Ann Surg Treat Res.  2021 Jun;100(6):313-319. 10.4174/astr.2021.100.6.313.

Mammography with a fully automated breast volumetric software as a novel method for estimating the preoperative breast volume prior to mastectomy

• Kim JS
• Bae K
• Lee EJ
• Bang M

• KMID: 2516224
• DOI: http://doi.org/10.4174/astr.2021.100.6.313

Abstract

Purpose
Increasing interest in maintaining a positive body image following breast cancer surgery has become an important aspect of reconstruction surgery. Volume matching of the reconstructed breast to natural breasts is the most important consideration. This study aimed to explore the feasibility of using mammography with a fully automated breast volumetric software to measure the preoperative breast volume in patients with breast cancer.
Methods
We evaluated patients who underwent a total mastectomy between July 2016 and February 2021. The specimen volume following total mastectomy was compared with breast volume estimates using a fully automated volumetric software (Quantra ver. 2.1.1) and 4 other previously described mammography-based prediction methods. The association between the estimates and mastectomy specimen volume was assessed using Pearson correlation and Bland-Altman analysis.
Results
Sixty-six patients were included. Compared with previously described mammography-based methods, Quantra estimates were more strongly correlated with mastectomy specimen volume in the entire, fatty, and dense breast groups (r = 0.920, 0.921, and 0.915, respectively; P < 0.001). In applying Quantra estimates for measuring preoperative breast volume, we adjusted a simple equation: mastectomy specimen volume = Quantra estimate × 0.8.
Conclusion
Mammography with a fully automated breast volumetric software can be useful for measuring preoperative breast volume in patients with breast cancer who undergo reconstruction surgery.

Keyword

Breast density; Breast neoplasms; Mammography; Mastectomy; Organ size; Software

Figure

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  Fig. 1 Quantra processing.

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  Fig. 2 Sample mammography measurements in a 51-year-old woman with invasive ductal carcinoma. (A) Craniocaudal view shows representations of measurements. W = medial to lateral width, R = W/2, H = posterior to anterior height, perpendicular from the posterior film edge to the most anterior portion of the breast. (B) Mediolateral oblique view shows representations of measurements. w = superolateral to inferomedial width, measured as a distance from the most acute portion of axillary concavity to the inframammary fold; r = w/2; h = posterior to anterior height, perpendicular to the pectoralis muscle from the anterior border of the muscle to the most anterior portion of the breast.

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  Fig. 3 Bland-Altman plot showing difference in adjusted Quantra estimates and mastectomy specimen volume. (A) Entire breast group, (B) fatty breast group, and (C) dense breast group.

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  Fig. 4 Sample image for Quantra-based estimation of preoperative breast volume. A 57-year-old woman with invasive ductal carcinoma of the right breast underwent a total mastectomy. (A) Preoperatively, the patient underwent routine mammography with fully automated breast volumetric software (Quantra). (B) The Quantra- and adjusted Quantra-based breast volume was 571 cm3 and 456.8 cm3, respectively. After total mastectomy, the weight of the actual mastectomy specimen was 460 g, and the converted specimen volume was 447.2 cm3.

Reference

1. Utsunomiya H, Kusano T, Sato N, Yoshimoto S. Estimating implant volume and mastectomy-specimen volume by measuring breast volume with a 3-dimensional scanner. Ann Plast Surg. 2017; 79:79–81. PMID: 28328637.

2. Choppin SB, Wheat JS, Gee M, Goyal A. The accuracy of breast volume measurement methods: a systematic review. Breast. 2016; 28:121–129. PMID: 27288864.

3. Kayar R, Civelek S, Cobanoglu M, Gungor O, Catal H, Emiroglu M. Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. . Breast Cancer (Auckl). 2011; 5:43–52. PMID: 21494401.

4. Kovacs L, Eder M, Hol lweck R, Zimmermann A, Settles M, Schneider A, et al. Comparison between breast volume measurement using 3D surface imaging and classical techniques. Breast. 2007; 16:137–145. PMID: 17029808.

5. Yip JM, Mouratova N, Jeffery RM, Veitch DE, Woodman RJ, Dean NR. Accurate assessment of breast volume: a study comparing the volumetric gold standard (direct water displacement measurement of mastectomy specimen) with a 3D laser scanning technique. Ann Plast Surg. 2012; 68:135–141. PMID: 21587046.

6. Losken A, Seify H, Denson DD, Paredes AA Jr, Carlson GW. Validating threedimensional imaging of the breast. Ann Plast Surg. 2005; 54:471–476. PMID: 15838205.

7. Bulstrode N, Bellamy E, Shrotria S. Breast volume assessment: comparing five different techniques. Breast. 2001; 10:117–123. PMID: 14965570.

8. Howes BH, Watson DI, Fosh B, Dean NR. Efficacy of an external volume expansion device and autologous fat grafting for breast reconstruction following breast conserving surgery and total mastectomy: small improvements in quality of life found in a prospective cohort study. J Plast Reconstr Aesthet Surg. 2020; 73:27–35. PMID: 31495743.

9. Chae MP, Rozen WM, Spychal RT, Hunter-Smith DJ. Breast volumetric analysis for aesthetic planning in breast reconstruction: a literature review of techniques. Gland Surg. 2016; 5:212–226. PMID: 27047788.

10. Itsukage S, Sowa Y, Goto M, Taguchi T, Numajiri T. Breast volume measurement by recycling the data obtained from 2 routine modalities, mammography and magnetic resonance imaging. Eplasty. 2017; 17:e39. PMID: 29308107.

11. Katariya RN, Forrest AP, Gravelle IH. Breast volumes in cancer of the breast. Br J Cancer. 1974; 29:270–273. PMID: 4830145.

12. Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003; 90:1505–1509. PMID: 14648728.

13. Fung JT, Chan SW, Chiu AN, Cheung PS, Lam SH. Mammographic determination of breast volume by elliptical cone estimation. World J Surg. 2010; 34:1442–1445. PMID: 20091167.

14. Kalbhen CL, McGill JJ, Fendley PM, Corrigan KW, Angelats J. Mammographic determinat ion of breast volume: comparing different methods. AJR Am J Roentgenol. 1999; 173:1643–1649. PMID: 10584814.

15. Hoe AL, Mullee MA, Royle GT, Guyer PB, Taylor I. Breast size and prognosis in early breast cancer. Ann R Coll Surg Engl. 1993; 75:18–22. PMID: 8422138.

16. Gweon HM, Youk JH, Kim JA, Son EJ. Radiologist assessment of breast density by BI-RADS categories versus fully automated volumetric assessment. AJR Am J Roentgenol. 2013; 201:692–697. PMID: 23971465.

17. Ciatto S, Bernardi D, Calabrese M, Durando M, Gentilini MA, Mariscotti G, et al. A first evaluation of breast radiological density assessment by QUANTRA software as compared to visual classification. Breast. 2012; 21:503–506. PMID: 22285387.

18. Youk JH, Gweon HM, Son EJ, Kim JA. Automated volumetric breast density measurements in the era of the birads fifth edition: a comparison with visual assessment. AJR Am J Roentgenol. 2016; 206:1056–1062. PMID: 26934689.

19. Skippage P, Wilkinson L, Allen S, Roche N, Dowsett M, A'hern R. Correlation of age and HRT use with breast density as assessed by Quantra™. Breast J. 2013; 19:79–86. PMID: 23230974.

20. Alonzo-Proulx O, Mawdsley GE, Patrie JT, Yaffe MJ, Harvey JA. Reliability of automated breast density measurements. Radiology. 2015; 275:366–376. PMID: 25734553.

21. Rahbar K, Gubern-Merida A, Patrie JT, Harvey JA. Automated volumetric mammographic breast density measurements may underestimate percent breast density for high-density breasts. Acad Radiol. 2017; 24:1561–1569. PMID: 28754209.

22. Boone JM, Fewell TR, Jennings RJ. Molybdenum, rhodium, and tungsten anode spectral models using interpolating polynomials with application to mammography. Med Phys. 1997; 24:1863–1874. PMID: 9434969.

23. Wilson CB, Lammertsma AA, McKenzie CG, Sikora K, Jones T. Measurements of blood flow and exchanging water space in breast tumors using positron emission tomography: a rapid and noninvasive dynamic method. Cancer Res. 1992; 52:1592–1597. PMID: 1540969.

24. Shaheed SU, Tait C, Kyriacou K, Linforth R, Salhab M, Sutton C. Evaluation of nipple aspirate fluid as a diagnostic tool for early detection of breast cancer. Clin Proteomics. 2018; 15:3. PMID: 29344009.

25. Herold C, Reichelt A, Stieglitz LH, Dettmer S, Knobloch K, Lotz J, et al. MRI-based breast volumetry-evaluation of three different software solutions. J Digit Imaging. 2010; 23:603–610. PMID: 20066465.

26. Herly M, Müller FC, Ørholt M, Hansen J, Sværke S, Hemmingsen MN, et al. The current gold standard breast volumetry technique seems to overestimate fat graft volume retention in the breast: a validation study. J Plast Reconstr Aesthet Surg. 2019; 72:1278–1284. PMID: 31029582.

27. Rha EY, Choi IK, Yoo G. Accuracy of the method for estimating breast volume on three-dimensional simulated magnetic resonance imaging scans in breast reconstruction. Plast Reconstr Surg. 2014; 133:14–20.