3D virtual histopathology of human breast tissues using an X-ray grating interferometry micro CT system

Background: Breast cancer remains the most prevalent malignancy among women worldwide. When suspicious lesions are detected, standard clinical workflows rely on histopathological evaluation of excised tissue (biopsy) and the choice of preoperative systemic therapies or primary surgical excision. This study explores the potential of X-ray grating-interferometry (GI)-based micro-computed tomography (μCT) as a complementary virtual tool to the gold-standard conventional histopathology Methods: Small (up to 2 cm) residual samples from 20 formalin-fixed mastectomy specimens (from 19 patients) underwent imaging using GI-based μCT and were subsequently processed for routine histology. Diagnostic concordance between gold-standard histological sections and μCT images was established with input from an expert pathologist and an expert radiologist Results: GI-based μCT enabled differentiation of neoplastic and benign findings from surrounding tissue based on morphology and gray-value contrast. While μCT lacks the cellular resolution of histology, its 3D volumetric data provided valuable spatial context for small structures. Imaging a 2 cm specimen required approximately 13.4 h, with negligible degradation in diagnostic image quality when the acquisition time was reduced to 4.4 h Conclusions: GI-based μCT demonstrates strong potential as an adjunct to gold-standard histopathology, providing high-quality soft-tissue contrast comparable to conventional μCT and aiding in the identification of regions of interest for further tissue-based analysis. The possible clinical utility of GI-based μCT diagnostics needs further clinical evaluation, also on smaller samples