Intraoperative Supine Breast MR Imaging to Quantify Tumor Deformation and Detection of Residual Breast Cancer: Preliminary Results

Abstract

Purpose To use intraoperative supine magnetic resonance (MR) imaging to quantify breast tumor deformation and displacement secondary to the change in patient positioning from imaging (prone) to surgery (supine) and to evaluate residual tumor immediately after breast-conserving surgery (BCS). Materials and Methods Fifteen women gave informed written consent to participate in this prospective HIPAA-compliant, institutional review board–approved study between April 2012 and November 2014. Twelve patients underwent lumpectomy and postsurgical intraoperative supine MR imaging. Six of 12 patients underwent both pre- and postsurgical supine MR imaging. Geometric, structural, and heterogeneity metrics of the cancer and distances of the tumor from the nipple, chest wall, and skin were computed. Mean and standard deviations of the changes in volume, surface area, compactness, spherical disproportion, sphericity, and distances from key landmarks were computed from tumor models. Imaging duration was recorded. Results The mean differences in tumor deformation metrics between prone and supine imaging were as follows: volume, 23.8% (range, −30% to 103.95%); surface area, 6.5% (range, −13.24% to 63%); compactness, 16.2% (range, −23% to 47.3%); sphericity, 6.8% (range, −9.10% to 20.78%); and decrease in spherical disproportion, −11.3% (range, −60.81% to 76.95%). All tumors were closer to the chest wall on supine images than on prone images. No evidence of residual tumor was seen on MR images obtained after the procedures. Mean duration of pre- and postoperative supine MR imaging was 25 minutes (range, 18.4–31.6 minutes) and 19 minutes (range, 15.1–22.9 minutes), respectively. Conclusion Intraoperative supine breast MR imaging, when performed in conjunction with standard prone breast MR imaging, enables quantification of breast tumor deformation and displacement secondary to changes in patient positioning from standard imaging (prone) to surgery (supine) and may help clinicians evaluate for residual tumor immediately after BCS.

Breast tumor movements analysis using MRI scans in prone and supine positions

“…No difference in tumor volume according to posture change was found. This differs from a study by Gombos et al 15 which observed an average change of 23.8% in the measured tumor volume in 12 patients. This is likely due to the fact that this study only had six cases that underwent both pre-and post-surgical supine MRI.…”

Population-based study of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ

“…These images are made with the breast in a different position to that on the operating table, making extrapolation of the exact position and growth pattern of the DCIS difficult during surgery. Gombos and colleagues showed considerable deformity of the breast and change in tumour position between MRI in the supine and prone positions. Sakakibara and co‐workers reported a lower rate of positive resection margins after MRI in the supine position than in the prone position in patients with DCIS.…”

ConoSurf: Open‐source 3D scanning system based on a conoscopic holography device for acquiring surgical surfaces

“…Furthermore, as intraoperative information nowadays is important during CAI, preoperative images could be updated with the intraoperative data (surface) acquired by the ConoProbe. Gombos et al have recently described their experience with a supine intraoperative MR imaging protocol to evaluate tumor deformation. For the same procedure, Ungi et al propose an US‐based framework relying on a tracked stylus for acquiring the necessary surface points.…”