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

Richard J. Barth, Venkataramanan Krishnaswamy, Keith D. Paulsen, Timothy B. Rooney, Wendy A. Wells, Christina V. Angeles, Rebecca A. Zuurbier, Kari Rosenkranz, Steven Poplack, Tor D. Tosteson

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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.

Original languageEnglish
Pages (from-to)3099-3108
Number of pages10
JournalAnnals of Surgical Oncology
Volume26
Issue number10
DOIs
StatePublished - Oct 1 2019
Externally publishedYes

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