System for image-guided resection of nonpalpable breast lesions: Proof of concept.

Abstract

In breast-conserving surgery (BCS), the cancer is sometimes incompletely excised, leading to reduced patient survival. To pursue complete excisions, radioactive seed localization (RSL) may be used to insert an iodine-125 seed into the tumor. The seed is used as a marker for the location of the tumor during surgery. RSL does not, however, show the extent of the tumor. Based on RSL, we pursue to visualize the seed location together with the extent from diagnostic images. A system with two gamma-camera heads and two parallel-hole collimators was recently proposed to triangulate the location of an iodine-125 seed during BCS. In the present study, this system was extended with a range camera to visualize a sphere centered on the seed in relation to the breast. This sphere contains the entire tumor and thus defines the target volume for BCS. Physical experiments with acrylic block phantoms (thickness ranging from 3.5 to 6.5cm) were performed to assess the absolute bias and the precision with which this sphere can be visualized. When a 6.5cm thick phantom was used, along the horizontal plane, the target volume was visualized with an absolute bias and a precision of 2.1 and 0.8mm, respectively. Along the vertical axis (i.e., z-axis), these values were 4.2 and 2.8mm, respectively. The proposed system visualizes the target volume with an absolute bias that may be acceptable for BCS.