Abstract
BackgroundRoughly 23% of breast conserving surgery (BCS) patients undergo a second re-excision procedure due to pathologically positive surgical margins. We investigated the feasibility and potential value of micro-Computed Tomography (micro-CT) as a surgical margin guidance tool during BCS.MethodsA cohort of 32 BCS specimens was prospectively imaged with a pre-clinical micro-CT system upon arrival in the surgical pathology laboratory. Reconstructed micro-CT scans were evaluated retrospectively by an experienced breast radiologist, who provided binary determinations whether lesions extended to the specimen margin. These readings were then compared to the final pathological diagnosis and to 2D specimen radiography readings.ResultsOf the 32 specimens imaged, 28 had malignant and four had benign pathological diagnoses. Overall five (four malignant, one benign) of the 32 specimens had lesion tissue extending to the margin. For all 32 specimens, micro-CT reconstructions were calculated (< 4 min. acquisition + reconstruction time) and each specimen was volumetrically analyzed by a radiologist. Of the 28 malignant specimen readings, 18 matched the final pathological diagnosis [64%, 95 CI (47%–81%)], with a negative predictive value of 89% [95 CI (74%–96%)]. Micro-CT readings revealed changes in the tumor location and margin status as compared to single-projection radiography readings.ConclusionsMicro-CT scanning of BCS specimens enabled margin status assessment over the entirety of the surgical surface in a clinically relevant time frame, provided additional spatial information over single-projection radiography, and may be a potentially useful BCS guidance tool.
Highlights
23% of breast conserving surgery (BCS) patients undergo a second re-excision procedure due to pathologically positive surgical margins
Tang et al have motivated the potential value of this technology in assessing shaved cavity margins [15] and they have shown it to measure the largest tumor dimension in resected BCS specimens accurately [16]
The feasibility and potential diagnostic value of micro-CT was evaluated as a surgical guidance tool for BCS by performing an initial correlation of micro-CT analysis to the final histopathologic diagnosis, and qualitatively comparing specimen micro-CT to single-projection specimen mammography
Summary
23% of breast conserving surgery (BCS) patients undergo a second re-excision procedure due to pathologically positive surgical margins. Reconstructed micro-CT scans were evaluated retrospectively by an experienced breast radiologist, who provided binary determinations whether lesions extended to the specimen margin These readings were compared to the final pathological diagnosis and to 2D specimen radiography readings. The pre-clinical imaging technology, micro-Computed Tomography (micro-CT), offers three dimensional (3D) image reconstruction with sub-millimeter resolution but at much smaller fields of view than clinical CT While this technology has been utilized extensively in pre-clinical specimen and animal studies [11,12,13], it has not been widely used to image surgically resected breast tissues [14]. The feasibility and potential diagnostic value of micro-CT was evaluated as a surgical guidance tool for BCS by performing an initial correlation of micro-CT analysis to the final histopathologic diagnosis, and qualitatively comparing specimen micro-CT to single-projection specimen mammography
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