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Breast-Conserving Surgery Margin Guidance Using Micro-Computed Tomography: Challenges When Imaging Radiodense Resection Specimens

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast-conserving surgery (BCS) is an integral component of early-stage breast cancer treatment, but costly reexcision procedures are common due to the high prevalence of cancer-positive margins on primary resections. A need exists to develop and evaluate improved methods of margin assessment to detect positive margins intraoperatively.

Methods

A prospective trial was conducted through which micro-computed tomography (micro-CT) with radiological interpretation by three independent readers was evaluated for BCS margin assessment. Results were compared to standard-of-care intraoperative margin assessment (i.e., specimen palpation and radiography [abbreviated SIA]) for detecting cancer-positive margins.

Results

Six hundred margins from 100 patients were analyzed. Twenty-one margins in 14 patients were pathologically positive. On analysis at the specimen-level, SIA yielded a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 42.9%, 76.7%, 23.1%, and 89.2%, respectively. SIA correctly identified six of 14 margin-positive cases with a 23.5% false positive rate (FPR). Micro-CT readers achieved sensitivity, specificity, PPV, and NPV ranges of 35.7–50.0%, 55.8–68.6%, 15.6–15.8%, and 86.8–87.3%, respectively. Micro-CT readers correctly identified five to seven of 14 margin-positive cases with an FPR range of 31.4–44.2%. If micro-CT scanning had been combined with SIA, up to three additional margin-positive specimens would have been identified.

Discussion

Micro-CT identified a similar proportion of margin-positive cases as standard specimen palpation and radiography, but due to difficulty distinguishing between radiodense fibroglandular tissue and cancer, resulted in a higher proportion of false positive margin assessments.

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Acknowledgment

The authors thank the Dartmouth Health Outpatient Surgery Center nursing and scheduling staff for supporting this work, especially Ms. Melissa A. Ferris. This work was funded by an NIH National Cancer Institute Academic-Industrial Partnership (NIH/NCI R01CA192803). Samuel S. Streeter received funding from a Ruth L. Kirschstein National Research Service Award Individual Predoctoral Fellowship (NIH/NCI F31CA257340).

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Author notes

  1. Samuel S. Streeter PhD

    Present address: Department of Orthopaedics, Dartmouth Health, Lebanon, NH, USA

Authors and Affiliations

  1. Thayer School of Engineering, Dartmouth College, Hanover, NH, USA

    Samuel S. Streeter PhD, Benjamin W. Maloney PhD, Brian W. Pogue PhD & Keith D. Paulsen PhD

  2. Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA

    Rebecca A. Zuurbier MD, Roberta M. diFlorio-Alexander MD & Mark T. Hansberry MD

  3. Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA

    Rebecca A. Zuurbier MD, Roberta M. diFlorio-Alexander MD, Brian W. Pogue PhD, Wendy A. Wells MD, Keith D. Paulsen PhD & Richard J. Barth Jr MD

  4. Department of Medical Physics, University of Wisconsin, Madison, WI, USA

    Brian W. Pogue PhD

  5. Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA

    Wendy A. Wells MD

  6. Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA

    Richard J. Barth Jr MD

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Correspondence to Samuel S. Streeter PhD or Richard J. Barth Jr MD.

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Disclosures

Samuel S. Streeter, Benjamin W. Maloney, Keith D. Paulsen, and Brian W. Pogue have a patent pending (US Application No.: 17/076,788) related to this study. Richard J. Barth Jr. is Co-Founder and CMO of CairnSurgical, Inc. Keith D. Paulsen is Co-Founder of CairnSurgical, Inc. Brian W. Pogue is President and Co-Founder of DoseOptics, LLC. Authors in their roles in the medical industry did not in any way impact this study. The remaining authors have no competing interests.

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Streeter, S.S., Zuurbier, R.A., diFlorio-Alexander, R.M. et al. Breast-Conserving Surgery Margin Guidance Using Micro-Computed Tomography: Challenges When Imaging Radiodense Resection Specimens. Ann Surg Oncol 30, 4097–4108 (2023). https://doi.org/10.1245/s10434-023-13364-z

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