When Cherie Sanders’ doctor in Amarillo diagnosed her with breast cancer, he described her tumor as “5 centimeters by 2.5 centimeters” and “the size of a walnut.”
These words left Cherie wondering what her tumor really looked like. Walnuts vary in size, so how big was it? Was it round or asymmetrical?
Cherie got answers at MD Anderson, where she sought a second opinion. Here, doctors provided her with a 3D-printed replica of her breast and the tumor inside.
“The model helped me see that my tumor is not perfectly round and has irregular edges,” Cherie says, who learned her breast cancer was triple-negative after coming to MD Anderson, making it harder to treat. “It helped me visualize exactly what my surgeon would need to cut out, and why removing a tumor with irregular borders can be difficult.”
Seeing breast cancer in 3D
Most people, when shown a mammogram image, have trouble comprehending the two-dimensional view on the screen. Breast MRIs provide a more detailed, three-dimensional image, but they’re taken while the patient is face-down, on her stomach. When viewed, the images are therefore reversed. This can make it extremely difficult for a patient to visualize her tumor’s size, volume and location.
Radiologists Elsa Arribas, M.D., and Lumarie Santiago, M.D., knew patients often struggled to understand their breast images, yet they were asked to make treatment choices based on those images. Years later, some even questioned whether they had chosen the best option.
3D printing offers a model for personalized breast cancer treatment
After reading an article about 3D printing, Arribas wondered if she could create 3D-printed, personalized breast models for each patient, to help them “see” their tumors and feel more confident in their treatment choices.
Arribas studied a National Institutes of Health website that teaches beginners how to 3D print. She watched YouTube videos and used government-sponsored software program tutorials. After successfully printing a practice “skull,” she launched a clinical trial.
Each patient who enrolled received a 3D-printed life-sized model of her own breast, tumor and chest wall. The process of creating the custom models included painting the tumor a different color from the noncancerous areas of the breast, and painting the nipple and areola to make the models even more realistic and useful for patients.
“It was important to show more than just the tumor,” says Arribas. “We wanted the patient to easily understand the volume of the tumor and how much of the breast it occupies or doesn’t occupy.”
Reassuring patients about breast cancer treatment decisions
Before and after viewing their breast models, patients completed questionnaires that evaluated their uncertainty about which treatment to choose. Their answers showed that the personalized breast models decreased uncertainty and reassured patients they were making the right treatment choices.
“Seeing the disease for themselves helped patients better understand what was happening in their bodies,” Santiago says.
Patients’ families and friends benefited from viewing the models, too.
“When families and friends understand the disease better, it helps patients feel more supported,” Santiago says.
Arribas and Santiago also printed models before and after chemotherapy. They wanted to show how the treatment impacts tumors over time.
“My breast model showed me how much my tumor shrank after chemotherapy,” Sanders says. “It was very reassuring to see the treatment working.”
Educating patients to make the best choice
Today’s breast cancer patients have more treatment options than ever, thanks to medical advances. For many patients, that can make it even harder to decide on a treatment plan.
But personalized 3D breast models can help patients and their care teams have more informed discussions about treatment options.
“Patients often have a choice between a lumpectomy or a mastectomy, and most women come into the conversation knowing which surgery they prefer,” says breast cancer surgeon Cristina Checka, M.D. “The breast model allows us to have a visual to explain their specific case and really make an informed decision together.”
Cherie has seen the benefits firsthand. After receiving chemotherapy to shrink her tumor, she met with Checka to discuss her surgery options. She ultimately opted for a lumpectomy – not the treatment she would’ve picked otherwise.
“Without the 3D model and Dr. Checka, I have no doubt I would have had a mastectomy,” says Cherie, who successfully had her tumor removed, with no remaining signs of cancer.
“The personalized care I received at MD Anderson is hard to beat,” she says, “and I believe going there saved my life.”
Cherie hopes 3D models will someday be provided to all women facing breast cancer surgery.
“Seeing my tumor in the model saved me from worrying about whether I was making the right surgical decision,” she says.
3D printing helps plan treatment and train young doctors
Besides helping patients with treatment decisions, breast models also help breast and plastic surgeons plan exactly how a surgery will go. Together, they can decide the best way to reach the tumor, what tissue needs to be removed, and how to get the best cosmetic and medical outcomes for the patient.
3D breast models also work well as a teaching tool for residents and fellows, Arribas has found.
“You may have all the descriptors of a patient’s disease and you’re told what it looks like,” she says. “But until you hold the model in your hands, you can’t fully visualize what is going on inside the breast.”
Expanding 3D printing beyond breast cancer treatment
The 3D printing clinical trial ended last year. Its success led MD Anderson to open a 3D printing and visualization lab. Breast specialists continue to use it to provide personalized treatment for patients, while doctors in other specialties also are starting to find new uses for 3D printing.
Arribas and Santiago worked with reconstructive plastic surgeons to explore the application of 3D printing used as a guide during surgery. The team developed patient-specific models that could be sterilized and used in surgery based upon imaging of blood vessels.
“Using 3D guides during surgery resulted in a more efficient operation and led to fewer complications for patients undergoing a type of breast reconstruction that uses flaps of tissue from other parts of the patient’s own body to rebuild the breast,” says plastic surgeon Mark Clemens, M.D.
They also worked with surgeon Stephen Swisher, M.D., to print personalized models of organs for surgical planning. One of the models helped save the lung of a patient who had been told by local doctors that her lung needed to be removed due to the tumor’s location.
Arribas and Santiago are now working with pulmonologists George Eapen, M.D., and Bruce Sabath, M.D., to print custom 3D tracheobronchial stents – hollow tubes placed in the airway to open a narrowed area and help patients breathe.
“3D printing offers a new dimension in cancer treatment,” Arribas says. “It’s the perfect example of what personalized medicine is all about.”