New x-ray scanner could improve breast cancer surgery

The research team from UCL and Queen Mary University of London, working closely with Barts Health NHS Trust and Nikon, said the new approach will aid surgeons performing breast tumour removal surgery by allowing for 2.5 times better detection of diseased tissue in the margins (edges of extracted tissue) than with standard imaging.

Published in Scientific Reports, the study involved the use of X-Ray Phase Contrast Imaging (XPCI) to develop a scanner that would provide surgeons with a full 3D image of the extracted tissue lump, known as a wide local excision (WLE).

While standard imaging picks up the x-ray beam's change in intensity as it travels through tissue, phase contrast imaging measures the changes in speed with which x-ray travels through different tissues, which has been proven to enhance soft tissue contrast.

Currently, WLE is assessed through histopathology - the microscopic examination of tissue - with results only available after several days. Most breast cancer operations are what as known as conserving surgeries, which remove the cancerous tumour rather than the whole breast, but second operations are often required if the margins are found not to be clear of cancer.

The new approach was described by lead author Alessandro Olivo, UCL professor of Medical Physics & Biomedical Engineering, as having ‘tremendous potential’. It would allow surgeons to assess extracted tissue intraoperatively, or during the initial surgery.

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So far, most proposed approaches to intraoperative assessment had too many shortcomings to be effective, either in the ability to detect all of the diseased tissue or in achieving a significant penetration depth in the specimen, researchers explained.

The scanner was tested on 101 WLEs and results were compared with the current standard method used intraoperatively, based on conventional x-rays. Researchers believe the detection rate of 2.5 times could result in a similar reduction in the re-operation rate.

Co-author Tamara Suaris, consultant breast radiologist at Barts NHS Health Trust, said: “Although we have focused on the impact of XPCI in breast surgery, there is a much wider clinical potential of this technology including other intraoperative areas such as intestinal, oesophageal and prostatic surgery and in the longer term, diagnostic imaging, notably mammography.”

The work was supported by the Wellcome Trust, Royal Academy of Engineering and the Royal Society. Tissue samples were collected by the Breast Cancer Now Tissue Bank, donated by anonymous patients.