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The American Society of Breast Surgeons.
Annals of Surgical Oncology

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

Richard J. Barth Jr MD, Venkataramanan Krishnaswamy PhD, Keith D. Paulsen PhD, Timothy B. Rooney MD, Wendy A. Wells MD, Christina V. Angeles MD, Rebecca A. Zuurbier MD, Kari Rosenkranz MD, Steven Poplack MD, Tor D. Tosteson ScD
Breast Oncology
Volume 26, Issue 10 / October , 2019

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.

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