid. Size of cancer image on Micro-CT was very similar to the size of cancer at specimen dissection. Micro-CT images of surgical specimens in cassettes revealed sizes and shapes very similar to cancer later seen on the slide. Micro CT images of multicentric/multifocal cancers appeared as separate, clearly non-contiguous, masses. Additional image realization was carried out with image analysis software, with which we created a variety of three-dimensional image visualizations seen by rotation, slicing, and various degrees of transparentness, achieved by volume rendering with adjustment of opacity and maximum intensity projection imaging modified by the transfer function, making viewing through the 3D mass possible. Video can be seen at https://youtu.be/1hyNmFDidO4. Micro-CT assessment found cancer to touch edge in 134 (77%) of cases, while assessment of the microscope slides revealed positivity in 114 (66%) of cases. Cases judged by the pathologist to be margin positive were margin positive by Micro CT 93% the time. Cancer occupied 0.45% of surface area for “Micro-CT-Only-Positive Cases” but more than three times as much space, at 1.55% when both the pathologist and the Micro-CT suggested cancer at the edge. Conclusions: Micro-CT provides full 3D images of partial mastectomy specimens, allowing one to identify, in a few minutes, and thus while the patient is in OR, margin positive cases, with information on where cancer touches the edge, in a fashion more accurate than possible from the histology slides alone. Citation Format: Ankur Tiwari, Daniel DiCorpo, Kevin Hughes, James Michaelson. The role of micro-CT in imaging breast cancer specimens [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-10.
Published Version
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