Breast conserving surgery (BCS) is a common procedure for early-stage breast cancer patients. Supine preoperative magnetic resonance (MR) breast imaging for visualizing tumor location and extent, while not standard for procedural guidance, is being explored since it more closely represents the surgical presentation compared to conventional diagnostic imaging positions. Despite this preoperative imaging position, deformation is still present between the supine imaging and surgical state. As a result, a fast and accurate image-to-physical registration approach is needed to realize image-guided breast surgery.

In this study, three registration methods were investigated on healthy volunteers’ breasts (n  =  11) with the supine arm-down position simulating preoperative imaging and supine arm-up position simulating intraoperative presentation. The registration methods included (1) point-based rigid registration using synthetic fiducials, (2) nonrigid biomechanical model-based registration using sparse data, and (3) a data-dense three-dimensional diffeomorphic image-based registration from the Advanced Normalization Tools (ANTs) repository. Additionally, deformation metrics (volume change and anisotropy) were calculated from the ANTs deformation field to better understand breast material mechanics.

The average target registration errors (TRE) were 10.4  ±  2.3, 6.4  ±  1.5, and 2.8  ±  1.3  mm (mean ± standard deviation) and the average fiducial registration errors (FRE) were 7.8  ±  1.7, 2.5  ±  1.1, and 3.1  ±  1.1  mm for the point-based rigid, nonrigid biomechanical, and ANTs registrations, respectively. The mechanics-based deformation metrics revealed an overall anisotropic tissue behavior and a statistically significant difference in volume change between glandular and adipose tissue, suggesting that nonrigid modeling methods may be improved by incorporating material heterogeneity and anisotropy.

Overall, registration accuracy significantly improved with increasingly flexible and data-dense registration methods. Analysis of these outcomes may inform the future development of image guidance systems for lumpectomy procedures.