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Samuel S Streeter1,2, Rebecca A Zuurbier3,4, Roberta M diFlorio-Alexander3,4

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Micro-computed tomography (micro-CT) showed similar cancer margin detection rates as standard methods in breast-conserving surgery. However, micro-CT had a higher false positive rate, indicating it

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Area of Science:

  • Oncology
  • Surgical Pathology
  • Medical Imaging

Background:

  • Breast-conserving surgery (BCS) is a standard treatment for early-stage breast cancer.
  • Positive margins after BCS often necessitate reexcision, increasing costs and patient burden.
  • Improved intraoperative margin assessment is crucial to reduce reoperations.

Purpose of the Study:

  • To evaluate micro-computed tomography (micro-CT) as an intraoperative tool for assessing surgical margins in BCS.
  • To compare the diagnostic performance of micro-CT with standard intraoperative assessment (SIA).

Main Methods:

  • A prospective trial involving 100 patients undergoing BCS.
  • Micro-CT imaging of 600 surgical margins.
  • Radiological interpretation of micro-CT scans by three independent readers.
  • Comparison of micro-CT results with standard intraoperative assessment (specimen palpation and radiography).

Main Results:

  • Twenty-one of 600 margins (14 patients) were pathologically positive.
  • Standard intraoperative assessment (SIA) had 42.9% sensitivity and 76.7% specificity.
  • Micro-CT readers showed a sensitivity range of 35.7-50.0% and specificity range of 55.8-68.6%.
  • Micro-CT resulted in a higher false positive rate (31.4-44.2%) compared to SIA (23.5%).

Conclusions:

  • Micro-computed tomography (micro-CT) demonstrated comparable cancer margin detection rates to standard intraoperative assessment (SIA) in breast-conserving surgery.
  • Micro-CT's higher false positive rate, attributed to difficulty distinguishing fibroglandular tissue from cancer, limits its current utility.
  • Combining micro-CT with SIA could potentially improve the identification of positive margins.