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CONSORT flow diagram.. Flow chart for the patient enrolled in the study.
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The study was designed to include adult females >= 30 years old who had early stage non-metastatic breast cancer, received a pre-operative mammogram within 30 days of surgery, have received a pre-operative MRI exam within 30 days of surgery, would be planning to undergo lumpectomy, and receive post-surgery radiotherapy of the whole breast (Fig 1).
Timeline of the clinical study.. Calendar of the medical exams and dates at which the data acquisition was performed during the clinical study.
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From the series of frontal photographs of the patient during the clinical protocol of Fig 2, we notice that the difference in height between the left and right nipple changed over time in a fairly non trivial way.
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Timeline of the clinical study.. Calendar of the medical exams and dates at which the data acquisition was performed during the clinical study.
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From the series of frontal photographs of the patient during the clinical protocol of Fig 2, we notice that the difference in height between the left and right nipple changed over time in a fairly non trivial way.
Right breast MRI in the transverse plane.. The dimensions of the tumor were measured and annotated on the MRI image.
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MRI data were acquired 30 days prior to the operation (Figs 3 and 4).
Right breast MRI in the sagittal plane.. The dimensions of the tumor were measured and annotated on the MRI image.
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MRI data were acquired 30 days prior to the operation (Figs 3 and 4). The tumor was measured as a compact ellipsoid-shaped mass of 12 x 9 mm in the considered sagittal plane (Fig 4).
3D reconstruction of the MRI data.. In this figure only the elevation map of the skin surface is shown, scaled to the MRI voxel resolution.
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The resulting reconstructed surface of the skin is shown in Fig 5.
Mesh of the virtual breast, in the sagittal plane of interest.. We show in a different color intensity the fat and glandular materials of the elements of the mesh.
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A new mesh of the virtual breast was created as shown in Fig 6.
Illustration of the mechanico-biological model of the breast after BCT.. Upper half of the diagram (unloaded): biological agent-based model of the wound healing; lower half of the diagram (loaded): mechanical model of the breast. The stress distribution at the wound edge is normalized and mapped from the loaded geometry of the breast under gravity to the unloaded geometry of the breast of the biological model.
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A detailed description of the implementation of that multiscale model from Garbey et al. is summarized in Fig 7.
First metric.. Evolution of the difference in the vertical position of the nipple of the right breast and the left breast; the three phases of healing are separated by the vertical dashed lines.
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We defined the first metric as the absolute vertical difference in height between the nipples of each breast of the patient (Fig 8). The curve obtained with the first metric (Fig 8) highlights the 3 distinct phases of healing that we will investigate with our model later on in this paper. Perhaps we should have seen the patient more often to fill our potential measurement gap around weeks 10 and 25 in Fig 8.
Second metric.. Evolution of the difference in the lateral surface of the right breast and the left breast; the three phases of healing are separated by the vertical dashed lines.
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This complemented the first metric, giving an estimate of the change of volume of the operated breast (Fig 9). Those results were validated by the second metric (Fig 9) showing the evolution of the difference in lateral area, that we assimilated to the volume of the breast.
Third metric.. Evolution of the surface temperature of both breasts, measured at the location of the surgical incision on the skin on the right breast, and the corresponding location on the left breast.
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Finally in Fig 10 we report on the evolution of the difference in temperature between the two breasts measured from thermal imaging.