3D成像技术在乳腺癌保乳术中术前评估的应用

Application of 3D imaging technology in preoperative evaluation of breast conserving surgery

目的:探讨3D成像技术在乳腺癌保乳术中的术前评估应用价值。方法:回顾性分析2017年4月至2019年1月武汉科技大学附属孝感医院38例在3D成像技术辅助下行乳腺癌保乳术患者的临床资料。所有患者术前均行3.0 T乳腺MRI检查,通过医学数字成像及通信(digital imaging and communication of medicine,DICOM)数据立体建模,构建3D成像技术重建虚拟图像。比较术前预计切除组织体积(predicted resected tissue volume,PRTV)及术中实际切除组织体积(actual resection tissue volume,ARTV)差异性及一致性,并行保乳术后组织标本切缘及乳房美学评价。结果:3D成像技术能准确反映乳腺、肿瘤、腺体及血管等解剖结构及其三维毗邻关系。术中所见与术前3D图像吻合度为97.4%(37/38)。术前PRTV为(61.7±20.1)m L,术中ARTV为(65.1±20.7)m L,两者比较差异无统计学意义(P>0.05),具有较好的一致性(P<0.01)。术后补充二次手术1例,发生率2.6%(1/38)。术后乳房外形满意度100%(38/38)。结论:3D成像技术可清晰地显示乳腺肿瘤与周围组织的解剖关系,准确评估保乳术切除体积,指导手术切除。

Objective: To evaluate 3 D imaging technology in the preoperative evaluation of breast conserving surgery. Methods: A retrospective analysis was conducted using clinical data from 38 patients who underwent breast conserving surgery that was assisted by3 D imaging technology in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from April 2017 to January 2019.All 38 patients underwent 3.0-T breast magnetic resonance imaging(MRI) examination before surgery, and 3 D reconstruction of virtual images was constructed through 3 D modeling of medical digital imaging and communication(DICOM) data. The predicted resected tissue volume was compared with the volume of the actual resected specimen, and the surgical margin and postoperative aesthetics of the breast conserving surgery were evaluated. Results: The reconstructed 3 D model clearly displayed the anatomical structures of the breast, tumor, gland, and blood vessels, and their relationship in 3 D spaces. The goodness of fit of the 3 D model to the practical situation was 97.4%(37/38). In terms of the resection tissue volume, there was no significant difference between the predicted results(PRTV) and actual results(ARTV)[(61.7±20.1) mL vs.(65.1±20.7) mL, P>0.05]. There was a strong positive correlation between ARTV and PRTV(P<0.01). One patient underwent supplementary secondary surgery, resulting in an incidence of 2.6%(1/38). The postoperative satisfaction for breast conserving surgery was 100%(38/38). Conclusions: 3 D imaging technology clearly displays the anatomical relationship between breast tumor and surrounding tissues, and correctly assesses breast volume, guiding surgical resection.