A Patient-Specific 3D-Printed Form Accurately Transfers Supine MRI-Derived Tumor Localization Information to Guide Breast-Conserving Surgery

Abstract

Background Wire-localized excision of nonpalpable breast cancer is imprecise, resulting in positive margins 25–30% of the time. Methods Patients underwent preoperative supine magnetic resonance imaging (MRI). A radiologist outlined the tumor edges on consecutive images, creating a three-dimensional (3D) view of its location. Using 3D printing, a bra-like plastic form (the Breast Cancer Locator [BCL]) was fabricated, with features that allowed a surgeon to (1) mark the edges of the tumor on the breast surface; (2) inject blue dye into the breast 1 cm from the tumor edges; and (3) place a wire in the tumor at the time of surgery. Results Nineteen patients with palpable cancers underwent partial mastectomy after placement of surgical cues using patient-specific BCLs. The cues were in place in <5 min and no adverse events occurred. The BCL accurately localized 18/19 cancers. In the 18 accurately localized cases, all 68 blue-dye injections were outside of the tumor edges. Median distance from the blue-dye center to the pathologic tumor edge was 1.4 cm, while distance from the blue dye to the tumor edge was <5 mm in 4% of injections, 0.5–2.0 cm in 72% of injections, and >2 cm in 24% of injections. Median distance from the tumor center to the BCL-localized wire and to the clip placed at the time of diagnosis was similar (0.49 vs. 0.73 cm) on specimen mammograms. Conclusions Information on breast cancer location and shape derived from a supine MRI can be transferred safely and accurately to patients in the operating room using a 3D-printed form.

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios

“…Use in breast malignancies with chest wall involvement and/or nipple-areolar complex involvement, evaluation of tumor-breast size ratio, and tumors where oncoplastic surgery is considered. PubMed Search: ((3D printing) AND (breast cancer) OR ((rapid prototyping) AND (breast cancer)) Results: [ 546 – 552 ]…”

Feasibility, Image Quality and Clinical Evaluation of Contrast-Enhanced Breast MRI Performed in a Supine Position Compared to the Standard Prone Position

“…This new technique permits objectivity during the second-look ultrasound [ 10 ] and reduces the need for MRI-guided biopsy [ 11 , 12 ], but it requires the MRI to be performed in a supine position, that is the same position in which breast ultrasound is performed [ 13 ]. In addition to those already reported, supine MRI offers many other advantages: it has better correspondence with the breast lesions during conservative surgery [ 14 , 15 , 16 , 17 ], it clearly identifies the area of residual presence of the disease [ 18 ], it correctly identifies the volume to be subjected to radiotherapy [ 19 , 20 , 21 ], and effectively maps breast cancer in patients scheduled for oncoplastic surgery [ 15 ].…”

Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy

“…With the preoperative supine MRI, Barth RJ Jr et al [74] outline the tumor edges on consecutive images and create a bra-like plastic form (the Breast Cancer Locator [BCL]) that is manufactured for each patient using a 3D printer. The BCL can transmit both surface and intraparenchymal information to locate the tumor precisely in the OR and can help the surgeon to perform the breast-conserving surgery with the goal of removing 1 cm of normal-feeling tissue around the palpable tumor.…”