A Randomized Prospective Trial of Supine MRI-Guided Versus Wire-Localized Lumpectomy for Breast Cancer
Wire-localized excision of non-palpable breast cancer is imprecise, resulting in positive margins 15–35% of the time.
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.
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.
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.
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.
- 3.Morrow M, Van Zee K, Solin L, et al. Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology consensus guideline on margins for breast-consercving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol. 2016;23:3801–10.CrossRefGoogle Scholar
- 12.Postma E, Koffijberg H, Verkooijen H, et al. Cost effectiveness of radio-guided occult lesion localization versus wire-guided localization in breast-conserving surgery for non-palpable breast cancer: results from a randomized controlled multicenter trial. Ann Surg Oncol. 2013:20:2219–26.CrossRefGoogle Scholar
- 22.Wiberg MK, Aspelin P, Sylvan M, Bone B. Comparison of lesion size estimated by dynamic MR imaging, mammography, and histopathology in breast neoplasms. Eur Radiol. 2003;13:1207–12.Google Scholar
- 27.Sakakibara M, Yokomizu J, Shima N, et al. MRI-guided quadrantectomy in patients with DCIS detected preoperatively by mammographic calcifications. JACS. 2014;219:295–302.Google Scholar
- 30.Hill DLG, Batchelor P. Registration methodology: concepts and algorithms. In: Hajnal JV, Hawkes DJ, Hill DLG, editors. Medical image registration, 1st ed. Boca Raton: CRC Press; 2001. p. 48.Google Scholar