The Relationship Between Breast Volume and Thoracic Kyphosis Angle

Şenay Bengin Ertem; Ümit Ali Malçok

doi:10.58600/eurjther1907

Authors

Şenay Bengin Ertem Department of Radiology, Çanakkale Onsekiz Mart University, Faculty of Medicine, Çanakkale, Türkiye https://orcid.org/0000-0002-7237-6061
Ümit Ali Malçok Department of Neurosurgery, Çanakkale Onsekiz Mart University, Faculty of Medicine, Çanakkale, Türkiye https://orcid.org/0000-0002-1272-9654

DOI:

https://doi.org/10.58600/eurjther1907

Keywords:

Breast volume, Thoracic kyphosis angle, Organ segmentation technique, thorax computed tomography

Abstract

Objective: It has been hypothesized that a disproportionate upper body weight caused by macromastia places abnormal stress on the spine, which may lead to skeletal abnormalities. To evaluate whether there is a relationship between breast volume and the thoracic kyphosis angle measured on thorax CT images.

Methods: A total of 448 female patients who underwent thoracic CT examinations were included in this study. Breast volume [ml], by using the "organ segmentation method"; thoracic kyphosis angles by using Cobb's method were made manually on the workstation.

Results: Mean right breast volume was 902.03 ± 376.47 (154.21 - 2366.20 ml), left breast volume was 911.01 ± 383.34 (167.93 - 2894.07 ml), total breast volume was 1810.09 ± 750.82 (354.39 - 5100.68 ml). The total breast volume (p<0.001) and thoracic kyphosis angle (p=0.012)in patients aged 50-69 years were significantly higher than those aged 17-29 years. Larger total breast volume [p<0.001] and thoracic kyphosis angle (p<0.001) values were associated with larger BMI intervals. A significant positive correlation was observed between the total breast volume and thoracic kyphosis angle (r=0.771, p<0.001).

Conclusion: Our results showed that the thoracic kyphosis angle significantly increased in parallel with a larger total breast volume, and that total breast volume was an independent risk factor for thoracic kyphosis angle. The manual organ segmentation method we used was found to be reliable and easy to apply, but time-consuming technique for calculating BV.

Metrics

Metrics Loading ...

References

McGhee DE, Coltman KA, Riddiford-Harland DL, Steele JR (2018) Upper torso pain and musculoskeletal structure and function in women with and without large breasts: A cross sectional study. Clin Biomech. 51:99-104. https://doi.org/10.1016/j.clinbiomech.2017.12.009

Elowitz EH (2014) Does Reduction Mammaplasty Revert Skeletal Disturbances in the Vertebral Column of Patients With Macromastia? A Preliminary Study. Aesthetic Plast Surg. 38(1):113-4. https://doi.org/10.1007/s00266-013-0215-0

Fındıkcıoğlu K, Fındıkcıoğlu F, Bulam H, Sezgin B, Ozmen S (2013) The impact of breast reduction surgery on the vertebral column. Ann Plast Surg. 70(6):639-42. https://doi.org/10.1097/sap.0b013e31823fac41

Tunçkale T, Gürdal SÖ, Çalışkan T, Topçu B, Yüksel MO (2021) The impact of various breast sizes of women on vertebral column and spinopelvic parameters. Turk Neurosurg. 31(5):699-703. https://doi.org/10.5137/1019-5149.jtn.30936-20.2

Coltman CE, Steele JR, McGhee DE (2019) Effect of breast size on upper torso musculoskeletal structure and function: a cross-sectional study. Plast Reconstr Surg. 143(3):686-95. https://doi.org/10.1097/prs.0000000000005319

Kovacs L, Eder M, Hollweck R, Zimmermann A, Settles M, Schneider A, Endlich M, Mueller A, Schwenzer- Zimmerer A, Papadopulos NA, Biemer E (2007) Comparison between breast volume measurement using 3D surface imaging and classical techniques. The Breast. 16(2):137-45. https://doi.org/10.1016/j.breast.2006.08.001

Erić M, Anderla A, Stefanović D, Drapšin M (2014) Breast volume estimation from systematic series of CT scans using the Cavalieri principle and 3D reconstruction. Int Surg. 12(9):912-7. https://doi.org/10.1016/j.ijsu.2014.07.018

Lee WY, Kim MJ, Lew DH, Song SY, Lee DW (2016) Three-dimensional surface imaging is an effective tool for measuring breast volume: a validation study. Arch Plast Surg. 43(5):430-7. https://doi.org/10.5999/aps.2016.43.5.430

Choppin SB, Wheat JS, Gee M, Goyal A (2016) The accuracy of breast volume measurement methods: a systematic review. The Breast. 28:121-9. https://doi.org/10.1016/j.breast.2016.05.010

Ma J, Zhang Y, Gu S, Zhu C, Ge C, Zhang Y, An X, Wang C, Wang Q, Liu X, Cao S, Zhang Q, Liu S, Wang Y, Li Y, He J,Yang X (2021) Abdomen CT-1K: Is abdominal organ segmentation a solved problem?. IEEE Trans. Pattern Anal Mach Intell. 27:1-19. https://doi.org/10.1109/tpami.2021.3100536

Sanal B, Korkmaz M, Nas OF, Can F, Hacikurt K (2017) The effect of gigantomasty on vertebral degeneration: a computed tomography study. J Back Musculoskelet Rehabil. 30(5):1031-5. https://doi.org/10.3233/bmr-169600

Quesada O, Lauzon M, Buttle R, Wei J, Suppogu N, Kelsey SF, Reis SE, Shaw LJ, Sopko G, Handberg E, Pepine CJ, Merz CNB (2022) Body weight and physical fitness in women with ischaemic heart disease: does physical fitness contribute to our understanding of the obesity paradox in women? Eur J Prev Cardiol. 4;zvac046. https://doi.org/10.1093/eurjpc/zwac046

Koelé MC, Lems WF, Willems HC (2020) The clinical relevance of hyperkyphosis: A narrative review. Front Endocrinol [Lausanne]. 11:5. https://doi.org/10.3389/fendo.2020.00005

Kruse M, Thoreson O (2021) The prevalence of diagnosed specific back pain in primary health care in Region Västra Götaland: a register study of 1.7 million inhabitants. Prim Health Care Res Dev. 22:e37. https://doi.org/10.1017/s1463423621000426

Schinkel-Ivy A, Drake JDM (2016) Breast size impacts spine motion and postural muscle activation. J Back Musculoskelet Rehabil. 29(4):741-8. https://doi.org/10.3233/bmr-160680

Shimizu M, Kobayashi T, Chiba H, Senoo I, Ito H, Matsukura K, Saito S (2020) Adult spinal deformity and its relationship with height loss: a 34-year longitudinal cohort study. BMC Musculoskelet Disord. 21(1):1-7. https://doi.org/10.1186/s12891-020-03464-2

Oxland TR (2016) Fundamental biomechanics of the spine-what we have learned in the past 25 years and future directions. J Biomech. 49(6):817-32. https://doi.org/10.1016/j.jbiomech.2015.10.035

Fındıkcıoğlu K, Fındıkcıoğlu F, Özmen S, Güçlü T (2007) The impact of breast size on the vertebral column: a radiologic study. Aesthetic Plast Surg. 31(1):23-7. https://doi.org/10.1007/s00266-006-0178-5

Berberoğlu Ö, Temel M, Türkmen A (2015) Effects of reduction mammaplasty operations on the spinal column: clinical and radiological response. Aesthetic Plast Surg. 39 (4):514-22. https://doi.org/10.1007/s00266-015-0516-6

Karabekmez FE, Gökkaya A, Işık C, Sağlam I, Efeoğlu FB, Görgü M (2014) Does reduction mammaplasty revert skeletal disturbances in the vertebral column of patiensts with macromastia? A preliminary study. Aesthetic Plast Surg. 38(1):104-12. https://doi.org/10.1007/s00266-013-0194-1

Fon GT, Pitt MJ, Thies AC Jr. Toracic kyphosis: range in normal subjects. Am J Roentgenol 134:979-83 https://doi.org/10.2214/ajr.134.5.979

Ensrud KE, Black DM, Harris F, Ettinger B, Cummings SR (1997) Correlates of kyphosis in older women. The fracture intervention trial research group. J Am Geriatr Soc 45:682-7 https://doi.org/10.1111/j.1532-5415.1997.tb01470.x

Katzma WB, Wanek L, Shepherd JA, Sellmeyer DE (2010). Age- related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther 40(6): 352-60 https://doi.org/10.2519%2Fjospt.2010.3099

Roghani T, Zavieh MK, Manshadi FD (2017) Age-related hyperkyphosis: update of its potential cuses and clinical impacts- narrative review. Aging Clin Exp Res 29: 567-77 https://doi.org/10.1007/s40520-016-0617-3

McDaniels-Davidson C, Davis A, Wing D, Macera C, Lindsay SP, Schousboe JT, Nichols JF and Kado DM (2017) Kyphosis and incidental falls among community-dwelling older adults. Osteporos Int 29:163-9 https://doi.org/10.1007/s00198-017-4253-3

van der Jagt-Willems HC, de Groot MH, van Campen JP, Lamoth CJ, Lems WF (2015) Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study. BMC Geriatr. 15:34 https://doi.org/10.1186/s12877-015-0018-z

Kado DM, Miller- Martinez D, Lui LY, Cawthon P, Katzman WB, Hillier TA, Fink AH (2014) Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: the study of osteoporotic fractures (SOF). J Bone Miner Res. 29: 2210-6 https://doi.org/10.1002/jbmr.2251

Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR (2005) Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporos İnt. 16:1004-10 https://doi.org/ 10.1007/s00198-004-1791-2

Milne JS, Lauder IJ (1976) The relationship of kyphosis to the shape of vertebral bodies. Ann Hum Biol 3:173-9 https://doi.org/10.1080/03014467600001281

Anderson DE, D’Agostino JM, Bruno AG, Demissie S, Kiel DP, Bouxsein ML (2013) Variations of CT- based trunk muscle attenuation by age, sex, and specific muscle. J Gerontol A Biol Sci Med Sci 68:317-23 https://doi.org/10.1093/gerona/gls168

Kamel HK (2003) Sarcopenia and aging. Nutr Rev 61:157-67 https://doi.org/10.1301/nr.2003.may.157-167

Van der Klift M, De Laet CE, McCloskey EV, Hofman A, Pols HA (2002) The incidence of vertebral fractures in men and women: Rotterdam Study. J Bone Miner Res 17: 1051-6 https://doi.org/10.1359/jbmr.2002.17.6.1051

Bonner FJ, Lindsay R (2005). Osteoporosis. İn: Delisa JA (ed) Physical medicine and rehabilitation, 4th edn. Lippincott Wiliams and Wilkins, Philadelphia, pp 699-719

Hall SE, Criddle RA, Comito TL, Price RL (1999). A case- control study of quality of life and functional impairement in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9(6): 508-15 http://dx.doi.org/10.1007/s001980050178

Sarıdoğan ME (2005) Osteoporoz Epidemiyolojisi. Gökçe Kutsal Y (ed) Osteoporoz, Ankara, pp 5-36

Sinaki M (1998) Musculoskeletal challenges of osteoporosis. Aging 10(3): 249-62 https://doi.org/10.1007/bf03339659

Gölpınar M, Komut E (2022) The reliability of the projection area per length squared for measuring lumbar lordosis an lateral radiographs: A comparison with Cobb Method. Eur J Ther. 28(4):285-91. https://doi.org/10.58600/eurjther-28-4-0091

Hussain Z, Roberts N, Whitehouse GH, Garcia-Finana M, Percy D (1999) Estimation of breast volume and its variation during the menstrual cycle using MRI and stereology. BJR. 72(855):236-45. https://doi.org/10.1259/bjr.72.855.10396212

Bulstrode N, Bellamy E, Shrotria S (2001) Breast volume assessment: comparing five different techniques. The Breast. 10(2):117-23. https://doi.org/10.1054/brst.2000.0196

Kayar R, Civelek S, Cobanoglu M, Gungor O, Catal H, Emiroglu M (2011) Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. Breast Cancer: Basic and Clinical Research. 5:43-52. https://doi.org/10.4137/bcbcr.s6128

Sigurdson LJ, Kirkland SA (2006) Breast volume determination in breast hypertrophy: an accurate method using two anthropomorphic measurements. Plast Reconstr Surg. 118(2):313-20. https://doi.org/10.1097/01.prs.0000227627.75771.5c

Yip JM, Mouratova N, Jeffery RM, Veitch DE, Woodman RJ, Dean NR (2012) Accurate assessment of breast volume: a study comparing the volumetric gold standard [direct water displacement measurement of mastectomy specimen] with a 3D laser scanning technique. Ann Plast Surg. 68(2):135-41. https://doi.org/10.1097/sap.0b013e31820ebdd0

Ratib O, Valentino DJ, McCoy MJ, Balbona JA, Amato CL, Boots K (2000) Computer-aided design and modeling of workstations and radiology reading rooms for the new millennium. Radiographics. 20(6):1807-16. https://doi.org/10.1148/radiographics.20.6.g00nv191807

Lenchik L, Heacock L, Weaver AA, Boutin RD, Cook TS, Itri J, Cristopher GF, Gullapalli RP, Lee J, Zagurovskaya M, Redson T, Godwin K, Nicholson J, Narayana PA (2019) Automated segmentation of tissues using CT and MRI: a systematic review. Acad Radiol. 26(12):1695-706. https://doi.org/10.1016/j.acra.2019.07.006

Ortiz CG, Martel AL (2012) Automatic atlas‐based segmentation of the breast in MRI for 3D breast volume computation. Med Phys. 39(10):5835-48. https://doi.org/10.1118/1.4748504

Kim YS, Cho HG, Kim J, Park SJ, Kim HJ, Lee SE, Yang JD, Kim WH, Lee JS (2022) Prediction of implant size based on breast volume using mammography with fully automated measurements and brest MRI. Ann. Surg. Oncol 29(12): 7845-54. https:// doi: 10.1245/s10434-022-11972-9. Epub 2022 Jun 20

Nara M, Fujioka T, Mori M, Agura T, Tateishi U (2022) Prediction of breast cancer risk by automated volumetric breast density measurement. Jpn J Radiol. 41(1): 54-62. https://doi: 10.1007/s11604-022-013-y. Epub 2022 Aug 1

Ma JJ, Meng S, Dang SJ, Wang JZ, Yuan Q, Yang Q, Song CX (2022) Evaluation of a new method of calculating breast tumor volume based on automated breast ultrasound. Front Oncol. 13:12:895575. https://doi:10.3389/fonc.2022.895575.eCollection 2022.

Lagendijk M, Vos EL, Ramlakhan KP, Verhoef C, Koning AHJ, Lankeren WV, Koppert LB (2018) Breast and tumour volume measurements in breast cancer patients using 3-D automated breast volume scanner images. World J Surg. 42(7): 2087-93 https://doi.org/10.1007/s00268-017-4432-6

Schmachtenberg C, Fischer T, Hamm B, Bick U (2017) Diagnostic performance of automated breast volume scanning (ABVS) compared to handheld ultrasonography with breast MRI as the gold standard. Acad Radiol. 24(8):954-61 https://doi.org/10.1016/j.acra.2017.01.021

Kim JS, Bae K, Lee EJ, Bang M (2021) Mammography with a fully automated breast volumetric software as a novel method for estimating the preoperative breast volüme prior to mastectomy. Ann Surg Treat Res. 100(6):313-19 https://doi.org/10.4174/astr.2021.100.6.313

Li H, Yao L, Jin P, Hu L, Li x, Gua T, Yang K (2018) MRI and PET-CT for evaluation of the pathological response to neoadjuvant chemotherapy in breast cancer: A systematic review and meta- analysis. Breast 40:106-15 https://doi.org/10.1016/j.breast.2018.04.018

Li J, Gao W, Yu B, Wang F, Wang L (2018) Multi-slice spiral CT evaluation of breast cancer chemotherapy and correlation between CT results and breast cancer specifik gene1. J BUON 23(2):378-83

Dobruch-Sobczak K, Piotrkowska- Wroblewska H, Klimonda Z, Roszkowska- Purska K, Litniewski (2019) J Ultrasound echogenity reveals the response of breat cancer to chemotherapy. Clin Imaging 55:41-6 https://doi.org/10.1038%2Fs41598-021-82141-3

Vourtis A (2019) Three-dimensional automated breast ultrasound: Technical aspects and first results. Diagn Interv Imaging 100:579-92 https://doi.org/10.1016/j.diii.2019.03.012

Xu Z, Gertz AL, Burke RP, Bansal N, Kang H, Landman BA, Abramson RG (2016) Improving spleen volume estimation via computer-assisted segmentation on clinically acquired CT scans. Acad Radiol. 23(10):1214-20. https://doi.org/10.1016/j.acra.2016.05.015

Gotra A, Sivakumaran L, Chartrand G, Vu K-N, Vandenbroucke-Menu F, Kauffmann C, Kadoury S, Gallix B, de Guise JA, Tang A (2017) Liver segmentation: indications, techniques and future directions. Insights into Imaging. 8(4):377-92. https://doi.org/10.1007%2Fs13244-017-0558-1

Hu HH, Nayak KS, Goran MI (2011) Assessment of abdominal adipose tissue and organ fat content by magnetic resonance imaging. Obes Rev. 12(5):e504-15. https://doi.org/10.1111/j.1467-789x.2010.00824.x