Claire Bourgain MD, PhD, Presenter: Nothing to Disclose

Bart Dierickx, Abstract Co-Author: Nothing to Disclose

Inneke Willekens MD, Abstract Co-Author: Nothing to Disclose

Nico Buls DSc, PhD, Abstract Co-Author: Nothing to Disclose

Catherine Breucq, Abstract Co-Author: Nothing to Disclose

Ann Schiettecatte MD, Abstract Co-Author: Nothing to Disclose

Johan De Mey, Abstract Co-Author: Research grant, General Electric Company

The pathological reconstruction of the spatial pattern of malignant breast lesions is challenging. Routine application of high cost and time consuming large-format histological sections is now recommended to address tumor multifocality and extension. Multi-energy ‘color’ specimen X-ray was investigated as a new tool to optimize targeted histopathological assessment of tumor complexity.

In 38 breast specimen resections for cancer (35/38) or benign pathology, a multi-energy whole-specimen color X-ray image was produced by image processing (coding absorption as luminance and pixel-wise energy difference as chrominance) from a triple (22-30-40 keV) energy exposure recorded with a GE Senographe Essential.  Histological sampling was mapped to correlate with the color image. The presence of tumor size, extend and heterogeneity, microcalcifications, and multifocality were evaluated.  Statistical analysis was done by Student t test.

Multi-energy X-ray demonstrated enhanced visibility of tumor versus benign tissue, tumor borders and heterogeneity (fibrosis, necrosis, bleeding) as compared to classical single-energy specimen X-ray. Microcalcifications were readily identified. Comparing macroscopical palpation and naked eye examination to ‘color’ X-ray, the former underestimated tumour size determined by microscopical measurement, especially missing tumour bridges between masses (mean 16.8 mm, range 0.3-100, p < 0.02). This would increase the tumor stage in 23 % (8/35) of patients. In 35% (12/35) multifocality of the lesion was identified, half of which only by the color X-ray. In 5/6 of the latter cases, lesions were < 3 mm.

Multi-energy color breast specimen X-ray shows good correlation with cancer complexity and may be advocated as guide for targeted histopathological lesion sampling.

Multi-energy color breast specimen X-ray is a promising tool to optimize radiological-pathological correlation, indication positions of interest thus reducing histopathological workload.

Bourgain, C, Dierickx, B, Willekens, I, Buls, N, Breucq, C, Schiettecatte, A, De Mey, J, Multi-energy "Color" X-ray: A New Technique for Enhanced Radiological-Pathological Correlation in Breast Cancer.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009778.html