3D-Printed Guides Aid Breast Conservation Surgery

By HospiMedica International staff writers
Posted on 02 Mar 2021

Image: MRI-based 3DP-BSG modeling (A); marking on the skin surface using 3DP-BSG, and targeting the tumor inside the breast by injecting blue dye (B); After removal of the guide. (Photo courtesy of AMC)

3D printed-breast surgical guides (3DP-BSG) can help delineate the tumor area during breast-conserving surgery (BCS), according to a new study.

Developed at Asan Medical Center (AMC; Seoul, Korea) and Gyeongsang National University Changwon Hospital (Republic of Korea), the 3DP-BSG are to mark the safety excision margin, 0.5 cm outside of the tumor edges. Fabricates using supine magnetic resonance imaging (MRI) scans and 3D images, the guide fits on the surface of the breast and includes a hole at the nipple, with direction markers indicating the opposite nipple and the suprasternal notch to prevent rotation. The digital model is exported to a 3D printer in a stereolithography (STL) file format.

To test their accuracy and efficacy, the guides were used in a prospective study that included 39 patients who underwent BCS and neoadjuvant systemic therapy (NST). Overall, tumor-positive resection margins were found in four patients (10.3%), compared to the 40% rate of tumor-positive margins reported in the literature. Over a three-year follow-up, three (7.7%) of the patients suffered recurrent breast cancer, compared with the five-year 12.1% local recurrence rate reported in literature. The study was published on February 9, 2021, in Scientific Reports.

“By using 3D-printed breast surgical guides as a localization method in patients receiving neoadjuvant systemic therapy, it is possible to precisely target the original tumor area observed in the pretreatment MRI,” concluded senior author Beom Seok Ko, MD, of AMC, and colleagues. “The advantages of the method are that it is painless, does not include radiation, and does not increase the procedure time. In addition, it allows for the preservation of normal breast tissue and precise tumor removal, enhancing the cosmetic effect.”

Several localization methods have been used to remove tumors that are challenging to identify with breast palpation alone. The most commonly used method, wire localization, may be associated with complications such as vasovagal syncope and pneumothorax, leading to problems during surgery like migration, cutting, and loss. Newer localization methods, such as radio-guided occult lesion localization (ROLL) and radioactive seed localization have also been developed due to the limitations of WL, and have been useful in BCS patients who underwent NST.

Related Links:
Asan Medical Center
Gyeongsang National University Changwon Hospital