Tomosynthesis-based Tomography for Intraoperative Evaluation of Breast Tumor Margin A Simulation Study

Qingsong Yang, Ge Wang, Gary Ge, Xiaoqin Wang, Jie Zhang


Published in:Fully3D 2017 Proceedings


breast conserving surgery, excision, 3D imaging, image reconstruction, tomosynthesis, digital breast tomosynthesis, specimen
Breast conserving surgery involves an excision procedure to achieve clear margins.  This goal is usually achieved by performing intraoperative margin assessment with specimen imaging and immediate excision of any margins thought to be close or positive.  However, routine two-dimensional specimen radiography cannot clearly discern residual disease at the margins.  Quasi-three-dimensional digital breast tomosynthesis potentially increases sensitivity but still cannot sufficiently meet the need, due to the limitation of its cross-sectional in-plane images.  We propose a novel tomographic technique that uses limited-angle tomosynthesis projections to reconstruct 3D transverse images.  A simulation study was performed based on the geometry of a commercial DBT system to demonstrate the feasibility.  The proposed tomographic technique will have the potential to more effectively guide surgeons to precisely remove the tumor with a clear margin and better cosmetic result, significantly reducing the need for a return to the operating room
Qingsong Yang
Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
Ge Wang
Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
Gary Ge
Department of Radiology, College of Medicine University of Kentucky
Xiaoqin Wang
Department of Radiology, College of Medicine University of Kentucky
Jie Zhang
Department of Radiology, College of Medicine University of Kentucky
  1. Chagpar, A.B., Surgical Margins and Minimizing the Need for Re-excision. Breast Diseases: a YB Quarterly. 27(3): p. 186-188.
  2. Houssami, N., et al., The Association of Surgical Margins and Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy: A Meta-Analysis. Annals of Surgical Oncology, 2014. 21(3): p. 717-730.
  3. Britton, P.D., et al., Breast surgical specimen radiographs: How reliable are they? European Journal of Radiology. 79(2): p. 245-249.
  4. Schulz-Wendtland, R., et al., Use of Tomosynthesis in Intraoperative Digital Specimen Radiography – Is a Reduction of Breast Re-excision Rates Possible? Geburtshilfe und Frauenheilkunde, 2011. 71(12): p. 1080-1084.
  5. Chagpar, A.B., et al., Does three-dimensional intraoperative specimen imaging reduce the need for re-excision in breast cancer patients? A prospective cohort study. Am J Surg, 2015. 210(5): p. 886-90.
  6. Peppard, H.R., et al., Digital Breast Tomosynthesis in the Diagnostic Setting: Indications and Clinical Applications. Radiographics, 2015. 35(4): p. 975-90.
  7. Chen, Z., et al., A limited-angle CT reconstruction method based on anisotropic TV minimization. Phys Med Biol, 2013. 58(7): p. 2119-41.
  8. Yu, H. and G. Wang, Compressed sensing based interior tomography. Physics in Medicine and Biology, 2009. 54(9): p. 2791.
  9. Wang, G., et al. Innovation and fusion of x-ray and optical tomography for mouse studies of breast cancer. 2016.
  10. Hagay, C., et al., Contrast-enhanced CT: value for diagnosing local breast cancer recurrence after conservative treatment. Radiology, 1996. 200(3): p. 631-638.
  11. Yang, W.T., et al., Dedicated Cone-Beam Breast CT: Feasibility Study with Surgical Mastectomy Specimens. AJR. American journal of roentgenology, 2007. 189(6): p. 1312-1315.
  12. Lindfors, K.K., et al., Dedicated Breast CT: Initial Clinical Experience. Radiology, 2008. 246(3): p. 725-733.
  13. Keyriläinen, J., et al., Toward High-Contrast Breast CT at Low Radiation Dose. Radiology, 2008. 249(1): p. 321-327.
  14. (accessed on Jan 13th, 2017)
  15. Holdsworth, D.W. and M.M. Thornton, Micro-CT in small animal and specimen imaging. Trends in Biotechnology. 20(8): p. S34-S39.
  16. Tang, R., et al., Micro-computed tomography (Micro-CT): a novel approach for intraoperative breast cancer specimen imaging. Breast Cancer Res Treat, 2013. 139(2): p. 311-6.
  17. Bewes, J.M., et al., Imaging ancient and mummified specimens: Dual-energy CT with effective atomic number imaging of two ancient Egyptian cat mummies. Journal of Archaeological Science: Reports, 2016. 8: p. 173- 177.
  18. Fan, X., et al., High-resolution MRI of excised human prostate specimens acquired with 9.4T in detection and identification of cancers: Validation of a technique. Journal of Magnetic Resonance Imaging, 2011. 34(4): p. 956-961.
  19. Abe, H., et al., Comparing post-operative human breast specimen radiograph and MRI in lesion margin and volume assessment. J Appl Clin Med Phys, 2012. 13(6): p. 3802.