A new scanner that combines the benefits of X-ray phase contrast imaging (XPCI) with the 3D image mapping capabilities of a CT scan may significantly reduce the incidence of reoperations among breast cancer patients.
Researchers at University College London (UCL) published the results of a study on the effectiveness of their breadboard XPCI-CT imaging system on breast-conserving surgeries, which showed 2.5 times superior detection of cancer in the soft tissue margins versus traditional imaging.
"I am terribly excited about these results, as they are likely to lead to the first clinical use of XPCI," said lead author of the study, professor Alessandro Olivo, in a statement. "The technology has tremendous potential, and I am sure once people see what it can do many other clinical areas will follow suit.”
Breast-conserving surgery is the most common surgical procedure for the treatment of breast cancer. As opposed to a mastectomy, conserving surgery aims to identify and remove cancerous tissue while sparing healthy breast tissue, which can be less traumatizing for patients and ultimately leave them with a better cosmetic result. Standard techniques frequently require further surgical interventions when additional cancerous tissue is detected later in the soft tissue margins adjacent to the excision.
Unlike conventional X-ray, XPCI measures changes to the speed the X-rays travel as they encounter different types of tissue allowing for greater detection of faint soft tissue differences that may indicate cancer. Combining this advantage with the rapidly rendered 3D mapping may allow surgeons to target significantly more cancerous tissue intraoperatively, thereby reducing the rate of reoperations.
Given the high rates of reoperation resulting from breast-conserving surgery, and the complications and prolonged recovery time that can result from additional surgeries, there has been a marked decline in patients opting for this procedure
in recent decades. Instead, in light of advances in breast cancer genetic risk identification and reconstructive surgery, more patients have opted to undergo prophylactic risk-reducing mastectomies — procedures that saw an increase from 5% to 29.7%, between 1998 and 2011, among patients who were otherwise considered good candidates for breast-conserving surgery.
Additionally, technological advances may not be the most important contributing factor driving high rates of reoperation following an insufficiently successfully breast-conserving surgery. In a study by Weill Cornell Medical College published in the JAMA Network Journals
in 2016, researchers found that reoperation rates vary from 0% to 100% depending on the surgeon performing the procedure. The rate of reoperation was found to be strongly correlated with the volume of breast-conserving surgeries a doctor performs, increasing risk by as much as 50% between low and high volume surgeons. However, the study’s authors go on to note
, that this increased risk may be, in part, due to higher-volume surgeons more often performing breast-conserving surgeries on higher-risk patients, leading them to subordinate maximizing the cosmetic advantages of the procedure to more aggressive removal of all possible cancerous tissue.
The researchers are hopeful that their XPCI-CT imaging system may have other applications beyond breast-conserving surgery.
"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,” observed co-author, and breast radiologist consultant, Tamara Suaris.