Name: integrating augmented reality tools in breast cancer related lymphedema prognostication and diagnosis
Uploaded: 2020-02-06T12:00:00
Description: Watch this Scientific Journal Video about Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis at JoVE.com

This study was approved by the Institutional Review Boards from the Authors&#39; Institutions. This protocol applies to node-positive (i.e., N&#62;1 according to the TNM staging system)14 breast cancers showing LVI and/or ENE.
1. Real time arm measurements
<ol>
	<li>Install the free downloadable application (e.g., Captevia) on a tablet computer.</li>
	<li>Take a marker of the highest-contrast color compared to the skin of the patient (e.g., white, black).
	<ol>
		<li>...

<ol>
	<li>Michelotti, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tackling+the+diversity+of+breast+cancer+related+lymphedema:+Perspectives+on+diagnosis,+risk+assessment,+and+clinical+management.">Tackling the diversity of breast cancer related lymphedema: Perspectives on diagnosis, risk assessment, and clinical management.</a> Breast. 44, 15-23 (2018).</li><li>Noguchi, M., Yokoi, M., Nakano, Y., Ohno, Y., Kosaka, T., Singh, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Axillary+reverse+mapping+in+breast+cancer.">Axillary reverse mapping in breast cancer.</a> Radioisotopes - Applications in Bio-Medical Science. , (2011).</li><li>Wilke, L. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+complications+associated+with+sentinel+lymph+node+biopsy:+results+from+a+prospective+international+cooperative+group+trial.">Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial.</a> Annals of Surgical Oncology. 13 (4), 491-500 (2006).</li><li>Taghian, N. R., Miller, C. L., Jammallo, L. S., O'Toole, J., Skolny, M. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphedema+following+breast+cancer+treatment+and+impact+on+quality+of+life:+a+review.">Lymphedema following breast cancer treatment and impact on quality of life: a review.</a> Critical Reviews in Oncology/Hematology. 92 (3), 227-234 (2014).</li><li>Dean, L. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=34;It+still+affects+our+economic+situation&amp;#34;:+long-term+economic+burden+of+breast+cancer+and+lymphedema.">34;It still affects our economic situation&amp;#34;: long-term economic burden of breast cancer and lymphedema.</a> Supportive Care in Cancer. , (2018).</li><li>Invernizzi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphovascular+invasion+and+extranodal+tumour+extension+are+risk+indicators+of+breast+cancer+related+lymphoedema:+an+observational+retrospective+study+with+long-term+follow-up.">Lymphovascular invasion and extranodal tumour extension are risk indicators of breast cancer related lymphoedema: an observational retrospective study with long-term follow-up.</a> BMC Cancer. 18 (1), 935 (2018).</li><li>Invernizzi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breast+Cancer+Systemic+Treatments+and+Upper+Limb+Lymphedema:+A+Risk-Assessment+Platform+Encompassing+Tumor-Specific+Pathological+Features+Reveals+the+Potential+Role+of+Trastuzumab.">Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab.</a> Journal of Clinical Medicine. 8 (2), (2019).</li><li>Kilbreath, S. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+for+lymphoedema+in+women+with+breast+cancer:+A+large+prospective+cohort.">Risk factors for lymphoedema in women with breast cancer: A large prospective cohort.</a> Breast. 28, 29-36 (2016).</li><li>Sun, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+need+for+preoperative+baseline+arm+measurement+to+accurately+quantify+breast+cancer-related+lymphedema.">The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema.</a> Breast Cancer Research and Treatment. 157 (2), 229-240 (2016).</li><li>Deltombe, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+and+limits+of+agreement+of+circumferential,+water+displacement,+and+optoelectronic+volumetry+in+the+measurement+of+upper+limb+lymphedema.">Reliability and limits of agreement of circumferential, water displacement, and optoelectronic volumetry in the measurement of upper limb lymphedema.</a> Lymphology. 40 (1), 26-34 (2007).</li><li>Tewari, N., Gill, P. G., Bochner, M. A., Kollias, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+volume+displacement+versus+circumferential+arm+measurements+for+lymphoedema:+implications+for+the+SNAC+trial.">Comparison of volume displacement versus circumferential arm measurements for lymphoedema: implications for the SNAC trial.</a> ANZ Journal of Surgery. 78 (10), 889-893 (2008).</li><li>Cau, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+study+between+circumferential+method+and+laser+scanner+3D+method+for+the+evaluation+of+arm+volume+in+healthy+subjects.">Comparative study between circumferential method and laser scanner 3D method for the evaluation of arm volume in healthy subjects.</a> Journal of Vascular Surgery: Venous and Lymphatic Disorders. 4 (1), 64-72 (2016).</li><li>Hameeteman, M., Verhulst, A. C., Vreeken, R. D., Maal, T. J., Ulrich, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=3D+stereophotogrammetry+in+upper-extremity+lymphedema:+An+accurate+diagnostic+method.">3D stereophotogrammetry in upper-extremity lymphedema: An accurate diagnostic method.</a> Journal of Plastic, Reconstructive &amp; Aesthetic Surgery. 69 (2), 241-247 (2016).</li><li>Amin, M. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> AJCC Cancer Staging Manual. , (2017).</li><li>Kamper, S. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Global+Perceived+Effect+scales+provided+reliable+assessments+of+health+transition+in+people+with+musculoskeletal+disorders,+but+ratings+are+strongly+influenced+by+current+status.">Global Perceived Effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status.</a> Journal of Clinical Epidemiology. 63 (7), 760-766 (2010).</li></ol>

The use of an accurate and reliable tool for limb volume measurement is mandatory in breast cancer survivors, given that an early diagnosis of BCRL is related to improved outcomes. In addition, the identification of high-risk individuals should consider not only clinical and surgical data but also tumor-specific pathological features. This study demonstrates the reproducibility and reliability of a new portable 3DLS device in upper limb volume measurement both in healthy subjects and in a BCRL women with high-risk featur...

Breast cancer related lymphedema (BCRL) is fluid retention in the upper extremity occurring after axillary surgery and/or radiation therapy in approximately 20-80% of breast cancer patients with lymph node metastases (N&#62;1)1,2,3. This condition results in swelling of the limb with subsequent reduced functionality, increased risk of comorbidities, frustration, anxiety, and depression4,5. BCRL is currently considered a long-standing threat for breast cancer survivors given that it can arise up to 9 years after surgery6.
BCRL pathogenesis is a subject of lively debate among breast cancer specialists. Hence, several studies have shown that it could be related not only to axillary interventions but also to systemic treatments, such as taxanes-based chemotherapy and anti-HER2 therapy7,8. Furthermore, there are recent lines of evidence to suggest that tumor-specific pathological characteristics are involved in its pathogenesis1,6,7. For this reason, the invasion of lymphovascular spaces at the periphery of the tumor by neoplastic cells (lymphovascular invasion, LVI) and of the extension of the metastasis beyond the lymph node capsule (extra-nodal extension, ENE) have been proposed as a complementary analysis for BCRL risk stratification6,7.
Despite the novel insights of BCRL biology, the arm volume measurement remains a cornerstone phase in the diagnosis and follow-up of these patients9. For this task, however, there are not widely-adopted guidelines. The measurement of multiple circumferences across the arm has been traditionally used to estimate its total volume using the truncated cone formula10. Despite its reliability, however, this circumferential method (CM) lack sensitivity and reproducibility, particularly in the case of arm shape irregularities11. Lately, augmented reality methods, such as three-dimensional laser scanner (3DLS), have emerged as promising tools for the measurement of the upper limb volume12. This technology is cheap, user-friendly, reproducible, and extremely precise also in the presence of gibbousness and swelling12,13.
The aim of this study was to assess the reliability of 3DLS in comparison to the circumferential method for BCRL diagnosis and quantification. Here, a protocol is detailed for real-time measurements of the upper limb volume by means of 3DLS in breast cancer patients at increased risk for BCRL.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Structure sensor + Captevia V3.1</td>
			<td>Rodin4D, Rodin SAS</td>
			<td></td>
			<td>Three dimensional laser scanner</td>
		</tr>
	</tbody>
</table>

integrating augmented reality tools in breast cancer related lymphedema prognostication and diagnosis

Breast cancer related lymphedema (BCRL) is a detrimental condition characterized by fluid accumulation in the upper limb in breast cancer patients subjected to axillary surgery and/or radiations. Its etiology is multifactorial and include also tumor-specific pathological features, such as lymphovascular invasion (LVI) and extranodal extension (ENE). To date, no widely employed guidelines for the early diagnosis of BCRL are available. Here, we illustrate a protocol for a digitally assisted BCRL assessment using a 3D laser scanner (3DLS) and a tablet computer. It has been specifically optimized in a discovery cohort of high-risk breast cancer patients. This study provides a proof-of-principle that augmented reality tools, such as 3DLS, can be incorporated into the clinical workup of BCRL to allow for a precise, reproducible, reliable, and cheap diagnosis.

This was a pilot single-blind, randomized controlled study involving adult individuals. Inclusion criteria were the following: 1) young adults aged &#62;18 and &#60;45 years; 2) normal weight (body mass index, BMI, &#62;18 and &#60;25 kg/m2); 3) absence of any kind of skin lesion at upper limb level; 4) absence of trauma and/or any kind of condition able to modify arm structure and volume. The exclusion criteria: 1) cardiovascular comorbidities; 2) vascular diseases involving t...

Watch this Scientific Journal Video about Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis at JoVE.com

Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis

Breast cancer related lymphedema is frequent in breast cancer survivors, but there are not widely employed guidelines for its diagnosis and quantification. Here, we introduce a reliable and cost-effective protocol to define, quantify, and compare upper limb volume in breast cancer patients.

Breast cancer related lymphedema (BCRL) is a detrimental condition characterized by fluid accumulation in the upper limb in breast cancer patients ...

Research

JoVE Journal

Medicine

Multi-modal Imaging of Angiogenesis in a Nude Rat Model of Breast Cancer Bone Metastasis Using Magnetic Resonance Imaging, Volumetric Computed Tomography and Ultrasound

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell ...

Profiling of Estrogen-regulated MicroRNAs in Breast Cancer Cells

Estrogen plays vital roles in mammary gland development and breast cancer progression. It mediates its function by binding to and activating the estrogen ...

Quantification of Breast Cancer Cell Invasiveness Using a Three-dimensional (3D) Model

Quantification of Breast Cancer Cell Invasiveness Using a Three-dimensional 3D Model

It is now well known that the cellular and tissue microenvironment are critical regulators influencing tumor initiation and progression. Moreover, the ...

Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these ...

Mammosphere Formation Assay from Human Breast Cancer Tissues and Cell Lines

Similar to healthy tissues, many blood and solid malignancies are now thought to be organised hierarchically, with a subset of stem-like cancer cells that ...

In Vivo and Ex Vivo Approaches to Study Ovarian Cancer Metastatic Colonization of Milky Spot Structures in Peritoneal Adipose

In Vivo and Ex Vivo Approaches to Study Ovarian Cancer Metastatic Colonization of Milky Spot Structures in Peritoneal Adipose

High-grade serous ovarian cancer (HGSC), the cause of widespread peritoneal metastases, continues to have an extremely poor prognosis; fewer than 30% of ...

Systems Biology of Metabolic Regulation by Estrogen Receptor Signaling in Breast Cancer

With the advent of the -omics approaches our understanding of the chronic diseases like cancer and metabolic syndrome has improved. However, effective ...

An Orthotopic Mouse Model of Spontaneous Breast Cancer Metastasis

Metastasis is the primary cause of mortality of breast cancer patients. The mechanism underlying cancer cell metastasis, including breast cancer ...

Studying the Role of Alveolar Macrophages in Breast Cancer Metastasis

This paper describes the application of the syngeneic model of breast cancer (4T1) to the studies on a role of pulmonary alveolar macrophages in cancer ...

Combining Augmented Reality and 3D Printing to Display Patient Models on a Smartphone

Augmented reality (AR) has great potential in education, training, and surgical guidance in the medical field. Its combination with three-dimensional (3D) ...