Intraoperative micro-computed tomography (micro-CT): a novel method for determination of primary tumour dimensions in breast cancer specimens

Abstract

Objectives: Micro-CT is a promising modality to determine breast tumour size in three dimensions in intact lumpectomy specimens. We compared the accuracy of tumour size measurements using specimen micro-CT with measurements using multimodality pre-operative imaging. Methods: A tabletop micro-CT was used to image breast lumpectomy specimens. The largest tumour dimension on three-dimensional reconstructed micro-CT images of the specimen was compared with the measurements determined by pre-operative mammography, ultrasound and MRI. The largest dimension of pathologic invasive cancer size was used as the gold standard reference to assess the accuracy of imaging assessments. Results: 50 invasive breast cancer specimens in 50 patients had micro-CT imaging. 42 were invasive ductal carcinoma, 6 were invasive lobular carcinoma and 2 were other invasive cancer. Median patient age was 63 years (range 33-82 years). When compared with the largest pathologic tumour dimension, micro-CT measurements had the best correlation coefficient (r 5 0.82, p , 0.001) followed by MRI (r 5 0.78, p , 0.001), ultrasound (r 5 0.61, p , 0.001) and mammography (r 5 0.40, p , 0.01). When compared with preoperative modalities, micro-CT had the best correlation coefficient (r 5 0.86, p , 0.001) with MRI, followed by ultrasound (r 5 0.60, p , 0.001) and mammography (r 5 0.54, p , 0.001). Overall, mammography and ultrasound tended to underestimate the largest tumour dimension, while MRI and micro-CT overestimated the largest tumour dimension more frequently. Conclusion: Micro-CT is a potentially useful tool for accurate assessment of tumour dimensions within a lumpectomy specimen. Future studies need to be carried out to see if this technology could have a role in margin assessment. Advances in knowledge: Micro-CT is a promising new technique which could potentially be used for rapid assessment of breast cancer dimensions in an intact lumpectomy specimen in order to guide surgical excision.

Feasibility of Perioperative Micro–Computed Tomography of Human Lung Cancer Specimens: A Pilot Study

“…The degree of discrepancy between lesion size measurement by micro-CT and pathology (up to 14% of lesion diameter) and the trend toward size overestimation with micro-CT were in line with a prior study of breast lumpectomy specimens. 13 This discrepancy, as previously postulated, was possibly attrib- . Micro-computed tomography image (A) of a fresh wedge resection specimen of a 76-year-old woman demonstrates the location of a ground-glass nodule (arrow).…”

“…First and foremost, artifacts obscured the target lesion in a number of scans. Although suboptimal lesion-to-tissue contrast was occasionally reported in breast lumpectomy specimens, 13 lesions were never obscured to a degree that precluded analysis, suggesting that fresh lung specimens present unique challenges. Indeed, most of the artifacts in our study were directly attributable to insufficient air-tissue contrast and motion generated by tissue deflation during image acquisition.…”

“…11,12 Application of micro-CT to fresh human tissue, however, has thus far been limited to breast lumpectomy specimens. 13,14 Intraoperative 3D specimen assessment by micro-CT has the potential to make a significant clinical impact in lung cancer care. However, whether micro-CT can be employed safely in this setting, without imparting damage to lung specimens via irradiation or significantly delaying specimen processing prior to routine pathologic and molecular analysis, has not been previously studied.…”

Review of quantitative multiscale imaging of breast cancer

“…morphology. 57 This depth limitation can also be overcome by systems that calculate attenuation based on x-ray energy, also known as spectral CT. 115 Most QMIB applications of CT occur at the mesoscale. Systems capable of performing mesoscale CT are labeled micro-CT (μCT).…”

“…Preclinical μCT has already been paired with many other imaging modalities for QMIB over a wide range of biomedical applications ( Table 3). Some examples include characterizing the biodynamics of molecular imaging agents, 83,86,87,117,118 the biological effects of therapeutic interventions, 84,[119][120][121][122] rapid ex vivo IMA on resected tumors or tumor morphology analysis, [57][58][59]123,124 and the study of vasculature and angiogenesis. 17,84,120,122,125 There is still much room to expand the preclinical applications of this technology.…”