Micro-computed Tomography in the Evaluation of Eosin-stained Axillary Lymph Node Biopsies of Females Diagnosed with Breast Cancer

Sep 21, 2026

Uploaded by Eden

Histopathological evaluation of core needle axillary lymph node (ALN) biopsies is crucial for prognosis and treatment planning in breast cancer, yet conventional 2D slicing can introduce sampling errors and limited views that contribute to false-negative preoperative detection and underestimation of metastatic foci. This proof-of-concept study tests whether 3D X-ray micro-computed tomography (micro-CT) can improve error detection, histopathological accuracy, and quantitative measurement of metastatic lesions in ALN biopsy cores from two patients. A self-developed eosin-enhanced micro-CT protocol enables cancer/healthy segmentation and assessment of longest diameter and deposit volume, showing potential to improve tumor deposit estimates compared with standard 2D histology, though further validation is needed.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Micro-computed Tomography for ALN Biopsy Evaluation

Limitations of 2D Histology and Sampling Error

Proof-of-Concept Study: Eosin-Enhanced 3D Micro-CT Protocol

Quantification Workflow: Segmentation and Lesion Measurements

Clinical Context: Preoperative Nodal Assessment and Implications

Expected Benefits and Need for Further Validation

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN Micro-computed Tomography in the Evaluation of Eosin-stained Axillary Lymph Node Biopsies of Females Diagnosed with Breast Cancer Santiago Laguna-Castro1,2􀀍, Annukka Salminen3, OtsoArponen3,4, Markus Hannula1,2, Irina Rinta-Kiikka3,4, Jari Hyttinen1,2 & Teemu Tolonen4,5 Histopathological investigation of metastasis in core needle axillary lymph node (ALN) biopsies is crucial for the prognosis and treatment planning of breast cancer patients. Biopsies are typically sliced and evaluated as two-dimensional (2D) images. Biopsy sampling errors and the limited view provided by 2D histology are leading factors contributing to false-negative results in the preoperative detection of metastatic lymph nodes and underestimation of metastatic foci. In this proof-of-concept study, we aim to explore the technical feasibility and the potential capacities of tridimensional (3D) X-ray micro-computed tomography imaging to expedite error detection, enhancement of histopathological accuracy, and precise measurement of metastatic lesion on ALN core needle biopsies of two breast cancer patients. Our self-developed micro-CT protocol uses eosin for the first time, a common histological dye, to enhance 3D architecture of ALNs. Performed analysis on the images oftheALN biopsies involves cancer tissue segmentation, swift biopsy evaluation, and measurement of the metastatic longest diameter and deposit volume. The eosin micro-CT protocol shows potential for an improved tumor deposit estimates, offering additional clinical value compared to standard 2D histology, however, further studies for validating this method are needed. Breast cancer (BC) is the most common non-skin cancer worldwide, responsible for 6.9% of global cancer deaths in 20201. The prognosis for women with early-stage BC is strongly influenced by the presence and number of metastatic axillary lymph nodes (ALNs)2. Histopathological analysis reveals metastatic ALNs in 24.8–35.5% of newly diagnosed BC cases3–6. Preoperative assessment of the axilla is generally performed using ultrasound (US)2. If suspicious ALNs are detected, a US-guided lymph node biopsy (US-LNB) is conducted for further histopathological evaluation2. If no suspicious ALNs are detected, or if the US-LNB does not confirm metastasis, sentinel lymph nodes (S-LNB)—those first to drain from the tumor—are removed and biopsied during surgery for histopathological assessment. Accurate nodal evaluation is critical for BC treatment planning: patients without micrometastases (metastatic focus longest diameter (LD) ≤ 2 mm) or macrometastases (LD > 2 mm) do not require adjuvant axillary radiotherapy, while those with confirmed micrometastases or 1–2 macrometastases receive radiotherapy. If more than two macrometastases are identified, axillary lymph node dissection (ALND) is performed2. Detection of more than two macrometastases on US-LNB eliminates the need for intraoperative S-LNB2. A key challenge in current clinical practice is the risk of missing metastatic tissue during US-LNB or underestimating the extent of metastases during histopathological evaluation. These oversights can lead to nodal involvement false negatives (FN), which can cause delays or complications in treatment, increasing the risk to patients7,8. The FN rate in nodal histopathology is approximately 30%, often resulting from sampling errors9, 10, thus, ongoing research is very oriented to enhance nodal status assessment with novel methodologies. Most 1Computational Biophysics and Imaging Group, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland. 2BioMediTech Unit, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland. 3Department of Radiology, Tampere University Hospital, Tampere 33520, Finland. 4Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland. 5Department of Patholog

FAQs

Why is 2D histopathology of axillary lymph node biopsies prone to false negatives in breast cancer?

Biopsies are typically sliced into 2D images, which can miss metastatic tissue due to sampling errors and provide a limited view of the lymph node architecture, leading to nodal evaluation false negatives and underestimation of metastatic foci.

What is the main goal of this proof-of-concept study using 3D micro-CT?

The study aims to assess the technical feasibility and potential capabilities of 3D X-ray micro-CT to speed error detection, enhance histopathological accuracy, and enable precise measurement of metastatic lesions in ALN core needle biopsy samples.

How does the eosin micro-CT protocol evaluate metastatic deposits?

The protocol uses eosin to enhance 3D architecture, then performs segmentation of cancerous versus healthy tissue and measures the metastatic longest diameter and deposit volume in the micro-CT images.

Sep 21, 2026

Uploaded by Eden