Abstract
Background
Wire-localized excision of nonpalpable breast cancer is imprecise, resulting in positive margins 25–30% of the time.
Methods
Patients underwent preoperative supine magnetic resonance imaging (MRI). A radiologist outlined the tumor edges on consecutive images, creating a three-dimensional (3D) view of its location. Using 3D printing, a bra-like plastic form (the Breast Cancer Locator [BCL]) was fabricated, with features that allowed a surgeon to (1) mark the edges of the tumor on the breast surface; (2) inject blue dye into the breast 1 cm from the tumor edges; and (3) place a wire in the tumor at the time of surgery.
Results
Nineteen patients with palpable cancers underwent partial mastectomy after placement of surgical cues using patient-specific BCLs. The cues were in place in <5 min and no adverse events occurred. The BCL accurately localized 18/19 cancers. In the 18 accurately localized cases, all 68 blue-dye injections were outside of the tumor edges. Median distance from the blue-dye center to the pathologic tumor edge was 1.4 cm, while distance from the blue dye to the tumor edge was <5 mm in 4% of injections, 0.5–2.0 cm in 72% of injections, and >2 cm in 24% of injections. Median distance from the tumor center to the BCL-localized wire and to the clip placed at the time of diagnosis was similar (0.49 vs. 0.73 cm) on specimen mammograms.
Conclusions
Information on breast cancer location and shape derived from a supine MRI can be transferred safely and accurately to patients in the operating room using a 3D-printed form.
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Disclosure
Drs. Barth, Krishnaswamy and Paulsen have ownership interest in CairnSurgical LLC. This work was supported by National Institutes of Health/National Cancer Institute (NIH/NCI) Grant R43 CA210810 to CairnSurgical LLC, and a Synergy Clinician Entrepreneur Fellowship to Richard J. Barth. Timothy B. Rooney, Wendy A. Wells, Elizabeth Rizzo, Christina V. Angeles, Jonathan D. Marotti, Rebecca A. Zuurbier, and Candice C. Black have no conflicts of interest to declare.
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Barth, R.J., Krishnaswamy, V., Paulsen, K.D. et al. A Patient-Specific 3D-Printed Form Accurately Transfers Supine MRI-Derived Tumor Localization Information to Guide Breast-Conserving Surgery. Ann Surg Oncol 24, 2950–2956 (2017). https://doi.org/10.1245/s10434-017-5979-z
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DOI: https://doi.org/10.1245/s10434-017-5979-z