Validation of Vectra XT three-dimensional imaging system for measuring breast volume and symmetry following oncological reconstruction
O’Connell RL, Khabra K, Bamber JC, deSouza N, Meybodi F, Barry PA, Rusby JE
Published in Journal of Breast Cancer & Research Treatment February 2018
This study aimed to investigate whether breast volume and symmetry measured by a 3D surface imaging system (3D-SI) called Vectra XT is accurate enough to be used in planning breast cancer surgery and whether it can be used as an objective measure of cosmetic appearance.
Breast ‘’phantom’’ models of different volumes were created using plasticine, and small amounts of plasticine were then removed to mimic pieces of breast tissue being removed, as would be done during lumpectomy surgery.
The volumes of these phantoms were then measured using 3D-SI by two observers and the measurements were then compared between the 3D-SI and true volume as measured with a water displacement technique (the gold standard). This study showed that 3D-SI volume measurements for the breast phantom were accurate enough when compared to the gold standard for both observers, with an acceptable variation in measurements between both observers.
The study also assessed difference in symmetry measurements between two observers and showed this was insignificant. This study demonstrated that the VECTRA XT 3D-SI system has the potential to help with pre-operative planning and could also be used to help measure cosmetic appearance after surgery.
Previous 3D-SI work at the Royal Marsden Hospital
A comparison of volume and anthropometric breast measurements using the Crisalix and VECTRA XT 3-dimensional surface imaging systems in women who have undergone breast-conserving surgery
Leusink A, O’Connell RL, Dean SL, Di Micco R, Alotaibi N, Barry PA, Kirby AM, Rusby JE
Published in the Journal of Medical Archives in April 2021
This study followed on from the previous study by O’Connell and aimed to compare measurements taken by two different 3D surface imaging (3D-SI) systems currently on the market, namely VECTRA XT and a portable device called Crisalix.
Participants were had their images taken three times with each device and measurements such as breast volume, distance from the sternal notch to the nipple, distance between the nipples and breast width were measured with both devices and compared. The variation between the measurements captured by each device was low. The average differences between the two devices for each measurement were small but for any individual patient there were wide ranges of agreement. This study therefore showed that although the devices were individually accurate, they currently cannot be used interchangeably.
Three-dimensional simulation of aesthetic outcome from breast-conserving surgery compared with viewing photographs or standard of care: randomised clinical trial
Godden AR, Micha A, Wolf LM, Pitches C, Barry PA, Khan AA, Krupa KDC, Kirby AM, Rusby JE
Published in the British Journal of Surgery in October 2021
This study is most similar to the MIBREAST study. It investigated whether patients who get to see a 3D simulation of their post-surgery appearance following a lumpectomy have improved confidence in understanding what they will look like, compared to those patients who received standard information without simulation.
This was a randomised controlled trial consisting of 117 women, where one group received the usual standard of care that patients receive in clinic, such as a verbal description of outcome, the second group viewed 2-dimensional photographs of other women who had undergone similar surgery and the third group got to see their own 3D simulated appearance. It showed that there was a significantly higher level of confidence in those patients who get to see their own 3D simulation compared to the two groups who did not.
3-Dimensional objective aesthetic evaluation to replace panel assessment after breast-conserving treatment
Godden AR, O’Connell RL, Barry PA, Krupa KDC, Wolf LM, Mohammed K, Kirby AM, Rusby JE
Published in Journal of Breast Cancer in May 2020
Cosmetic appearance following breast-conserving surgery (lumpectomy) for breast cancer is important and has long term effects on patient psychosocial wellbeing.
The goal of breast-conserving surgery is to achieve symmetry between the between the breasts. This is difficult to measure and there is no gold standard for evaluation. Expert panel assessments have been widely used but there are many issues with this. An objective scoring system for outcomes of breast-conserving surgery using 3D surface imaging was developed. Objective measurements and panel assessment of 3D images of a group of patients who underwent breast-conserving surgery between 1 and 5 years previously were recorded. Statistical analyses were used to identify areas of agreement between the measurements and the panel score.
Using the 3D measurements, a model was developed to predict panel scores, which was compared to the actual observed panel score in images of a second group of women. The predicted panel score and actual panel score were found to be very similar, suggesting that the model is reliable and valid and could potentially replace the traditional expert panel assessment, providing an independent and unbiased assessment of cosmetic outcome after breast-conserving surgery.
Comparison of Immediate versus Delayed DIEP Flap Reconstruction in Women Who Require Postmastectomy Radiotherapy
O’Connell RL, Di Micco R, Khabra K, Kirby AM, Harris PA, James SE, Power K, Ramsey KWD, Rusby JE
Published in the Journal of Plastic and Reconstructive Surgery in September 2018
This study investigated patient satisfaction and cosmetic outcome in women who receive radiotherapy after having an immediate breast reconstruction using a flap of their own tissue (deep inferior epigastric artery perforator flap, DIEP) following a mastectomy and those having a delayed flap reconstruction following a period with a flat chest or a temporary implant, compared with women who did not receive any radiotherapy.
Participants completed a questionnaire to assess satisfaction with the reconstructed breast and other facets of recovery (called BREAST-Q questionnaire) and underwent 3D imaging, which was used to assess cosmetic outcome by a panel of experts.
The study showed that women who received radiotherapy after their mastectomy and immediate DIEP flap reconstruction were significantly less satisfied than the other groups. Those who underwent a delayed flap reconstruction a while after a simple mastectomy (and flat chest wall) were most satisfied. Participants who did not receive radiotherapy after their immediate flap reconstruction scored significantly higher in the expert panel assessment of their 3D images than those who received radiotherapy after immediate DIEP flap reconstruction, and there was no difference in the panel assessment between all three groups who received radiotherapy. This showed that, as expected, patients who do not receive radiotherapy after an immediate flap reconstruction are more satisfied and have a better cosmetic outcome than those who do receive radiotherapy.
There was no difference in panel assessment for those women requiring radiotherapy who had an immediate or delayed flap reconstruction, and both are therefore acceptable treatment options.
A scoring system for 3D surface images of breast reconstruction developed using the Delphi consensus process
Godden AR, Wood SH, James SE, MacNeill FA, Rusby JE
Published in the European journal of Surgical Oncology in May 2020
Evaluating the cosmetic outcome after breast reconstruction is even more challenging than it is for breast-conserving surgery. Again, it is often assessed by a panel of experts reporting on photographs. Differences in assessment scales and lack of consistency between experts makes this even more difficult.
This study aimed to develop an objective scoring system of 3D images to assess the cosmetic appearance of breast reconstruction using a Delphi consensus process. Development of a Delphi consensus is a well-described process by which experts have multiple rounds of discussions and voting to whittle down from a large number of possible items to the most important items to be included in an assessment scale. 61 breast and plastic surgeons participated in this process. The assessment scale included symmetry, volume, shape, position of the breast mound, nipple position, as well as a global score.
The reliability between rates was deemed fair for individual items and good for the global score and the reliability within the panel was good. This paper described the development of a panel evaluation of cosmetic appearance following breast reconstruction using 3D-SI and showed that it is as good as other scales previously described in medical literature. It however also highlighted that the issues with panel assessment remain and emphasised the need to develop an objective evaluation method