Can laboratory x-ray virtual histology provide intraoperative 3D tumor resection margin assessment?

William Twengström,Hans M Hertz,Jakob C Larsson,Jenny Romell,Carlos F Moro,Ernesto Sparrelid,Mikael Björnstedt

doi:10.1117/1.jmi.9.3.031503

William Twengström, Hans M Hertz + Show 5 more

Open Access

https://doi.org/10.1117/1.jmi.9.3.031503

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Abstract

Purpose: Surgery is an essential part of the curative plan for most patients affected with solid tumors. The outcome of such surgery, e.g., recurrence rates and ultimately patient survival, depends on several factors where the resection margin is of key importance. Presently, the resection margin is assessed by classical histology, which is time-consuming (several days), destructive, and basically only gives two-dimensional information. Clearly, it would be advantageous if immediate feedback on tumor extension in all three dimensions were available to the surgeon intraoperatively. Approach: We investigate a laboratory propagation-based phase-contrast x-ray computed tomography system that provides the resolution, the contrast, and, potentially, the speed for this purpose. The system relies on a liquid-metal jet microfocus source and a scintillator-coated CMOS detector. Our study is performed on paraffin-embedded non-stained samples of human pancreatic neuroendocrine tumors, liver intrahepatic cholangiocarcinoma, and pancreatic serous cystic neoplasm (benign). Results: We observe tumors with distinct and sharp edges having cellular resolution ( ) as well as many assisting histological landmarks, allowing for resection margin assessment. All x-ray data are compared with classical histology. The agreement is excellent. Conclusion: We conclude that the method has potential for intraoperative three-dimensional virtual histology.

Highlights

Surgery is an essential part of the curative plan for most patients affected with solid tumors. The outcome of such tumor surgery, e.g., recurrence rates and patient survival, depends on several factors where the resection margin is of key importance
We show that laboratory-source-based phase-contrast x-ray imaging has potential to provide rapid intraoperative information of the resection margin
We show that laboratory propagation-based phase-contrast x-ray tomography of unstained resected tissue has the proper properties for rapid and high-resolution 3D assessment of the resection margins

Summary

Introduction

Surgery is an essential part of the curative plan for most patients affected with solid tumors. No malignant growth should extend past the resection margin, as this would indicate incomplete surgical removal of the tumor For this purpose, all surgical oncology is followed by a pathological assessment of the tumor itself and of the removed surrounding tissues and in particular the resection margin. All surgical oncology is followed by a pathological assessment of the tumor itself and of the removed surrounding tissues and in particular the resection margin This is presently a time-consuming and largely manual process involving many steps, starting with formalin fixation, dehydration, and paraffin embedding, followed by classical multistep histology. It typically takes several days or a week before the surgeon receives the pathology report. Due to the present process of cutting in 3- to 5-mm slices, the pathology risks missing small groups of cells inside the slices

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Discussion

Conclusion