A Prospective Investigation of Predictive Parameters for Preoperative Volume Assessment in Breast Reconstruction

Preoperative breast volume estimation is very important for the success of the breast surgery. In this study four different breast volume determination methods were compared. The end-point of this prospective study was to evaluate the concordance between different modalities of breast volume assessment (MRI, BREAST-V, mastectomy specimen weight, conversion from weight to volume of mastectomy specimen) and the breast prosthetic volume implanted. The study enrolled 64 patients between 2017 and 2019, who had all been treated by the same surgeons for monolateral nipple–areola complex-sparing mastectomy and implant breast reconstruction. Only patients who had a breast reconstruction classified as “excellent” from an objective (BCCT.core software) and subjective (questionnaire) point of view at the 6-month interval after the operation were included in the study. Data analysis highlighted a strong correlation between the volumes of the chosen prostheses and the weights of mastectomy converted into volume, especially for patients with grades B and C parenchymal density. The values of the agreement between the volumes of the chosen prostheses and the assessments from MRI and BREAST -V proved to be lower than expected from the literature. None of the four studied methods presented any strong correlation with the initial breast width. Our results suggest that conversion from weight to volume of mastectomy specimen should be used to assist in determining the volume of the breast implant to be implanted. This method would help the reconstructive surgeon guide the choice of the most appropriate implant preoperatively.

3D Breast Volume Estimation

<b><i>Introduction:</i></b> Breast volume estimation is considered crucial for breast cancer surgery planning. A single, easy, and reproducible method to estimate breast volume is not available. This study aims to evaluate, in patients proposed for mastectomy, the accuracy of the calculation of breast volume from a low-cost 3D surface scan (Microsoft Kinect) compared to the breast MRI and water displacement technique. <b><i>Material and Methods:</i></b> Patients with a Tis/T1–T3 breast cancer proposed for mastectomy between July 2015 and March 2017 were assessed for inclusion in the study. Breast volume calculations were performed using a 3D surface scan and the breast MRI and water displacement technique. Agreement between volumes obtained with both methods was assessed with the Spearman and Pearson correlation coefficients. <b><i>Results:</i></b> Eighteen patients with invasive breast cancer were included in the study and submitted to mastectomy. The level of agreement of the 3D breast volume compared to surgical specimens and breast MRI volumes was evaluated. For mastectomy specimen volume, an average (standard deviation) of 0.823 (0.027) and 0.875 (0.026) was obtained for the Pearson and Spearman correlations, respectively. With respect to MRI annotation, we obtained 0.828 (0.038) and 0.715 (0.018). <b><i>Discussion:</i></b> Although values obtained by both methodologies still differ, the strong linear correlation coefficient suggests that 3D breast volume measurement using a low-cost surface scan device is feasible and can approximate both the MRI breast volume and mastectomy specimen with sufficient accuracy. <b><i>Conclusion:</i></b> 3D breast volume measurement using a depth-sensor low-cost surface scan device is feasible and can parallel MRI breast and mastectomy specimen volumes with enough accuracy. Differences between methods need further development to reach clinical applicability. A possible approach could be the fusion of breast MRI and the 3D surface scan to harmonize anatomic limits and improve volume delimitation.

Prediction of the Ideal Implant Size Using 3-Dimensional Healthy Breast Volume in Unilateral Direct-to-Implant Breast Reconstruction

Background and objectives: There is no consensus regarding accurate methods for assessing the size of the implant required for achieving symmetry in direct-to-implant (DTI) breast reconstruction. The purpose of this study was to determine whether the ideal implant size could be estimated using 3D breast volume or mastectomy specimen weight, and to compare prediction performances between the two variables. Materials and Methods: Patients who underwent immediate DTI breast reconstruction from August 2017 to April 2020 were included in this study. Breast volumes were measured using 3D surface imaging preoperatively and at postoperative three months. Ideal implant size was calculated by correcting the used implant volume by the observed postoperative asymmetry in 3D surface imaging. Prediction models using mastectomy weight or 3D volume were made to predict the ideal implant volume. The prediction performance was compared between the models. Results: A total of 56 patients were included in the analysis. In correlation analysis, the volume of the implant used was significantly correlated with the mastectomy specimen weight (R2 = 0.810) and the healthy breast volume (R2 = 0.880). The mean ideal implant volume was 278 ± 123 cc. The prediction model was developed using the healthy breast volume: Implant volume (cc) = healthy breast volume × 0.78 + 26 cc (R2 = 0.900). The prediction model for the ideal implant size using the 3D volume showed better prediction performance than that of using the mastectomy specimen weight (R2 = 0.900 vs 0.759, p < 0.001). Conclusions: The 3D volume of the healthy breast is a more reliable predictor than mastectomy specimen weight to estimate the ideal implant size. The estimation formula obtained in this study may assist in the selection of the ideal implant size in unilateral DTI breast reconstruction.

Clinicohistologic Characteristics of Breast Cancer in Ghanaian Patients

Background Breast cancer is the leading cause of cancer morbidity and mortality worldwide. The management and prognosis of breast cancer depend heavily on the different histologic and molecular biologic features of the tumour. The different histologic types describe the distinct growth patterns and cytological features of the tumour. Methodology This is a retrospective study of archival breast cancer excision and mastectomy specimen at KBTH from 2012-2016. 729 cases were retrieved over the period and examined by two pathologists independently. Demography of the cases, tumour size, grade, histologic type, stage, mitosis, site of lesion etc. were entered into SPSS and analysed with chi-square done with P-value set at P < 0.05. Results and Conclusion The mean age of presentation is 52.45 ± 12.75 years. The commonest histologic type of breast cancer is invasive carcinoma (NOS) forming (87%). Only 1.2% of male presented with breast cancer with the other percentage in females. Most (88%) of the tumours were greater than 5cm at the time of surgery. The tumours are of high grade (II and III) forming 88%. Seventy-eight percent of cases presented with late stage of the disease (≥ stage IIB). There was association between histologic type and vascular invasion (P < 0.000) and lymph node involvement (P = 0.010). Moreover, tumour size showed an association with tumour grade (P < 0.05). This study has shown that breast cancer among Ghanaian patients has a worse histologic type with poor tumour characteristics giving it poor prognosis.

Post-reconstruction 3D single-distance phase retrieval for multi-stage phase-contrast tomography with photon-counting detectors

In the case of single-distance propagation-based phase-contrast X-ray computed tomography with synchrotron radiation, the conventional reconstruction pipeline includes an independent 2D phase retrieval filtering of each acquired projection prior to the actual reconstruction. In order to compensate for the limited height of the X-ray beam or the small sensitive area of most modern X-ray photon-counting detectors, it is quite common to image large objects with a multi-stage approach, i.e. several acquisitions at different vertical positions of the sample. In this context, the conventional reconstruction pipeline may introduce artifacts at the margins of each vertical stage. This article presents a modified computational protocol where a post-reconstruction 3D volume phase retrieval is applied. By comparing the conventional 2D and the proposed 3D reconstructions of a large mastectomy specimen (9 cm in diameter and 3 cm in height), it is here shown that the 3D approach compensates for the multi-stage artifacts, it avoids refined projection stitching, and the image quality in terms of spatial resolution, contrast and contrast-to-noise ratio is preserved.

Expression of Mesothelial Marker Calretinin in Breast Cancer

Calretinin (CR) is a calcium binding protein of calmodulin superfamily, a widely used marker for mesothelial differentiation. It is also found to be expressed in breast carcinoma. Breast carcinoma is the leading cause of cancer death in women and despite new approaches and advances, it is still difficult to predict the behaviour of the tumour and its prognosis. So there is a need and struggle to identify new markers for prognosis of breast cancer. The study is aimed at evaluating the frequency of Calretinin expression in breast carcinoma and assessing the characteristics of Calretinin positive tumours. Thirty mastectomy specimen of invasive breast carcinoma were analysed histopathologically and for immunohistochemical expression of ER, PR, HER2/neu and Calretinin. In this study 93.33% (28 cases) were of invasive carcinoma, NST and 6.67% were of other subtypes. Patients less than 40 years of age showed low CR expression and patients over 40 showed high CR expression (p = 0.22). Grade 3 tumours showed high CR, grades 1 and 2 showed low CR expression. Lymph node positive cases showed high CR and lymph node negative cases showed low CR. Tumours less than 5cms in size show low CR expression and those over 5cms showed high CR expression (p = 0.38). Negative ER, PR and HER2/neu showed high CR expression. CR expression was high in 54.5% of basal-like subtype and 66.7% of HER2-enriched.CR expression was low in 50% of luminal cases. High Calretinin expression was seen in grade 3, HER2-enriched and basal-like subtypes of breast cancer which may be of considerable prognostic significance.