Breast-conserving surgery with 3D-printed surgical guide: a single-center, prospective clinical study

Abstract

To facilitate precise tumor resection at the time of breast-conserving surgery (BCS), we developed and implemented a magnetic resonance imaging (MRI)-based three-dimensional-printed (3DP) breast surgical guide (BSG). This prospective cohort study was conducted at a single institution from July 2017 to February 2019 on women with breast cancer who underwent partial breast resection using patient-specific 3DP BSGs. Eighty-eight patients with invasive cancer were enrolled, of whom 1 patient had bilateral breast cancer. The mean size of the tumor long-axis on MRI before surgery was 2.8 ± 0.9 cm, and multiple tumors were observed in 34 patients. In 16 cases (18.0%), the resection margin was tumor-positive according to intraoperative frozen biopsy; all of these tumors were ductal carcinoma in situ and were re-excised intraoperatively. In 93.3% of the cases, the resection margin was tumor-free in the permanent pathology. The mean pathological tumor size was 1.7 ± 1.0 cm, and the mean distance from the tumor to the border was 1.5 ± 1.0 cm. This exploratory study showed that the tumor area on the MRI could be directly displayed on the breast when using a 3DP BSG for BCS, thereby allowing precise surgery and safe tumor removal.Trial Registration Clinical Research Information Service (CRIS) Identifier (No. KCT0002375, KCT0003043).

Figure 1

Segmentation of the breast and tumor in prone/supine magnetic resonance imaging (MRI) for breast surgical guide (BSG) modeling. (a) Segmented tumor on prone MRI, (b) Segmented tumor on supine MRI, (c) 3D modeling of the breast and tumor on supine MRI, (d) BSG tailored to the patient's breast surface to target tumors inside the breast.

Figure 2

Partial breast excision by applying a breast surgical guide (BSG). (a) To accurately localize the tumor, fix the BSG based on both nipples and the suprasternal notch, (b) Quantitatively mark the area of the tumor on the breast surface along the groove of the BSG, (c) Match the removed breast specimen to the tumor area in the BSG.