Novel Breast Specimen Orientation Approach through 3D Visualizations for Relocating Inadequate Margins based on the Surgical Clips: Feasibility Study.

Abstract

Purpose: The current breast specimen orientation method after breast-conserving surgery is potentially inaccurate due to deformability and mobility of the extracted breast tissue. This complicates targeted relocation during re-excision or radiation. Therefore, we propose a new 3D-visualization method to communicate the breast specimen orientation to instantly provide an intuitive overview of the resection margins in relation to the surgical clips on the wound bed.Methods: In 15 female patients undergoing breast-conserving surgery, the surgeon labeled the surgical clips on the specimen and the wound bed. During pathologic assessment, after inking, a 3D scan was made of the specimen. Tumor tissue was annotated on the histological image and transposed to the respective location inside the 3D model. The transposed resection margins with respect to the labeled surgical clips were calculated and visualized. Intuitivity of the visualization was tested (face validity) as well as the quality of displayed resection margins and labeled clips.Results: Average face validity score for 3D-visualization was between ‘++’ and ‘+’ for surgeons and between ‘+’ and ‘+/-’ for pathologists. Average difference between computed resection margins and reported histologic margins was 1 mm. In 8 cases not all clips could be labeled in situ. In 5 cases not all labeled clips could be retrieved by pathology. Conclusion: The visualizations appeared valuable in interdisciplinary communications. The displayed resection margins approximated the reported margins. Consistent accurate surgical clip labelling proved challenging.