Purpose: A need exists for better intraoperative tools in breast conserving surgery, where there is a high re-excision rate due to malignancy missed using conventional surgical tools. One potential solution is combined micro-CT and optical imaging which have shown promise in clinical studies. The micro-CT rapidly scans the macroscale morphology and interior information of the specimen, while the optical imaging provides surface-weighted scatter contrast from fibrous tissues. The purpose of this study is to highlight the evolution of this technology towards utility as a surgical tool.
Methods: A multimodal micro-CT and optical system imaged breast conserving surgery specimens at the time of surgery in a prospective clinical trial. In addition, a new multimodal system was developed for clinical translation. The system was built specifically to meet clinical time and cost constraints, as well as to enable ease of system control and image acquisition, reconstruction, and visualization by clinical staff.
Results: In the prospective clinical trial, image acquisition and reconstruction of full volume micro-CT and surface optical imaging of two margins was completed in under ten minutes without impeding clinical workflow from n=46 patients, to date. The new multimodal system was developed with a focus on speed and ease of clinical use. CT imaging and reconstruction times were significantly reduced in the new system. Software tools were developed such that the system could be operated with minimal training.
Conclusion: Micro-CT and optical imaging is feasible in the breast conserving surgery clinical workflow and has shown promise for use as a clinical tool to reduce the high positive margin rate in breast conserving surgery. This study represents the next steps toward clinical utility.