Can laboratory x-ray virtual histology provide intraoperative 3D tumor resection margin assessment?

Surgery is an essential part of the curative plan for most patients affected with solid tumors. The outcome of such surgery, e.g., recurrence rates and ultimately patient survival, depends on several factors where the resection margin is of key importance. Presently the resection margin is assessed by classical histology, which is time-consuming (several days), destructive, and basically only gives two-dimensional information. Clearly it would be advantageous if immediate feedback on tumor extension in all three dimensions were available to the surgeon intra-operatively. In the present paper we investigate a laboratory propagation-based phase-contrast x-ray computed tomography (CT) system that provides the resolution, contrast, and, potentially, the speed for this purpose. The system relies on a liquid-metal jet micro-focus source and a scintillator-coated CMOS detector. The study is performed on paraffin-embedded non-stained samples of human pancreatic neuroendocrine tumors, liver intrahepatic cholangiocarcinoma, and pancreatic serous cystic neoplasm (benign). We observe tumors with distinct and sharp edges having cellular resolution (similar to 10 mu m) as well as many assisting histological landmarks, allowing for resection margin assessment. All x-ray data is compared with classical histology. The agreement is excellent, and we conclude that the method has potential for intra-operative three-dimensional virtual histology.