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Does ultrasound provide any added value in breast contouring for radiotherapy after conserving surgery for cancer?

Aristei C, Palumbo I, Falcinelli L, Crisci R, Cardinali L, Palumbo B, Lancellotta V, Montesi G, Gobbi G, Zucchetti C, Bini V - Radiat Oncol (2015)

Bottom Line: Results were analyzed using descriptive statistics, percentage overlap and reproducibility measures (agreement and reliability).Since strong to almost perfect agreement emerged for all comparisons, reliability was high.US may be useful in defining the cranial and posterior extensions, mainly when tumours are localized there.

View Article: PubMed Central - PubMed

Affiliation: Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, 06156, Italy. cynthia.aristei@unipg.it.

ABSTRACT

Background: Whole breast irradiation after conserving surgery for breast cancer requires precise definition of the target volume. The standard approach uses computed tomography (CT) images. However, since fatty breast and non-breast tissues have similar electronic densities, difficulties in differentiating between them hamper breast volume delineation. To overcome this limitation the breast contour is defined by palpation and then radio-opaque wire is put around it before the CT scan. To optimize assessment of breast margins in the cranial, caudal, medial, lateral and posterior directions, the present study evaluated palpation and CT and determined whether ultrasound (US) provided any added value.

Methods: Twenty consecutive patients were enrolled after they had provided informed consent to participating in this prospective study which was approved by the Regional Public Health Ethics Committee. Palpation and US defined breast margins and each contour was marked and outlined with a fine plastic wire. Breasts were then contoured on axial CT images using the breast window width (WW) and window level (WL) (401 and 750 Hounsfield Units -HU- respectively), at which setting the plastic wires were invisible. Then, the lung window function (WW 1601 HU; WL -300 HU) was inserted to visualize the plastic wires which were used as guidelines to contour the palpable and US breast volumes. As each wire had a different diameter, both volumes were easily defined on CT slices. Results were analyzed using descriptive statistics, percentage overlap and reproducibility measures (agreement and reliability).

Results: Volumes: US gave the largest and palpation the smallest. Agreement was best between palpation and CT. Reliability was almost perfect in all correlations. Extensions: Cranial and posterior were highest with US and smallest with palpation. Agreement was best between palpation and CT in all extensions except the cranial. Since strong to almost perfect agreement emerged for all comparisons, reliability was high.

Conclusions: US may be useful in defining the cranial and posterior extensions, mainly when tumours are localized there. This study demonstrates that the now standard radio-opaque wires around the palpable breast may not be needed in breast contouring.

No MeSH data available.


Related in: MedlinePlus

Digitally reconstructed radiography showing: Panel a - Anterior field; Panel b - Lateral field. The figure shows the point of interest (POI), extensions from the POI (cranial, caudal, lateral, and medial in Panel a;  posterior in Panel b). Breast volume and the encompassing field are also illustrated. Distances from the POI and the field edges were used to measure breast extension
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Fig2: Digitally reconstructed radiography showing: Panel a - Anterior field; Panel b - Lateral field. The figure shows the point of interest (POI), extensions from the POI (cranial, caudal, lateral, and medial in Panel a; posterior in Panel b). Breast volume and the encompassing field are also illustrated. Distances from the POI and the field edges were used to measure breast extension

Mentions: The most medial, lateral, cranial, caudal and posterior extensions of each breast volume were defined for each patient. A point of interest (POI) was identified on the CT breast volume using a Pinnacle tool (autoplace point option). The placement algorithm uses the smallest possible box to cover the region of interest, i.e. breast volume and then places the POI at the center of this construct. The CT POI was used as a reference point for breast volume as defined by palpation and US. Starting from the POI anterior and lateral orthogonal fields were created to encompass each breast volume. Maximum extensions from the POI in the cranial, caudal, medial and lateral directions were automatically calculated in the anterior field, which was visible on the digitally reconstructed radiography (Fig.2A). Maximum posterior extension was similarly calculated in the lateral field (Fig.2B).Fig. 2


Does ultrasound provide any added value in breast contouring for radiotherapy after conserving surgery for cancer?

Aristei C, Palumbo I, Falcinelli L, Crisci R, Cardinali L, Palumbo B, Lancellotta V, Montesi G, Gobbi G, Zucchetti C, Bini V - Radiat Oncol (2015)

Digitally reconstructed radiography showing: Panel a - Anterior field; Panel b - Lateral field. The figure shows the point of interest (POI), extensions from the POI (cranial, caudal, lateral, and medial in Panel a;  posterior in Panel b). Breast volume and the encompassing field are also illustrated. Distances from the POI and the field edges were used to measure breast extension
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4554322&req=5

Fig2: Digitally reconstructed radiography showing: Panel a - Anterior field; Panel b - Lateral field. The figure shows the point of interest (POI), extensions from the POI (cranial, caudal, lateral, and medial in Panel a; posterior in Panel b). Breast volume and the encompassing field are also illustrated. Distances from the POI and the field edges were used to measure breast extension
Mentions: The most medial, lateral, cranial, caudal and posterior extensions of each breast volume were defined for each patient. A point of interest (POI) was identified on the CT breast volume using a Pinnacle tool (autoplace point option). The placement algorithm uses the smallest possible box to cover the region of interest, i.e. breast volume and then places the POI at the center of this construct. The CT POI was used as a reference point for breast volume as defined by palpation and US. Starting from the POI anterior and lateral orthogonal fields were created to encompass each breast volume. Maximum extensions from the POI in the cranial, caudal, medial and lateral directions were automatically calculated in the anterior field, which was visible on the digitally reconstructed radiography (Fig.2A). Maximum posterior extension was similarly calculated in the lateral field (Fig.2B).Fig. 2

Bottom Line: Results were analyzed using descriptive statistics, percentage overlap and reproducibility measures (agreement and reliability).Since strong to almost perfect agreement emerged for all comparisons, reliability was high.US may be useful in defining the cranial and posterior extensions, mainly when tumours are localized there.

View Article: PubMed Central - PubMed

Affiliation: Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, 06156, Italy. cynthia.aristei@unipg.it.

ABSTRACT

Background: Whole breast irradiation after conserving surgery for breast cancer requires precise definition of the target volume. The standard approach uses computed tomography (CT) images. However, since fatty breast and non-breast tissues have similar electronic densities, difficulties in differentiating between them hamper breast volume delineation. To overcome this limitation the breast contour is defined by palpation and then radio-opaque wire is put around it before the CT scan. To optimize assessment of breast margins in the cranial, caudal, medial, lateral and posterior directions, the present study evaluated palpation and CT and determined whether ultrasound (US) provided any added value.

Methods: Twenty consecutive patients were enrolled after they had provided informed consent to participating in this prospective study which was approved by the Regional Public Health Ethics Committee. Palpation and US defined breast margins and each contour was marked and outlined with a fine plastic wire. Breasts were then contoured on axial CT images using the breast window width (WW) and window level (WL) (401 and 750 Hounsfield Units -HU- respectively), at which setting the plastic wires were invisible. Then, the lung window function (WW 1601 HU; WL -300 HU) was inserted to visualize the plastic wires which were used as guidelines to contour the palpable and US breast volumes. As each wire had a different diameter, both volumes were easily defined on CT slices. Results were analyzed using descriptive statistics, percentage overlap and reproducibility measures (agreement and reliability).

Results: Volumes: US gave the largest and palpation the smallest. Agreement was best between palpation and CT. Reliability was almost perfect in all correlations. Extensions: Cranial and posterior were highest with US and smallest with palpation. Agreement was best between palpation and CT in all extensions except the cranial. Since strong to almost perfect agreement emerged for all comparisons, reliability was high.

Conclusions: US may be useful in defining the cranial and posterior extensions, mainly when tumours are localized there. This study demonstrates that the now standard radio-opaque wires around the palpable breast may not be needed in breast contouring.

No MeSH data available.


Related in: MedlinePlus