使用 X 射线相衬度CT扫描检测乳房标本中的相关切缘
在保乳手术中，通过组织学测试广泛的局部切缘，这会使结果延迟数天并导致第二次手术。在术中检测切缘将允许在同一介入期间去除额外的组织。X射线相衬成像 (XPCI) 提供优于传统X 射线的软组织灵敏度：我们建议使用它来检测术中切缘。我们开发了一个系统，可以在几分钟内执行基于相位衬度的计算机断层扫描 (CT) 扫描，使用它对101个样本进行成像，其中大约一半包含肿瘤病变，并将结果与商业系统的结果进行比较。对所有标本进行组织学分析并用作黄金标准。对于检测边缘病，XPCI-CT 显示出比传统标本成像（32%、95% CI 20-49%）具有更高的灵敏度（83%、95% CI 69-92%），并且具有可比的特异性（83%、95% CI 70–92% 与 86%、95% CI 73–93%）。在本研究的范围内，特别是从剩余组织中获得的通常包含小病灶的样本，这使得两种方法的检测都更加困难，我们认为，观察到的灵敏度增加可能会导致手术次数的相应减少。
Margins of wide local excisions in breast conserving surgery are tested through histology, which can delay results by days and lead to second operations. Detection of margin involvement intraoperatively would allow the removal of additional tissue during the same intervention. X-ray phase contrast imaging (XPCI) provides soft tissue sensitivity superior to conventional X-rays: we propose its use to detect margin involvement intraoperatively. We have developed a system that can perform phase-based computed tomography (CT) scans in minutes, used it to image 101 specimens approximately half of which contained neoplastic lesions, and compared results against those of a commercial system. Histological analysis was carried out on all specimens and used as the gold standard. XPCI-CT showed higher sensitivity (83%, 95% CI 69–92%) than conventional specimen imaging (32%, 95% CI 20–49%) for detection of lesions at margin, and comparable specificity (83%, 95% CI 70–92% vs 86%, 95% CI 73–93%). Within the limits of this study, in particular that specimens obtained from surplus tissue typically contain small lesions which makes detection more difficult for both methods, we believe it likely that the observed increase in sensitivity will lead to a comparable reduction in the number of re-operations.