Increasing specimen coverage using digital whole-mount breast pathology: Implementation, clinical feasibility and application in research

Conventional histopathological evaluation is performed on breast specimens using a highly limited sampling of tissues visualized in a two-dimensional (2D) manner although important tumor measurements are three-dimensional. Here we describe a ‘3D’ technique for whole-mount, whole-specimen processing which reduces conformational change and dramatically increases specimen coverage, based on digitizing whole-specimen, whole-mount (up to 12.7 cm × 17.8 cm) serial sections. We describe hardware and software tools for acquiring, viewing and processing the large image datasets (up to 400 GB), validation studies investigating the clinical significance of the additional information gleaned from the 3D approach, and application to radiologic-pathologic correlation and biomarker visualization.