3D Breast Anatomy Analysis in Cancer Treatment Planning and Outcome Assessment

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DESCRIPTION (provided by applicant): Breast cancer is the second leading cause of cancer death in American women. Breast Reconstruction (BR) surgery is an important component of the breast cancer treatment process. It is the surgical procedure used to rebuild breast tissue that has been removed due to cancer surgery. Most importantly, BR surgery is integral to improving the cancer patient's quality of life. However, planning and evaluation of the surgery are done subjectively, and the result is not always satisfactory. We propose to develop tools that will aid surgeons with pre-operative planning and post-operative outcome evaluation. They will also help breast cancer survivors make informed decisions about their treatment choices, by facilitating surgeon-patient communications. Objective outcome analysis will allow more concrete communication with the patient, who can then calibrate her expectations and be more comfortable with her treatment choices. Alterations in appearance (or loss) of the breast have significant psychological and sexual implications in cancer patients. Having recently experienced the trauma and stress associated with the diagnosis and treatment of a life-threatening illness, patients hope to relieve some of the stress and rebuild a positive body image. They hope to achieve a BR result that is attractive and natural looking. Most women who choose BR do so to restore their femininity, image, and body integrity, all of which have been altered negatively by breast cancer therapy. However, there is no information available from an objective analysis of aesthetic outcomes to facilitate the patient's decision making on a procedure that will permanently alter the appearance of her breast. Standards for BR have evolved in the past decade, and patients and surgeons alike expect, symmetrical and natural looking breasts. Surgeons rely on their personal experience and on subjective visual assessment skills to achieve these results. Similarly, aesthetic outcome assessment methods, following surgery, are rather subjective, and are based on observer evaluation of physical changes in breast morphology and symmetry. To date, no consensus exists on how to assess the aesthetic result following BR. With the recent developments in three-dimensional (3D) imaging, there is now an opportunity to develop diagnostic tools that permit 3D treatment planning and objective assessment of post-operative results. The proposed study develops a method for quantitatively describing breast aesthetics. The method will objectively detect relevant changes in breast appearance, making it possible to compare aesthetic outcome between different treatment modalities. A practical technique for quantitative assessment of breast appearance would improve breast cancer care in several ways. Key applications include enabling personalized, evidence-based medicine, surgical planning, setting fair charges, and surgery education. Breast cancer is the most common life-threatening malignancy in women. Treatment advances and early detection have resulted in decreased mortality from breast cancer despite a steadily rising incidence in the United States between 1990 and 2002. Encouraged by this trend and other evidence of progress, the National Cancer Institute (NCI) has issued a challenge goal to eliminate suffering and death from cancer by the year 2015. Achieving this goal for women requires addressing the psychosocial morbidity caused by physical deformities of the breast that result from cancer treatment. A major step towards minimizing treatment-related deformities is to improve the surgical techniques of breast reconstruction. Developing quantitative tools for assessing the aesthetic outcome of BR is thus a significant step in the right direction. The goal of this Phase I study is to develop software tools that would aid the surgeon in quantifying and interpreting 3D data in a meaningful and clinically relevant fashion. 3D measurements would also be invaluable for relating patient and surgical variables meaningfully to aesthetic outcomes, and for comparing the outcomes of different kinds of breast cancer treatments (e.g., different reconstruction procedures).