Abstract
Background
The rate of re-excision in breast conserving surgery (BCS) remains high, leading to delay in initiation of adjuvant therapy, increased cost, increased complications and a negative psychological impact to the patient (1-3). We initiated a phase I clinical trial to determine the feasibility of using the intraoperative MRI to assess margins in the Advanced Multimodality Image Guided Operating (AMIGO) suite.
Methods
All patients received contrast-enhanced 3D MRI under general anesthesia in the supine position, followed by standard breast conserving therapy with or without wire guidance and sentinel node biopsy. Additional margin re-excision was performed of suspicious margins and correlated to final pathology (Figure 1). Feasibility was assessed in two components: (1) demonstration of safety & sterility and acceptable duration of the operation and imaging, (2) adequacy of intraoperative MRI imaging for interpretation and its comparison to final pathology.
Results
Eight patients (mean age: 48.5), 4 with stage I breast cancer and 4 with stage II breast cancers were recruited. All patients underwent successful breast conserving therapy in the AMIGO suite with no AMIGO-specific complications or break in sterility during surgery. The mean operative time was 113 minutes [93-146].
Conclusion
Our experience AMIGO suggests that it is feasible to use intraoperative MRI imaging to evaluate margin assessment in real time. Further research is required to identify modalities that will lead to reduction in re-excision in breast cancer therapy.
Supplementary Material
Figure 1. Schema of AMIGO Trial.
Footnotes
The original publication is available at the Annals of Surgical Oncology website at http://link.springer.com/article/10.1245%2Fs10434-014-3926-9
References
- 1.Heil J, Breitkreuz K, Golatta M, et al. Do reexcisions impair aesthetic outcome in breast conservation surgery? Exploratory analysis of a prospective cohort study. Ann Surg Oncol. 2012;19:541–7. doi: 10.1245/s10434-011-1947-1. [DOI] [PubMed] [Google Scholar]
- 2.Russo AL, Arvold ND, Niemierko A, et al. Margin status and the risk of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy. Breast Cancer Res Treat. 2013;140:353–61. doi: 10.1007/s10549-013-2627-6. [DOI] [PubMed] [Google Scholar]
- 3.Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol. 2008;15:1297–1303. doi: 10.1245/s10434-007-9777-x. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.