Digital twins for breast cancer surgery

Breast-conserving surgery followed by adjuvant radiotherapy is the standard treatment for breast cancer, yet inaccurate tumor localization may lead to positive margins and re-excision. Current localization techniques are invasive and often imprecise. Digital twins (DT), patient-specific digital replicas, can offer a non-invasive approach for tumor localization. In this proof-of-concept study, breast DTs were created from supine magnetic resonance imaging and visualized through an extended reality (XR) headset in four breast conservative surgeries. DTs were automatically registered to the patient in real time using a 3D sensing system. The accuracy of the alignment deviations between the nipple and its position in the DT ranged 0-5 mm. The surgeon reported that the tumor XR visualization was consistent with intraoperative findings. Setup and marking times were clinically acceptable, and preliminary usability assessments indicated high perceived usability and low workload. These results support the feasibility of integrating DTs into breast cancer surgical workflows.