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Intra- and inter-observer variability in breast tumour bed contouring and the controversial role of surgical clips

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Abstract

The purpose of this study was to evaluate whether the visualization of surgical clips (SCs) on the same set of planning computed tomography (CT) of breast cancer (BC) patients influences agreement on tumour bed (TB) delineation. Planning CT (CTorig) of 47 BC patients with SCs to visualize the TB was processed in order to blur SCs and create a virtual CT (CTmod). Four radiation oncologists (ROs, 2 juniors and 2 seniors) contoured TB on both the CT sets. Centre of mass distance (CMD), percentage overlap as Dice similarity coefficient (DSC), surface distance as average Hausdorff distance (AHD) and TB volume size were analysed. The intra-observer variability when contouring TB with and without SCs was statistically significant (p-values = 0.016, 0.0002 and ≪ 0.001 for CMD, AHD and DSC, respectively). Junior ROs showed worse reproducibility compared to seniors. The median DSC was < 0.7. The inter-observer variability with and without SCs was statistically significant (p < 0.001) for all metrics, with an increase of 48.7% in DSC and decrease of 50.7% and 57.1% in CMD and AHD, respectively, as relative median values, when SCs were visible. Regarding TB volumes, when SCs were visible, the intra-observer analysis revealed that 3/4 ROs delineated larger volumes, especially juniors. The inter-observer analysis showed that, in presence of visible SCs, the difference in TB volume among all the ROs fell from statistically significant to borderline significance (p = 0.052). TB contouring is confirmed to be an observer-dependent task. SCs decreased the intra and inter-observer variability but the overall agreement between ROs remained low.

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Abbreviations

AHD:

Dice similarity coefficient

BC:

Breast cancer

BCS:

Breast conservative surgery

CMD:

Centre of mass distance

CT:

Computed tomography

CTmod :

Modified computed tomography

CTorig :

Original computed tomography

CTV:

Clinical tumour volume

DSC:

Average Hausdorff distance

GEC–ESTRO:

The Groupe Européen de Curiethérapie and the European SocieTy for Radiotherapy & Oncology

IMPORT LOW:

Intensity-Modulated Partial Organ Radiotherapy Low

IOERT:

Intraoperative RT with electrons

IQR:

Interquartile range

PBI:

Partial breast irradiation

ROs:

Radiation oncologists

RT:

Radiotherapy

SCs:

Surgical clips

TB:

Tumour bed

WBRT:

Whole breast radiotherapy

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Correspondence to Samantha Dicuonzo.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the present study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

This clinical and dosimetric study has been approved by the institutional Ethics Committee of the IRCCS European Institute of Oncology as part of the research project entitled “Adjuvant radiation treatments with intensity-modulated radiotherapy and/or hypofractionated schedules for breast cancer” (26 May 2016, Milan, Italy).

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Informed consent was obtained from all individual participants included in the study.

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Affiliation of Delia Ciardo, Giuseppe Fanetti and Marinella Mantovani was at the time of the study.

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Corrao, G., Rojas, D.P., Ciardo, D. et al. Intra- and inter-observer variability in breast tumour bed contouring and the controversial role of surgical clips. Med Oncol 36, 51 (2019). https://doi.org/10.1007/s12032-019-1273-1

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