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Open Access 01-12-2014 | Research

MRI and CT imaging for preoperative target volume delineation in breast-conserving therapy

Authors: Mariska D den Hartogh, Marielle EP Philippens, Iris E van Dam, Catharina E Kleynen, Robbert JHA Tersteeg, Ruud M Pijnappel, Alexis NTJ Kotte, Helena M Verkooijen, Maurice AAJ van den Bosch, Marco van Vulpen, Bram van Asselen, HJG Desirée van den Bongard

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

Accurate tumor bed delineation after breast-conserving surgery is important. However, consistency among observers on standard postoperative radiotherapy planning CT is low and volumes can be large due to seroma formation. A preoperative delineation of the tumor might be more consistent. Therefore, the purpose of this study was to determine the consistency of preoperative target volume delineation on CT and MRI for breast-conserving radiotherapy.

Methods

Tumors were delineated on preoperative contrast-enhanced (CE) CT and newly developed 3D CE-MR images, by four breast radiation oncologists. Clinical target volumes (CTVs) were created by addition of a 1.5 cm margin around the tumor, excluding skin and chest wall. Consistency in target volume delineation was expressed by the interobserver variability. Therefore, the conformity index (CI), center of mass distance (dCOM) and volumes were calculated. Tumor characteristics on CT and MRI were scored by an experienced breast radiologist.

Results

Preoperative tumor delineation resulted in a high interobserver agreement with a high median CI for the CTV, for both CT (0.80) and MRI (0.84). The tumor was missed on CT in 2/14 patients (14%). Leaving these 2 patients out of the analysis, CI was higher on MRI compared to CT for the GTV (p < 0.001) while not for the CTV (CT (0.82) versus MRI (0.84), p = 0.123). The dCOM did not differ between CT and MRI. The median CTV was 48 cm³ (range 28–137 cm³) on CT and 59 cm³ (range 30–153 cm³) on MRI (p < 0.001). Tumor shapes and margins were rated as more irregular and spiculated on CE-MRI.

Conclusions

This study showed that preoperative target volume delineation resulted in small target volumes with a high consistency among observers. MRI appeared to be necessary for tumor detection and the visualization of irregularities and spiculations. Regarding the tumor delineation itself, no clinically relevant differences in interobserver variability were observed. These results will be used to study the potential for future MRI-guided and neoadjuvant radiotherapy.

Trial registration

International Clinical Trials Registry Platform NTR3198.

Available only for authorised users

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Title: MRI and CT imaging for preoperative target volume delineation in breast-conserving therapy
Authors: Mariska D den Hartogh
Marielle EP Philippens
Iris E van Dam
Catharina E Kleynen
Robbert JHA Tersteeg
Ruud M Pijnappel
Alexis NTJ Kotte
Helena M Verkooijen
Maurice AAJ van den Bosch
Marco van Vulpen
Bram van Asselen
HJG Desirée van den Bongard
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-9-63

Keynote webinar | Spotlight on medication adherence

Springer Medicine

MRI and CT imaging for preoperative target volume delineation in breast-conserving therapy

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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