MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

Abstract

Omitting the placement of clips inside tumour bed during breast cancer surgery poses a challenge for delineation of lumpectomy cavity clinical target volume (CTVLC). We aimed to quantify inter-observer variation and accuracy for CT- and MRI-based segmentation of CTVLC in patients without clips. CT- and MRI-simulator images of 12 breast cancer patients, treated by breast conserving surgery and radiotherapy, were included in this study. Five radiation oncologists recorded the cavity visualization score (CVS) and delineated CTVLC on both modalities. Expert-consensus (EC) contours were delineated by a senior radiation oncologist, respecting opinions of all observers. Inter-observer volumetric variation and generalized conformity index (CIgen) were calculated. Deviations from EC contour were quantified by the accuracy index (AI) and inter-delineation distances (IDD). Mean CVS was 3.88 +/- 0.99 and 3.05 +/- 1.07 for MRI and CT, respectively (p = 0.001). Mean volumes of CTVLC were similar: 154 +/- 26 cm3 on CT and 152 +/- 19 cm3 on MRI. Mean CIgen and AI were superior for MRI when compared with CT (CIgen: 0.74 +/- 0.07 vs. 0.67 +/- 0.12, p = 0.007; AI: 0.81 +/- 0.04 vs. 0.76 +/- 0.07; p = 0.004). CIgen and AI increased with increasing CVS. Mean IDD was 3 mm +/- 1.5 mm and 3.6 mm +/- 2.3 mm for MRI and CT, respectively (p = 0.017). When compared with CT, MRI improved visualization of post-lumpectomy changes, reduced interobserver variation and improved the accuracy of CTVLC contouring in patients without clips in the tumour bed. Further studies with bigger sample sizes are needed to confirm our findings.