Pre-operative Assessment of Ablation Margins for Variable Blood Perfusion Metrics in a Magnetic Resonance Imaging Based Complex Breast Tumour Anatomy: Simulation Paradigms in Thermal Therapies.

ABSTRACT

BACKGROUND AND OBJECTIVES: Image-guided medical interventions facilitates precise visualization at treatment site. The conformal prediction for sparing healthy tissue fringes precisely in the vicinity of irregular tumour anatomy remains clinically challenging. Pre-clinical image-based computational modelling is imperative as it helps in enhancement of treatment quality, augmenting clinical-decision making, while planning, targeting, controlling, monitoring and assessing treatment response with an effective risk assessment before the onset of treatment in clinical settings. In this study, the influence of heat deposition rate (SAR), exposure duration, and variable blood perfusion metrics for a patient-specific breast tumour is quantified considering the tumour margins thereby suggesting need of geometrically accurate models. METHODS: A three-dimensional realistic model mimicking dimensions of a female breast, comprising ~1.7 cm irregular tumour, was generated from patient specific two-dimensional DICOM format MRI images through image segmentation tools MIMICS 19.0® and 3-Matic 11.0® which is finally exported to COMSOL Multiphysics 5.2® as a volumetric mesh for finite element analysis. The Pennes bioheat transfer model and Arrhenius thermal damage model of cell-death are integrated to simulate a coupled biophysics problem. A comparative blood perfusion analysis is done to evaluate the response of tumour during heating considering thermal damage extent, including the tumour margins while sparing critical adjoining healthy tissues. RESULTS: The evaluated thermal damage zones for 1 mm, 2 mm and 3 mm fringe heating region (beyond tumour boundary) reveals 0.09%, 0.21% and 0.34% thermal damage to the healthy tissue (which is <1%) and thus successful necrosis of the tumour. The iterative computational experiments suggests treatment margins < 5 mm are sufficient enough as heating beyond 3 mm fringe layer leads to higher damage surrounding the tumour approximately 1.5 times the tumour volume. Further, the heat-dosage requirements are 22% more for highly perfused tumour as compared to moderately perfused tumour with an approximate double time to ablate the whole tumour volume. CONCLUSIONS: Depending on the blood perfusion characteristics of a tumour, it is a trade-off between heat-dosage (SAR) and exposure/treatment duration to get desired thermal damage including the irregular tumour boundaries while taking into account, the margin of healthy tissue. The suggested patient-specific integrated multiphysics-model based on MRI-Images may be implemented for pre-treatment planning based on the tumour blood perfusion to evaluate the thermal ablation zone dimensions clinically and thereby avoiding the damage of off-target tissues. Thus, risks involving underestimation or overestimation of thermal coagulation zones may be minimised while preserving the surrounding normal breast parenchyma.