Richard J Barth1, Venkataramanan Krishnaswamy2, Keith D Paulsen2, Timothy B Rooney3, Wendy A Wells4, Christina V Angeles5, Rebecca A Zuurbier3, Kari Rosenkranz5, Steven Poplack3, Tor D Tosteson6. 1. Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. Richard.J.Barth.Jr@Hitchcock.org. 2. Thayer School of Engineering, Dartmouth College, Hanover, NH, USA. 3. Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 4. Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 5. Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 6. Department of Biomedical Data Science, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Abstract
BACKGROUND:Wire-localized excision of non-palpable breast cancer is imprecise, resulting in positive margins 15-35% of the time. METHODS:Women with a confirmed diagnosis of non-palpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) were randomized to a new technique using preoperative supine magnetic resonance imaging (MRI) with intraoperative optical scanning and tracking (MRI group) or wire-localized (WL group) partial mastectomy. The main outcome measure was the positive margin rate. RESULTS: In this study, 138 patients were randomly assigned. Sixty-six percent had IBC and DCIS, 22% had IBC, and 12% had DCIS. There were no differences in patient or tumor characteristics between the groups. The proportion of patients with positive margins in the MRI-guided surgery group was half that observed in the WL group (12 vs. 23%; p = 0.08). The specimen volumes in the MRI and WL groups did not differ significantly (74 ± 33.9 mL vs. 69.8 ± 25.1 mL; p = 0.45). The pathologic tumor diameters were underestimated by 2 cm or more in 4% of the cases by MRI and in 9% of the cases by mammography. Positive margins were observed in 68% and 58% of the cases underestimated by 2 cm or more using MRI and mammography, respectively, and in 15% and 14% of the cases not underestimated using MRI and mammography, respectively. CONCLUSIONS: A novel system using supine MRI images co-registered with intraoperative optical scanning and tracking enabled tumors to be resected with a trend toward a lower positive margin rate compared with wire-localized partial mastectomy. Margin positivity was more likely when imaging underestimated pathologic tumor size.
RCT Entities:
BACKGROUND: Wire-localized excision of non-palpable breast cancer is imprecise, resulting in positive margins 15-35% of the time. METHODS:Women with a confirmed diagnosis of non-palpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) were randomized to a new technique using preoperative supine magnetic resonance imaging (MRI) with intraoperative optical scanning and tracking (MRI group) or wire-localized (WL group) partial mastectomy. The main outcome measure was the positive margin rate. RESULTS: In this study, 138 patients were randomly assigned. Sixty-six percent had IBC and DCIS, 22% had IBC, and 12% had DCIS. There were no differences in patient or tumor characteristics between the groups. The proportion of patients with positive margins in the MRI-guided surgery group was half that observed in the WL group (12 vs. 23%; p = 0.08). The specimen volumes in the MRI and WL groups did not differ significantly (74 ± 33.9 mL vs. 69.8 ± 25.1 mL; p = 0.45). The pathologic tumor diameters were underestimated by 2 cm or more in 4% of the cases by MRI and in 9% of the cases by mammography. Positive margins were observed in 68% and 58% of the cases underestimated by 2 cm or more using MRI and mammography, respectively, and in 15% and 14% of the cases not underestimated using MRI and mammography, respectively. CONCLUSIONS: A novel system using supine MRI images co-registered with intraoperative optical scanning and tracking enabled tumors to be resected with a trend toward a lower positive margin rate compared with wire-localized partial mastectomy. Margin positivity was more likely when imaging underestimated pathologic tumor size.
Authors: Winona L Richey; Jon S Heiselman; Ma Luo; Ingrid M Meszoely; Michael I Miga Journal: Int J Comput Assist Radiol Surg Date: 2021-08-12 Impact factor: 3.421
Authors: Brook K Byrd; Venkataramanan Krishnaswamy; Jiang Gui; Timothy Rooney; Rebecca Zuurbier; Kari Rosenkranz; Keith Paulsen; Richard J Barth Journal: Breast Cancer Res Treat Date: 2020-07-12 Impact factor: 4.872