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Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3099–3108 | Cite as

A Randomized Prospective Trial of Supine MRI-Guided Versus Wire-Localized Lumpectomy for Breast Cancer

  • Richard J. BarthJrEmail author
  • Venkataramanan Krishnaswamy
  • Keith D. Paulsen
  • Timothy B. Rooney
  • Wendy A. Wells
  • Christina V. Angeles
  • Rebecca A. Zuurbier
  • Kari Rosenkranz
  • Steven Poplack
  • Tor D. Tosteson
Breast Oncology

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.

Notes

Acknowledgment

This study was supported by NIH/NCI Grant R21 CA182956-01 to Dr. Richard J. Barth Jr.

Conflict of interest

Drs. Barth, Krishnaswamy, and Paulsen have ownership interest in CairnSurgical Inc.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Richard J. BarthJr
    • 1
    Email author
  • Venkataramanan Krishnaswamy
    • 2
  • Keith D. Paulsen
    • 2
  • Timothy B. Rooney
    • 3
  • Wendy A. Wells
    • 4
  • Christina V. Angeles
    • 1
  • Rebecca A. Zuurbier
    • 3
  • Kari Rosenkranz
    • 1
  • Steven Poplack
    • 3
  • Tor D. Tosteson
    • 5
  1. 1.Section of General Surgery, Department of SurgeryDartmouth-Hitchcock Medical CenterLebanonUSA
  2. 2.Thayer School of EngineeringDartmouth CollegeHanoverUSA
  3. 3.Department of RadiologyDartmouth-Hitchcock Medical CenterLebanonUSA
  4. 4.Department of PathologyDartmouth-Hitchcock Medical CenterLebanonUSA
  5. 5.Department of Biomedical Data ScienceDartmouth-Hitchcock Medical CenterLebanonUSA

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