保乳手术（BCS）是早期乳腺癌治疗的一个重要组成部分，但由于原发切除术中癌阳性切缘的高患病率，昂贵的二次切除手术非常普遍。需要开发和评估改进的切缘评估方法，以在手术中检测阳性切缘。通过对微型计算机断层摄影（micro-CT）进行放射学解释的前瞻性试验对BCS切缘评估进行了评估。将结果与用于检测癌阳性切缘的标准护理内操作切缘评估（即标本触诊和放射学[缩写SIA]）进行比较。分析了来自100名患者的600个切缘。其中14名患者中的21个患者的切缘具有病理阳性。在标本级别上，SIA的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为42.9％、76.7％、23.1％和89.2％。SIA正确识别了14个阳性切缘病例中的6个，假阳性率（FPR）为23.5％。微型CT读者的敏感性、特异性、PPV和NPV范围分别为35.7-50.0％、55.8-68.6％、15.6-15.8％和86.8-87.3％。微型CT读者正确识别了14个阳性切缘病例中的5-7个，FPR范围为31.4-44.2％。如果将微型CT扫描与SIA相结合，最多可以识别出3个额外的阳性切片。微型CT发现了与标准标本触诊和放射学相似比例的阳性切缘病例，但由于难以区分放射密度的纤维腺体组织和癌细胞，导致假阳性切缘评估比例较高。 ©2023年外科肿瘤学会。

Breast-conserving surgery (BCS) is an integral component of early-stage breast cancer treatment, but costly reexcision procedures are common due to the high prevalence of cancer-positive margins on primary resections. A need exists to develop and evaluate improved methods of margin assessment to detect positive margins intraoperatively.A prospective trial was conducted through which micro-computed tomography (micro-CT) with radiological interpretation by three independent readers was evaluated for BCS margin assessment. Results were compared to standard-of-care intraoperative margin assessment (i.e., specimen palpation and radiography [abbreviated SIA]) for detecting cancer-positive margins.Six hundred margins from 100 patients were analyzed. Twenty-one margins in 14 patients were pathologically positive. On analysis at the specimen-level, SIA yielded a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 42.9%, 76.7%, 23.1%, and 89.2%, respectively. SIA correctly identified six of 14 margin-positive cases with a 23.5% false positive rate (FPR). Micro-CT readers achieved sensitivity, specificity, PPV, and NPV ranges of 35.7-50.0%, 55.8-68.6%, 15.6-15.8%, and 86.8-87.3%, respectively. Micro-CT readers correctly identified five to seven of 14 margin-positive cases with an FPR range of 31.4-44.2%. If micro-CT scanning had been combined with SIA, up to three additional margin-positive specimens would have been identified.Micro-CT identified a similar proportion of margin-positive cases as standard specimen palpation and radiography, but due to difficulty distinguishing between radiodense fibroglandular tissue and cancer, resulted in a higher proportion of false positive margin assessments.© 2023. Society of Surgical Oncology.