Improvement of consistency in delineating breast lumpectomy cavity using surgical clips

Injection of radiopaque hydrogel at time of lumpectomy improves the target definition for adjuvant radiotherapy

“…Our results compare well with other studies using standardized contouring protocols and surgical clips, which is the current gold standard in radiotherapy [15]. Previous studies evaluating the interobserver agreement for delineation with clips found comparable Cx to the one we reported here for the control group, between 0.56 and 0.61 [27,28,34]. Another study reports a higher agreement using gold fiducial markers, with a Cx of 0.70 [31].…”

“…Patients in the intervention group had their CT-simulation performed at a median of 39 days post-surgery (IQR [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]). For most patients, the hydrogel was easily identified in the surgical cavity on the radiotherapy planning CT.…”

Accelerated Partial Breast Irradiation

“…Kirova et al 14 studied the relationship between the gross tumor volume defined on the preoperative images and clips with a 5 mm margin on the postoperative scan in 22 patients: the accuracy of tumor bed delineation was improved if 3 or more clips were placed during the lumpectomy. Atrchian et al 15 found that the consistency of tumor bed delineation was significantly improved in the craniocaudal dimension by the presence of surgical clips. Postoperative seroma in the lumpectomy cavity and clear visualization of the seroma on CT images reduces interobserver variation although the presence of seroma could increase the average tumor bed volume.…”

Prototype volumetric ultrasound tomography image guidance system for prone stereotactic partial breast irradiation: proof-of-concept

“…From these studies, prone S-PBI is promising but still requires some technology improvement. Firstly, current computed tomography (CT)-based simulation provides insufficient soft tissue contrast to delineate the target (Atrchian et al 2018), resulting in a large target margin and a consequently unnecessary dose to the surrounding normal breast and adjacent critical organs. Secondly, interfraction lumpectomy shrinkage and radiation induced breast swelling are not accurately detected, due to the lack of effective image-guidance systems.…”