The role of micro-CT in breast cancer management: a systematic review on the clinical applications of micro-CT in breast cancer and a diagnostic accuracy meta-analysis on intraoperative margin assessment

Seyed Mostafa Meshkati Yazd¹MAHTAB VASIGH^1,2*Andreas S Papazoglou^3*Alexandros C Liatsos³Keivan Ranjbar⁴Austin D Williams²Richard J Bleicher²Orestis L Katsamenis⁵Mathew L Pierotti²Christian X Cruz Pico²Stamatios E Theocharis⁶Fani Tsolaki⁷Daniel Richard Leff⁸James Michaelson⁹

• ¹Tehran University of Medical Sciences, Tehran, Tehran, Iran
• ²Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States
• ³Athens Naval Hospital, Athens, Greece
• ⁴Shiraz University of Medical Sciences, Shiraz, Fars, Iran
• ⁵µ-VIS X-ray Imaging Centre, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
• ⁶First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
• ⁷Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
• ⁸Department of Surgery and Cancer, School of Medicine, Imperial College London, London, United Kingdom
• ⁹Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States

There is a growing interest in exploring intraoperative methods for margin assessment of malignant breast specimens in breast-conserving surgeries (BCS). Micro-computed tomography (micro-CT) has already exhibited clinical value, yielding high-resolution three-dimensional (3D) volumetric images. Against this background, this study aimed to systematically evaluate the role of micro-CT in intraoperative margin assessment (IMA) in BCS.A systematic literature review has been conducted in Scopus, EMBASE, and PubMed up to December 10, 2024.Studies reporting the diagnostic indices of micro-CT for IMA compared to histopathologic results were utilized for a diagnostic accuracy meta-analysis.Eight out of the initially retrieved 2,921 studies evaluated the role of micro-CT in IMA and were eligible for calculating the pooled diagnostic indices. In those studies, 988 specimens/margins were scanned, and the scanning time ranged from 4 to 30 minutes. The pooled diagnostic indices were: a sensitivity of 0.63 (95% CI: 0.45 -0.79), a specificity of 0.78 (95% CI: 0.68 -0.85), and an accuracy of 0.77 (95% CI: 0.71 -0.84) for micro-CT based IMA compared to the gold-standard histopathological assessment.This study demonstrates that micro-CT imaging is a promising IMA technique for BCS by providing highresolution 3D images. These images can be acquired within a few minutes, allowing surgeons to assess margin status intra-operatively, and identify more than 70% of positive margins where reoperation rates are likely to decrease. Although these findings are encouraging, their clinical translation is still under investigation, and adequately empowered clinical trials are warranted to investigate the re-excision and local recurrence rates after micro-CT IMA assessment.