Post-lumpectomy CT-guided tumor bed delineation for breast boost and partial breast irradiation: Can additional pre- and postoperative imaging reduce interobserver variability?

den Hartogh,Mariska  D.; Philippens,Marielle  E.P.; van Dam,Iris  E.; Kleynen,Catharina  E.; Tersteeg,Robbert  J.H.A.; Kotte,Alexis  N.T.J.; van Vulpen,Marco; van Asselen,Bram; van den Bongard,Desirée  H.J.G.

doi:10.3892/ol.2015.3697

November-2015 Volume 10 Issue 5

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November-2015 Volume 10 Issue 5

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Post-lumpectomy CT-guided tumor bed delineation for breast boost and partial breast irradiation: Can additional pre- and postoperative imaging reduce interobserver variability?

Authors:
- Mariska D. den Hartogh
- Marielle E.P. Philippens
- Iris E. van Dam
- Catharina E. Kleynen
- Robbert J.H.A. Tersteeg
- Alexis N.T.J. Kotte
- Marco van Vulpen
- Bram van Asselen
- Desirée H.J.G. van den Bongard
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Affiliations: Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

Copyright: © den Hartogh et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Pages: 2795-2801
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Published online on: September 14, 2015

https://doi.org/10.3892/ol.2015.3697
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Abstract

For breast boost radiotherapy or accelerated partial breast irradiation, the tumor bed (TB) is delineated by the radiation oncologist on a planning computed tomography (CT) scan. The aim of the present study was to investigate whether the interobserver variability (IOV) of the TB delineation is reduced by providing the radiation oncologist with additional magnetic resonance imaging (MRI) or CT scans. A total of 14 T1‑T2 breast cancer patients underwent a standard planning CT in the supine treatment position following lumpectomy, as well as additional pre‑ and postoperative imaging in the same position. Post‑lumpectomy TBs were independently delineated by four breast radiation oncologists on standard postoperative CT and on CT registered to an additional imaging modality. The additional imaging modalities used were postoperative MRI, preoperative contrast‑enhanced (CE)‑CT and preoperative CE‑MRI. A cavity visualization score (CVS) was assigned to each standard postoperative CT by each observer. In addition, the conformity index (CI), volume and distance between centers of mass (dCOM) of the TB delineations were calculated. On CT, the median CI was 0.57, with a median volume of 22 cm3 and dCOM of 5.1 mm. The addition of postoperative MRI increased the median TB volume significantly to 28 cm3 (P<0.001), while the CI (P=0.176) and dCOM (P=0.110) were not affected. The addition of preoperative CT or MRI increased the TB volume to 26 and 25 cm3, respectively (both P<0.001), while the CI increased to 0.58 and 0.59 (both P<0.001) and the dCOM decreased to 4.7 mm (P=0.004) and 4.6 mm (P=0.001), respectively. In patients with CVS≤3, the median CI was 0.40 on CT, which was significantly increased by all additional imaging modalities, up to 0.52, and was accompanied by a median volume increase up to 6 cm3. In conclusion, the addition of postoperative MRI, preoperative CE‑CT or preoperative CE‑MRI did not result in a considerable reduction in the IOV in postoperative CT‑guided TB delineation, while target volumes marginally increased. The value of additional imaging may be dependent on CVS.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Post-lumpectomy CT-guided tumor bed delineation for breast boost and partial breast irradiation: Can additional pre- and postoperative imaging reduce interobserver variability?

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