TBVR, as measured by the preoperative MRI, is an objective parameter which could contribute to the surgical decision of whether to perform breast-conserving surgery or a mastectomy, while also being potentially applied as a predictive factor of the cosmetic outcome in breast cancer patients undergoing conserving surgery. While improving overall cosmetic results compared to mastectomy (nonetheless achieving acceptable surgical outcomes), breast-conserving surgery can still lead to postoperative aesthetic deformity or involved margins. Discussionįor early-stage invasive breast cancer the standard of care is breast-conserving surgery followed by whole-breast radiation therapy. Reader 2’s measurements yielded a median TBVR of 10.37‰ (IQR 2.39–14.23‰) in the women who underwent mastectomy, and a median TBVR of 1.09‰ (IQR 0.49–2.64‰) in the women who underwent breast-conserving surgery ( p < 0.001, Figure 5). Also considering reader-specific assessment, Reader 1’s measurements showed a median TBVR of 10.43‰ (IQR 2.46–15.23‰) in the women who underwent mastectomy, and a median TBVR of 1.19‰ (IQR 0.49–2.51‰) in the women who underwent breast-conserving surgery ( p < 0.001, Figure 4). This difference was mirrored by the TBVR values: overall, lower TBVR values ( p < 0.001) were observed in the breast-conserving surgery group (median 1.14‰, interquartile range 0.49–2.55‰) than in the mastectomy group (median 10.52‰, interquartile range 2.42–14.73‰). When the women who underwent breast-conserving surgery and those who underwent mastectomy were compared, the Mann-Whitney U test found a statistically significant difference ( p = 0.008) between the median tumour size at the final pathology (available for 41 women), with a median 2.20 cm tumour size (IQR 1.50–2.50 cm) in the women who underwent mastectomy, and a median 1.35 cm tumour size (IQR 1.00–1.80 cm) in the women who underwent breast-conserving surgery ( Figure 3).
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However, several issues, such as the time-consuming and operator-dependent nature of manual image segmentation, need to be carefully addressed in order to establish the role of MRI-derived TBVR in the preoperative setting. Breast MRI, which is frequently used to guide surgical planning, has been associated more commonly than automated breast ultrasound with an accurate assessment of tumour size and of overall breast volume. However, TBVR measurement has yet to enter routine use, nor has it been consistently associated with a specific imaging modality, even though automated breast ultrasound and breast magnetic resonance imaging (MRI) are chiefly considered for such assessment as a consequence of being three-dimensional imaging methods. have recently defined a preoperative prediction model of cosmetic results based on tumour-to-breast volume ratio (TBVR) and tumour location.
A large tumour volume relative to the total breast volume and tumour location is known to be a relevant predictive factor of poor cosmetic results. In clinical practice, a preoperative standardized assessment of the expected cosmetic outcome after conserving surgery is lacking. Large scale prospective studies are needed in order to validate MRI-derived TBVR as a predictor of the type of breast surgery. Significantly-lower TBVR values were observed in the breast-conserving surgery group (median 1.14‰, interquartile range 0.49–2.55‰) than in the mastectomy group (median 10.52‰, interquartile range 2.42–14.73‰) for both readers ( p < 0.001). The median segmentation times were 54 s for the WBV and 141 s for the TV. The median TBVR was 2.08‰ (interquartile range 0.70–9.13‰) for Reader 1, and 2.28‰ (interquartile range 0.71–9.61‰) for Reader 2, with an 84% inter-reader reproducibility. Breast-conserving surgery (BCS) was performed in 31/51 cases (61%) mastectomy was performed in 20/51 cases (39%). Mann-Whitney U, Spearman correlations, and Bland-Altman statistics were used. The intraobserver and interobserver TBVR reproducibility were calculated. Two specifically-trained residents (R1 and R2) independently segmented T1-weighted datasets of 51 cancer cases in 51 patients (median age 57 years). The TBVR was obtained using a fully manual method for the segmentation of the tumour volume (TV) and a growing region semiautomatic method for the segmentation of the whole breast volume (WBV). In this retrospective Ethics-Committee–approved study, we assessed the correlation between magnetic resonance imaging (MRI)-derived TBVR and the performed surgery.
The tumour-to-breast volume ratio (TBVR) is a metric that may help surgical decision making.
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