Pilot Study to Evaluate Feasibility of Image-Guided Breast-Conserving Therapy in the Advanced Multimodal Image-Guided Operating (AMIGO) Suite

Background The rate of reexcision in breast-conserving surgery remains high, leading to delay in initiation of adjuvant therapy, increased cost, increased complications, and negative psychological impact to the patient. 1 – 3 We initiated a phase 1 clinical trial to determine the feasibility of the...

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Bibliographic Details
Published in:Annals of surgical oncology 2014-10, Vol.21 (10), p.3356-3357
Main Authors: Golshan, Mehra, Sagara, Yasuaki, Wexelman, Barbara, Aydogan, Fatih, Desantis, Stephen, Elise Min, H., Vosburgh, Kirby, Jagadeesan, Jayender, Caragacianu, Diana, Gombos, Eva, Jolesz, Ferenc Andras
Format: Article
Language:English
Subjects:
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Feasibility Studies
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Mastectomy, Segmental
Medicine
Medicine & Public Health
Middle Aged
Multimodal Imaging
Neoplasm Staging
Oncology
Original Article – Breast Oncology
Pilot Projects
Prognosis
Surgery
Surgery, Computer-Assisted
Surgical Oncology
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Summary:Background The rate of reexcision in breast-conserving surgery remains high, leading to delay in initiation of adjuvant therapy, increased cost, increased complications, and negative psychological impact to the patient. 1 – 3 We initiated a phase 1 clinical trial to determine the feasibility of the use of intraoperative magnetic resonance imaging (MRI) to assess margins in the advanced multimodal image-guided operating (AMIGO) suite. Methods All patients received contrast-enhanced three-dimensional MRI while under general anesthesia in the supine position, followed by standard BCT with or without wire guidance and sentinel node biopsy. Additional margin reexcision was performed of suspicious margins and correlated to final pathology (Fig.  1 ). Feasibility was assessed via two components: demonstration of safety and sterility and acceptable duration of the operation and imaging; and adequacy of intraoperative MRI imaging for interpretation and its comparison to final pathology. Fig. 1 Schema of AMIGO trial Results Eight patients (mean age 48.5 years), 4 with stage I breast cancer and 4 with stage II breast cancer, were recruited. All patients underwent successful BCT in the AMIGO suite with no AMIGO-specific complications or break in sterility during surgery. The mean operative time was 113 min (range 93–146 min). Conclusions Our experience with 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 a reduction in reexcision in breast cancer therapy.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-014-3926-9