Tumor Bed Delineation for Partial Breast and Breast Boost Radiotherapy Planned in the Prone Position: What Does MRI Add to X-ray CT Localization of Titanium Clips Placed in the Excision Cavity Wall?

Kirby, Anna M.; Yarnold, John; Evans, Philip; Morgan, Veronica A.; Schmidt, María Auxiliadora; Scurr, Erica; deSouza, Nandita M.

doi:10.1016/j.ijrobp.2009.02.028

Cited by 55 publications

(42 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, there are many studies that failed to demonstrate improved contouring with the use of MRI for various tumour sites 43-47. As far as breast cancer is concerned, several authors investigated the impact of adding MRI to CT for delineation of lumpectomy cavity with negative or inconclusive outcome 11,16,20-23. Den Hartogh et al .…”

Section: Discussionmentioning

confidence: 99%

“…reported that addition of MRI to CT resulted in tumour bed volumes that were discordant with those based on CT and clips alone. With the use of MRI, the tumour bed volume increased in 28 out of 30 cases included, resulting in a median CTV increase of 10.3% (−33.6%−80.9%) 20. Mast et al .…”

Section: Discussionmentioning

confidence: 99%

“…Due to its poor ability for soft tissue depiction, placement of surgical clips or markers at the edges of LC is recommended to improve tumour bed delineation 12-16. But reliability of inserted markers as a surrogate for tumour bed is a matter of debate9,16-18 and omission of their placement in some patients poses a special challenge to the radiation oncologist during CTV LC delineation.19 The role of MRI for contouring in breast cancer radiotherapy is controversial11,20-23 and the evidence to support its use in patients without markers in the tumour bed is scarce 24,25. In our present study, we aimed to (1) quantify the IOV and (2) assess the accuracy of CT- and MRI-based CTV LC contouring in patients without clips in the LC.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

Al-Hammadi

Caparrotti

Divakar

et al. 2017

Radiology and Oncology

View full text Add to dashboard Cite

BackgroundOmitting the placement of clips inside tumour bed during breast cancer surgery poses a challenge for delineation of lumpectomy cavity clinical target volume (CTVLC). We aimed to quantify inter-observer variation and accuracy for CT- and MRI-based segmentation of CTVLC in patients without clips.Patients and methodsCT- and MRI-simulator images of 12 breast cancer patients, treated by breast conserving surgery and radiotherapy, were included in this study. Five radiation oncologists recorded the cavity visualization score (CVS) and delineated CTVLC on both modalities. Expert-consensus (EC) contours were delineated by a senior radiation oncologist, respecting opinions of all observers. Inter-observer volumetric variation and generalized conformity index (CIgen) were calculated. Deviations from EC contour were quantified by the accuracy index (AI) and inter-delineation distances (IDD).ResultsMean CVS was 3.88 +/− 0.99 and 3.05 +/− 1.07 for MRI and CT, respectively (p = 0.001). Mean volumes of CTVLC were similar: 154 +/− 26 cm3 on CT and 152 +/− 19 cm3 on MRI. Mean CIgen and AI were superior for MRI when compared with CT (CIgen: 0.74 +/− 0.07 vs. 0.67 +/− 0.12, p = 0.007; AI: 0.81 +/− 0.04 vs. 0.76 +/− 0.07; p = 0.004). CIgen and AI increased with increasing CVS. Mean IDD was 3 mm +/− 1.5 mm and 3.6 mm +/− 2.3 mm for MRI and CT, respectively (p = 0.017).ConclusionsWhen compared with CT, MRI improved visualization of post-lumpectomy changes, reduced interobserver variation and improved the accuracy of CTVLC contouring in patients without clips in the tumour bed. Further studies with bigger sample sizes are needed to confirm our findings.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

Al-Hammadi

Caparrotti

Divakar

et al. 2017

Radiology and Oncology

View full text Add to dashboard Cite

show abstract

“…CVSs adopted from [19][20][21] for each image were established by two radiation oncologists (at least 4 months post the last delineation) and one radiation therapist (RT), utilizing the images alone, at the same window levels as for contouring.…”

Section: Cavity Visualization Score (Cvs)mentioning

confidence: 99%

Comparison of Magnetic Resonance Imaging and Computed Tomography for Breast Target Volume Delineation in Prone and Supine Positions

Pogson

Delaney

Ahern

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Purpose/Objective(s): MRI provides no ionizing radiation dose (allowing inter and intra fraction imaging), improved soft tissue contrast and potentially improved conformity in delineation than CT. This study aimed to determine if T2 weighted magnetic resonance imaging improves seroma cavity (SC) and Whole Breast (WB) inter-observer conformity for radiotherapy purposes compared with the gold standard of CT, both in the prone and supine positions. Results: Imaging modality did not affect inter-observer variation for WB CTVs. Prone WB CTVs were larger in volume and more conformal than Supine CTVs (on both MRI and CT). SC volumes were larger on CT than MRI. SC volumes proved to be comparable in inter-observer conformity in both modalities (VOI of 0.57±0.03 for CT supine, 0.52±0.04 for MR supine, 0.56±0.03 for CT prone and 0.55±0.04 for MR prone) however after registering modalities together the inter-modality variation (DSC of 0.41±0.05 for supine and 0.38±0.04 for prone) was larger than the inter-observer variability for SC despite the location typically remaining constant.Conclusions: MRI inter-observer variation was comparable to CT for the WB CTV and SC delineation, in both prone and supine positions. Whilst the CVS and inter-observer concordance M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 3 was not significantly higher for MRI than CT, the SCs were smaller on MRI, potentially due to clearer SC definition, especially on T2-weighted MR images.

show abstract

“…Multiple studies have shown the limitations of single modality imaging with interobserver differences in lumpectomy cavity definition [1][2][3][4]. CT-based imaging is commonly used for breast treatment planning; but the limited soft tissue contrast of CT can result in poor visualization of the lumpectomy site in patients with dense breast parenchyma, small lumpectomy cavities, or a prolonged delay between surgery and treatment planning [2,3].…”

Section: Introductionmentioning

confidence: 99%

Image-based Treatment Planning of the Post-lumpectomy Breast Utilizing CT and 3T MRI

Buechler-Price¹,

Betts²,

Muruganandham³

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Accurate lumpectomy cavity definition is critical in breast treatment planning. We compared contouring lumpectomy cavity volume and cavity visualization score (CVS) with CT versus 3T MRI. 29 patients were imaged with CT and 3T MRI. Seven additional boost planning sets were obtained for 36 image sets total. Three observers contoured the lumpectomy cavity on all images, assigning a cavity visualization score (CVS ) of 1 to 5. Measures of consistency and agreement for CT volumes were 98.84% and 98.62%, for T1 MRI were 95.65% and 95.55%, and for T2 MRI were 97.63% and 97.71%. The mean CT, T1 MRI, and T2 MRI CVS scores were 3.28, 3.38, and 4.32, respectively. There was a highly significant difference between CT and T2 scores (P < .00001) and between T1 and T2 scores (P < .00001). Interobserver consistency and agreement regarding volumes were high for all three modalities with T2 MRI CVS the highest. MRI may contribute to target definition in selected patients.

show abstract

Tumor Bed Delineation for Partial Breast and Breast Boost Radiotherapy Planned in the Prone Position: What Does MRI Add to X-ray CT Localization of Titanium Clips Placed in the Excision Cavity Wall?

Cited by 55 publications

References 22 publications

MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

Comparison of Magnetic Resonance Imaging and Computed Tomography for Breast Target Volume Delineation in Prone and Supine Positions

Image-based Treatment Planning of the Post-lumpectomy Breast Utilizing CT and 3T MRI

Contact Info

Product

Resources

About