High-Resolution Full-3D Specimen Imaging for Lumpectomy Margin Assessment in Breast Cancer

Abstract

Background Two-dimensional (2D) specimen radiography (SR) and tomosynthesis (DBT) for breast cancer yield data that lack high-depth resolution. A volumetric specimen imager (VSI) was developed to provide full-3D and thin-slice cross-sectional visualization at a 360° view angle. The purpose of this prospective trial was to compare VSI, 2D SR, and DBT interpretation of lumpectomy margin status with the final pathologic margin status of breast lumpectomy specimens. Methods The study enrolled 200 cases from two institutions. After standard imaging and interpretation was performed, the main lumpectomy specimen was imaged with the VSI device. Image interpretation was performed by three radiologists after surgery based on VSI, 2D SR, and DBT. A receiver operating characteristic (ROC) curve was created for each method. The area under the curve (AUC) was computed to characterize the performance of the imaging method interpreted by each user. Results From 200 lesions, 1200 margins were interpreted. The AUC values of VSI for the three radiologists were respectively 0.91, 0.90, and 0.94, showing relative improvement over the AUCs of 2D SR by 54%, 13%, and 40% and DBT by 32% and 11%, respectively. The VSI has sensitivity ranging from 91 to 94%, specificity ranging from 81 to 85%, a positive predictive value ranging from 25 to 30%, and a negative predicative value of 99%. Conclusions The ROC curves of the VSI were higher than those of the other specimen imaging methods. Full-3D specimen imaging can improve the correlation between the main lumpectomy specimen margin status and surgical pathology. The findings from this study suggest that using the VSI device for intraoperative margin assessment could further reduce the re-excision rates for women with malignant disease.

Computer Vision Analysis of Specimen Mammography to Predict Margin Status

“…23 AUROC is similarly variable, but low, ranging from 0.60 to 0.73. [23][24][25][26][27] The current models' accuracy metrics are higher than many of the results published in the literature, demonstrating the potential of this approach.…”

Advancements in Intraoperative Near-Infrared Fluorescence Imaging for Accurate Tumor Resection: A Promising Technique for Improved Surgical Outcomes and Patient Survival

“…The VSI enabled 360° visualization of the volume of specimen, and hence, close or positive margins could be precisely located in 3D reconstructed images in 5 to 7 min. This system gave results superior to routine radiographs and digital breast tomosynthesis and had sensitivity of 91–94%, specificity of 81–85% and negative predictive value of 99% …”

“…This system gave results superior to routine radiographs and digital breast tomosynthesis and had sensitivity of 91−94%, specificity of 81−85% and negative predictive value of 99%. 55 A cohort study of 32 breast conserving surgery specimens involved comparing the preclinical images taken using micro-CT with 2D specimen radiography readings. Micro-CT took less than 4 min of acquisition and reconstruction time for all the specimens, and these were volumetrically analyzed by a radiologist.…”

22nd Annual Virtual Meeting of the American Society of Breast Surgeons: Science, Innovation, and Practice Changes

“…6 The Scientific Impact Award went to Dr. David Lim from the Toronto Women's College Research Institute on the relationship between the breast tumor pathologic response to neoadjuvant systemic therapy and axillary nodal response. 7 Much gratitude is given to the 31 members of the Publication Committee for careful blinded review (to both authors and institutional source) of 220 research abstracts for selection of the top studies for oral scientific, ''quickshot,'' and poster-discussion presentations, and for the final review and selection of the highest impact publications for this issue of Annals of Surgical Oncology.Just some of the highlighted research studies published in this issue of Annals of Surgical Oncology include important work regarding post-operative pain management, 8 understanding current axillary management, 9,10 potential new methods for decreasing surgery for margin control, 11 inflammatory breast cancer, 12 cryoablation without surgery for early invasive breast cancer, 13 and how the COVID-19 pandemic has altered practice among our society members. 14 These and other ASBrS articles published in this issue provide current research results germane to today's delivery of high-quality breast cancer care.…”