Partial Breast Irradiation and Surgical Clip Usage for Tumor Bed Delineation After Breast-Conserving Surgery in Canada: A Radiation Oncology Perspective

Koch, Christine; Corey, Gemma; Liu, Zhihui Amy; Han, Kathy; Fyles, Anthony

doi:10.1016/j.adro.2021.100701

Cited by 3 publications

(5 citation statements)

References 35 publications

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“…None of the patients in our study had fewer than 4 clips, with the majority having significantly more. In addition, the variance across expert contours is consistent with other studies evaluating CM performance 1,10–14 . Therefore, our CM cohort represents a valid comparison group and supports the efficacy and superiority of FM.…”

Section: Discussionsupporting

confidence: 87%

“…In addition, the variance across expert contours is consistent with other studies evaluating CM performance. 1,[10][11][12][13][14] Therefore, our CM cohort represents a valid comparison group and supports the efficacy and superiority of FM.…”

Section: Discussionsupporting

confidence: 64%

“…[7][8][9] Several studies 1,[10][11][12][13] have demonstrated high rates of interobserver variability with surgical CMs after standard lumpectomy with or without oncoplastic reconstruction. 14 Oncoplastic breast surgery techniques first originated in the 1980s and have recently become an increasingly utilized approach for maintaining oncological effectiveness while optimizing cosmesis and quality of life outcomes in patients with breast cancer. [15][16][17][18] Oncoplastic surgery involves extensive rearrangement of breast tissue to reconstruct and minimize volume defects in breast tissue.…”

mentioning

confidence: 99%

“…Furthermore, clips are frequently displaced with full-thickness closure of the surrounding tissue and thus may not correlate with the true extent of the TB cavity 7–9 . Several studies 1,10–13 have demonstrated high rates of interobserver variability with surgical CMs after standard lumpectomy with or without oncoplastic reconstruction 14 …”

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confidence: 99%

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Comparison of Tumor Bed Delineation Using a Novel Radiopaque Filament Marker Versus Surgical Clips for Targeting Breast Cancer Radiotherapy

Shukla

Langner

Linshaw

et al. 2023

American Journal of Clinical Oncology

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Background: Accuracy of tumor bed (TB) delineation is essential for targeting boost doses or partial breast irradiation. Multiple studies have shown high interobserver variability with standardly used surgical clip markers (CMs). We hypothesize that a radiopaque filament marker (FM) woven along the TB will improve TB delineation consistency. Methods: An FDA-approved FM was intraoperatively used to outline the TB of patients undergoing lumpectomy. Between January 2020 and January 2022, consecutive patients with FM placed after either (1) lumpectomy or (2) lumpectomy with oncoplastic reconstruction were identified and compared with those with CM. Six “experts” (radiation oncologists specializing in breast cancer) across 2 institutions independently defined all TBs. Three metrics (volume variance, dice coefficient, and center of mass [COM] deviation). Two-tailed paired samples t tests were performed to compare FM and CM cohorts. Results: Twenty-eight total patients were evaluated (14 FM and 14 CM). In aggregate, differences in volume between expert contours were 29.7% (SD ± 58.8%) with FM and 55.4% (SD ± 105.9%) with CM (P < 0.001). The average dice coefficient in patients with FM was 0.54 (SD ± 0.15), and with CM was 0.44 (SD ± 0.22) (P < 0.001). The average COM deviation was 0.63 cm (SD ± 0.53 cm) for FM and 1.05 cm (SD ± 0.93 cm) for CM; (P < 0.001). In the subset of patients who underwent lumpectomy with oncoplastic reconstruction, the difference in average volume was 21.8% (SD ± 20.4%) with FM and 52.2% (SD ± 64.5%) with CM (P<0.001). The average dice coefficient was 0.53 (SD ± 0.12) for FM versus 0.39 (SD ± 0.24) for CM (P < 0.001). The average COM difference was 0.53 cm (SD ± 0.29 cm) with FM versus 1.25 cm (SD ± 1.08 cm) with CM (P < 0.001). Conclusion: FM consistently outperformed CM in the setting of both standard lumpectomy and complex oncoplastic reconstruction. These data suggest the superiority of FM in TB delineation.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 64%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison of Tumor Bed Delineation Using a Novel Radiopaque Filament Marker Versus Surgical Clips for Targeting Breast Cancer Radiotherapy

Shukla

Langner

Linshaw

et al. 2023

American Journal of Clinical Oncology

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“…BCS does not only lead to higher quality of life scores but can also increase overall survival [7][8][9]. During BCS, the tumor bed is Diagnostics 2023, 13, 3062 2 of 10 often marked with surgical clips to facilitate targeted adjuvant radiotherapy [10]. Therefore, metallic markers frequently occur in pre-operative breast imaging and in follow-up studies after surgery.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of In Vivo Metal Artifact Reduction in Contrast-Enhanced Dedicated Spiral Breast Computed Tomography

Wetzl,

Wenkel,

Steiding

et al. 2023

Diagnostics

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Background: Radiopaque breast markers cause artifacts in dedicated spiral breast-computed tomography (SBCT). This study investigates the extent of artifacts in different marker types and the feasibility of reducing artifacts through a metal artifact reduction (MAR) algorithm. Methods: The pilot study included 18 women who underwent contrast-enhanced SBCT. In total, 20 markers of 4 different types were analyzed for artifacts. The extent of artifacts with and without MAR was measured via the consensus of two readers. Image noise was quantitatively evaluated, and the effect of MAR on the detectability of breast lesions was evaluated on a 3-point Likert scale. Results: Breast markers caused significant artifacts that impaired image quality and the detectability of lesions. MAR decreased artifact size in all analyzed cases, even in cases with multiple markers in a single slice. The median length of in-plain artifacts significantly decreased from 31 mm (range 11–51 mm) in uncorrected to 2 mm (range 1–5 mm) in corrected images (p ≤ 0.05). Artifact size was dependent on marker size. Image noise in slices affected by artifacts was significantly lower in corrected (13.6 ± 2.2 HU) than in uncorrected images (19.2 ± 6.8 HU, p ≤ 0.05). MAR improved the detectability of lesions affected by artifacts in 5 out of 11 cases. Conclusion: MAR is feasible in SBCT and improves the image quality and detectability of lesions.

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Interobserver variability of clinical target volume delineation in patients undergoing breast-conserving surgery without surgical clips: a pilot study on preoperative magnetic resonance simulation

Jiao,

Wang,

et al. 2024

BMC Cancer

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Background In patients undergoing breast-conserving therapy without surgical clip implantation, the accuracy of tumor bed identification and the consistency of clinical target volume (CTV) delineation under computed tomography (CT) simulation remain suboptimal. This study aimed to investigate the feasibility of implementing preoperative magnetic resonance (MR) simulation on delineations by assessing interobserver variability (IOV). Methods Preoperative MR and postoperative CT simulations were performed in patients who underwent breast-conserving surgery with no surgical clips implanted. Custom immobilization pads were used to ensure the same supine position. Three radiation oncologists independently delineated the CTV of tumor bed on the images acquired from MR and CT simulation registration and CT simulation alone. Cavity visualization score (CVS) was assigned to each patient based on the clarity of the tumor bed on CT simulation images. IOV was indicated by generalized conformity index (CI gen ), denoted as CI gen−CT and CI gen−MR/CT , and the distance between the centroid of mass (dCOM), denoted as dCOM CT and dCOM MR/CT . The variation of IOV in different CVS subgroups was analyzed. Results A total of 10 patients were enrolled in this study. The median and interquartile range (IQR) of maximum pathological diameter of the tumors in all patients were 1.55 (0.80–1.92) cm. No statistical significance was found between the volumes of CTVs on CT simulation and on MR/CT simulation registration images ( p = 0.387). CI gen−MR/CT was significantly larger than CI gen−CT ( p = 0.005). dCOM MR/CT was significantly smaller than dCOM CT ( p = 0.037). The median and IQR of CVS in all patients were 2.34 (2.00–3.08). The difference of CI gen between CI gen−MR/CT and CI gen−CT was larger in the low CVS group ( p = 0.016). The difference of dCOM showed a decreasing trend when CVS was lower, although it did not reach statistical significance ( p = 0.095). Conclusions For patients who underwent breast-conserving surgery without surgical clip implantation, the use of preoperative MR simulation in delineating the CTV of tumor bed decreased the IOV among observers. The consistency of tumor bed identification was improved especially in cases where the margins of tumor bed were challenging to visualize on CT simulation images. The study findings offer potential benefits in reducing local recurrence and minimizing tissue irritation in the surrounding areas. Future investigation in a ...

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Partial Breast Irradiation and Surgical Clip Usage for Tumor Bed Delineation After Breast-Conserving Surgery in Canada: A Radiation Oncology Perspective

Cited by 3 publications

References 35 publications

Comparison of Tumor Bed Delineation Using a Novel Radiopaque Filament Marker Versus Surgical Clips for Targeting Breast Cancer Radiotherapy

Comparison of Tumor Bed Delineation Using a Novel Radiopaque Filament Marker Versus Surgical Clips for Targeting Breast Cancer Radiotherapy

Feasibility of In Vivo Metal Artifact Reduction in Contrast-Enhanced Dedicated Spiral Breast Computed Tomography

Interobserver variability of clinical target volume delineation in patients undergoing breast-conserving surgery without surgical clips: a pilot study on preoperative magnetic resonance simulation

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