Surgery of nonpalpable breast cancer: First step to a virtual per‐operative localization? First step to virtual breast cancer localization

Abstract

Introduction Preoperative localization procedures of occult breast cancer (radioisotopic and wire localization) are invasive and uncomfortable. We have evaluated a novel technique which allows a virtual localization. Material and Methods Our retrospective study focused on patients treated for occult and unifocal breast cancer from September 2016 to June 2017. All patients had radioisotopic preoperative localization. We included patients who had a preoperative prone Magnetic Resonance Imaging (MRI) and an intraoperative 3D optical scan. During surgery, the surgeon localized the tumor thanks to a gamma detection probe and marked the localization on the skin with a black marker. The breast was then optically scanned. MRI was adjusted to the optical surface to match the exact breast position in the Operating Room. The virtual localization provided by the 3D breast modeling tool was retrospectively compared with the radioisotopic localization, defined as the pen mark visible in the optical scan. Results Nine patients were included in this feasibility study. Tumors were successfully localized in the respective breast quadrant. The mean cutaneous distance between virtual and radioisotopic localization was 1.4 cm in patients with low breast volume (5/9) and 2.8 cm in those with large breast volume (4/9). Conclusion We developed a research prototype which enables virtual preoperative localization of nonpalpable breast lesions using MRI images and intraoperative optical scanning. Parameter optimization is required and will lead to a precise and noninvasive tool. By adding augmented reality, it will be possible to initiate a prospective study to compare this tool with the traditional localizations.

3D digital breast cancer models with multimodal fusion algorithms

“…The spatial computing applied to this dataset, merging digital and physical anatomic structures of the breast (with tumor) into a digital 3D model, can pave the way for the next generation breast surgeon, with the integration of augmented reality into the operation theater, allowing direct tumor visualization inside the patient’s breast. The concept of uploading a patient specific breast cancer 3D model to an augmented reality glasses in the operating theater as a non-invasive pre-operative tumor localization technique has already been addressed [ 19 ] but never attempted. The proposed validation protocol and the 3D model simulations performed are a first step to bring breast cancer computer vision into clinical use cases.…”

“…[ 5 ] 7 Registration MRI and 3D scan in upright International Conference Duraes et al. [ 19 ] 9 Registration MRI and 3D scan in supine Journal Lee et al. [ 16 ] 5 Registration MRI prone and supine International Conference Vavourakis et al.…”

Breast cancer surgery with augmented reality

“…Innovations in 3D spatial technology and augmented reality (AR) driven by digital high-tech industrial science have accelerated exploratory research in breast cancer imaging. Although extensive literature exists on 3D finite elements simulation and breast tissue modeling, few papers have addressed breast magnetic resonance imaging (MRI) to 3D scan fusion to simulate a real breast [3][4][5][6][7][8]. Recently, a patient-specific 3D digital breast model integrating the breast torso and tumor location was created and validated with a MRI to 3D surface scan fusion algorithm [9].…”

A rigged model of the breast for preoperative surgical planning

“…Before surgery, the surgeon draws surgical patterns on the patient in a preoperative position (standing). Then, the surgeon instantly operates in the intra-operative stance (supine) (Duraes et al, 2019). These patterns, also called surgical drawings, are part of the preoperative planning procedure.…”

“…These patterns, also called surgical drawings, are part of the preoperative planning procedure. Most of the time, they are noticeable anatomical landmarks or a visual map that will guide the surgeon during the surgery (Duraes et al, 2019). The operation success is highly dependent on the preoperative planning and will influence the final breast shape (Rahman, 2011).…”