Intraoperative Supine Breast MR Imaging to Quantify Tumor Deformation and Detection of Residual Breast Cancer: Preliminary Results

Abstract

Purpose To use intraoperative supine magnetic resonance (MR) imaging to quantify breast tumor deformation and displacement secondary to the change in patient positioning from imaging (prone) to surgery (supine) and to evaluate residual tumor immediately after breast-conserving surgery (BCS). Materials and Methods Fifteen women gave informed written consent to participate in this prospective HIPAA-compliant, institutional review board-approved study between April 2012 and November 2014. Twelve patients underwent lumpectomy and postsurgical intraoperative supine MR imaging. Six of 12 patients underwent both pre- and postsurgical supine MR imaging. Geometric, structural, and heterogeneity metrics of the cancer and distances of the tumor from the nipple, chest wall, and skin were computed. Mean and standard deviations of the changes in volume, surface area, compactness, spherical disproportion, sphericity, and distances from key landmarks were computed from tumor models. Imaging duration was recorded. Results The mean differences in tumor deformation metrics between prone and supine imaging were as follows: volume, 23.8% (range, -30% to 103.95%); surface area, 6.5% (range, -13.24% to 63%); compactness, 16.2% (range, -23% to 47.3%); sphericity, 6.8% (range, -9.10% to 20.78%); and decrease in spherical disproportion, -11.3% (range, -60.81% to 76.95%). All tumors were closer to the chest wall on supine images than on prone images. No evidence of residual tumor was seen on MR images obtained after the procedures. Mean duration of pre- and postoperative supine MR imaging was 25 minutes (range, 18.4-31.6 minutes) and 19 minutes (range, 15.1-22.9 minutes), respectively. Conclusion Intraoperative supine breast MR imaging, when performed in conjunction with standard prone breast MR imaging, enables quantification of breast tumor deformation and displacement secondary to changes in patient positioning from standard imaging (prone) to surgery (supine) and may help clinicians evaluate for residual tumor immediately after BCS. ^© RSNA, 2016 Online supplemental material is available for this article.

Figure 1:

Flowchart shows imaging workflow on the day of surgery in the operating room imaging suite. All patients underwent standard diagnostic dynamic contrast-enhanced breast MR imaging in the prone position on a prior day. Image-guided wire localization, if necessary, was performed prior to surgery with MR imaging–conditional wire.

Figure 2a:

Breast and tumor deformation and displacement in six patients. Prone diagnostic and supine preprocedural contrast-enhanced MR images are superimposed on one another with 3D prone (blue) and supine (green) tumor models after iterative closest point registration. The surgeon can view these images intraoperatively to plan the surgical incision. (a) Images in a 52-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-negative invasive lobular cancer. (b) Images in a 59-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-equivocal invasive ductal cancer and ductal carcinoma in situ. (c) Images in a 53-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer. (d) Images in a 43-year-old patient with a well-differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive mixed ductal and lobular cancer and ductal carcinoma in situ. (e) Images in a 64-year-old patient with poorly differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer and ductal carcinoma in situ. (f) Images in a 34-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer.

Figure 2b:

Breast and tumor deformation and displacement in six patients. Prone diagnostic and supine preprocedural contrast-enhanced MR images are superimposed on one another with 3D prone (blue) and supine (green) tumor models after iterative closest point registration. The surgeon can view these images intraoperatively to plan the surgical incision. (a) Images in a 52-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-negative invasive lobular cancer. (b) Images in a 59-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-equivocal invasive ductal cancer and ductal carcinoma in situ. (c) Images in a 53-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer. (d) Images in a 43-year-old patient with a well-differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive mixed ductal and lobular cancer and ductal carcinoma in situ. (e) Images in a 64-year-old patient with poorly differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer and ductal carcinoma in situ. (f) Images in a 34-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer.

Figure 2c:

Breast and tumor deformation and displacement in six patients. Prone diagnostic and supine preprocedural contrast-enhanced MR images are superimposed on one another with 3D prone (blue) and supine (green) tumor models after iterative closest point registration. The surgeon can view these images intraoperatively to plan the surgical incision. (a) Images in a 52-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-negative invasive lobular cancer. (b) Images in a 59-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-equivocal invasive ductal cancer and ductal carcinoma in situ. (c) Images in a 53-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer. (d) Images in a 43-year-old patient with a well-differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive mixed ductal and lobular cancer and ductal carcinoma in situ. (e) Images in a 64-year-old patient with poorly differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer and ductal carcinoma in situ. (f) Images in a 34-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer.

Figure 2d:

Breast and tumor deformation and displacement in six patients. Prone diagnostic and supine preprocedural contrast-enhanced MR images are superimposed on one another with 3D prone (blue) and supine (green) tumor models after iterative closest point registration. The surgeon can view these images intraoperatively to plan the surgical incision. (a) Images in a 52-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-negative invasive lobular cancer. (b) Images in a 59-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-equivocal invasive ductal cancer and ductal carcinoma in situ. (c) Images in a 53-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer. (d) Images in a 43-year-old patient with a well-differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive mixed ductal and lobular cancer and ductal carcinoma in situ. (e) Images in a 64-year-old patient with poorly differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer and ductal carcinoma in situ. (f) Images in a 34-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer.

Figure 2e:

Breast and tumor deformation and displacement in six patients. Prone diagnostic and supine preprocedural contrast-enhanced MR images are superimposed on one another with 3D prone (blue) and supine (green) tumor models after iterative closest point registration. The surgeon can view these images intraoperatively to plan the surgical incision. (a) Images in a 52-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-negative invasive lobular cancer. (b) Images in a 59-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-equivocal invasive ductal cancer and ductal carcinoma in situ. (c) Images in a 53-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer. (d) Images in a 43-year-old patient with a well-differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive mixed ductal and lobular cancer and ductal carcinoma in situ. (e) Images in a 64-year-old patient with poorly differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer and ductal carcinoma in situ. (f) Images in a 34-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer.

Figure 2f:

Breast and tumor deformation and displacement in six patients. Prone diagnostic and supine preprocedural contrast-enhanced MR images are superimposed on one another with 3D prone (blue) and supine (green) tumor models after iterative closest point registration. The surgeon can view these images intraoperatively to plan the surgical incision. (a) Images in a 52-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-negative invasive lobular cancer. (b) Images in a 59-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-equivocal invasive ductal cancer and ductal carcinoma in situ. (c) Images in a 53-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer. (d) Images in a 43-year-old patient with a well-differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive mixed ductal and lobular cancer and ductal carcinoma in situ. (e) Images in a 64-year-old patient with poorly differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer and ductal carcinoma in situ. (f) Images in a 34-year-old patient with moderately differentiated estrogen receptor, progesterone receptor–positive, and HER2/neu-positive invasive ductal cancer.