Cone-beam breast CT-guided surface location facilitates breast-conserving surgery in breast cancer patients with extensive calcifications: A pilot study

Ya Sun; Ni He; Feng Ye; Chunyan Zhou; Yaopan Wu; Chuanmiao Xie; Jun Tang

doi:10.3389/fsurg.2023.1070868

Cone-beam breast CT-guided surface location facilitates breast-conserving surgery in breast cancer patients with extensive calcifications: A pilot study

Front Surg. 2023 Feb 9:10:1070868. doi: 10.3389/fsurg.2023.1070868. eCollection 2023.

Authors

Ya Sun¹, Ni He², Feng Ye¹, Chunyan Zhou², Yaopan Wu², Chuanmiao Xie², Jun Tang¹

Affiliations

¹ Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
² Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.

Abstract

Background: Extensive malignant-appearing calcifications have traditionally been considered a contraindication for breast-conserving surgery. The evaluation of calcifications largely depends on mammography, which is limited by tissue superimposition and is unable to reveal spatial information about extensive calcifications. Three-dimensional imaging modality is needed to reveal the architecture of extensive calcifications. In the present study, a novel cone-beam breast CT-guided surface location technique was investigated to facilitate breast-conserving surgery in breast cancer patients with extensive malignant breast calcifications.

Methods: Biopsy-proved early breast cancer patients with extensive malignant-appearing breast calcifications were included. A patient will be considered suitable for breast-conserving surgery if the spatial segmental distribution of calcifications is found by 3D images of cone-beam breast CT. Then, the margins of the calcifications were located in contrast-enhanced cone-beam breast CT images. Next, skin markers were located using radiopaque materials, and cone-beam breast CT was reperformed to confirm the accuracy of surface location. During breast-conserving surgery, lumpectomy was performed according to the previous surface location, and an intraoperative specimen x-ray was applied to double-check that the entire lesion was removed. Margin assessment was made for both intraoperative frozen section and postoperative pathology examination.

Results: From May 2019 to Jun 2022, 11 eligible breast cancer patients in our institution were included. Breast-conserving surgery was performed successfully in all patients using the surface location approach mentioned before. All patients achieved negative margins and satisfied cosmetic results.

Conclusion: This study proved the feasibility of cone-beam breast CT-guided surface location for facilitating breast-conserving surgery in breast cancer patients with extensive malignant breast calcifications.

Keywords: DCIS—breast ductal carcinoma in situ; breast-conserving surgery; cone-beam breast CT; extensive calcifications; surface location.

Grants and funding

This work was supported by the National Natural Science Foundation of China (grant numbers 81772835 and 81972481), the National Key Research and Development Program of China (grant numbers 2107YFC0112600 and 2017YFC0112605), the Natural Science Foundation of Guangdong Province (grant number 2019A1515011209), and Guangdong Medical Science and Technology Research Fund of China (grant number A201805).