PMC8027348_01
Pretreatment imaging evaluation. Ultrasonography showed an irregular hypoechoic mass at the 4-o'clock position, 1 cm from the nipple, measuring 3.9 x 3.3 cm. Malignancy was confirmed with a biopsy (A). Magnetic resonance imaging revealed a mass (3.4 x 2.2 cm) at the 4-o'clock position, 1 cm from the nipple in the left breast, which was concordant with the biopsy-confirmed malignancy. Multiple enhanced nodules (1.4 cm in the longest diameter) were observed, and the total extent measured 5.8 cm (B).
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Ultrasonography revealed an irregular hypoechoic mass at the 4-o'clock position, 1 cm from the nipple, measuring 3.9 x 3.3 cm, which was consistent with the biopsy-confirmed malignancy ( Figure 1A ). Multiple enhanced nodules (1.4 cm in the longest diameter) were observed, and the total extent measured 5.8 cm ( Figure 1B ). MRI revealed multiple enlarged lymph nodes in the left axilla.
Posttreatment imaging evaluation. Ultrasonography showed that the dimensions of the malignant mass had decreased to 2.1 x 1.0 cm (A). Magnetic resonance imaging showed that the biopsy-confirmed malignant mass and multiple suspicious daughter nodules (total extent measuring 2.1 cm) in the left breast had decreased in size (B).
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After the fourth cycle, the dimensions of the malignant mass had decreased to 2.1 x 1.0 cm, as revealed by ultrasonography of the left breast ( Figure 2A ). The post-NACT MRI showed that the biopsy-confirmed malignant mass and the multiple suspicious daughter nodules (total extent measuring 2.1 cm) in the left breast also decreased in size ( Figure 2B ).
The breast surgical guide (BSG) targeted the original tumor region by combining pretreatment prone magnetic resonance imaging (MRI)-generated tumor data and posttreatment supine MRI-generated breast data (A). The BSG was manufactured as a hybrid type, containing a groove for marking the original tumor area on the breast surface with an extra 0.5 cm from the tumor boundary to guarantee safe margins. Blue dye injection columns were provided to indicate the extent of the tumor requiring removal (B). A surgical resection line was drawn onto the breast skin surface along with a groove designed to match the original tumor area (C).
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We designed a BSG to target the original tumor region by combining pre-NACT MRI-generated tumor data with post-NACT MRI-generated breast data ( Figure 3A ). The surgical resection line was drawn onto the breast skin surface along with the groove designed to match the tumor shape, and blue dye was injected into the breast through the columns indicating the resection boundary ( Figures 3B, C ).