Breast Cancer Surgery Can Be Improved By Turning Patient Over For MRI Interview with:

Eva C. Gombos, MD Assistant Professor, Radiology Harvard Medical School Brigham and Women’s Hospital

Dr. Eva Gombos

Eva C. Gombos, MD
Assistant Professor, Radiology
Harvard Medical School
Brigham and Women’s Hospital What is the background for this study?

Response: Treatment of early stage breast cancer, breast-conserving therapy (BCT), which consists of lumpectomy followed by whole-breast irradiation, requires re-excision 20 %–40% of patients due to positive margins.

Breast MR is the imaging modality with the highest sensitivity to detect breast cancer. However, patients who undergo breast MR imaging have not experienced reduced re-excision or improved survival rates.

Our hypothesis is that supine (performed with patient lying on her back) MR imaging within the operating room can be used to plan the extent of resection, to detect residual tumor immediately after the first attempt at definitive surgery, and to provide feedback to the surgeon within the surgical suite. The aim of this study was to use intraoperative supine MR imaging to quantify breast tumor deformation and displacement secondary to the change in patient positioning from imaging (prone performed the patient lying on her stomach) to surgery (supine) and to evaluate the residual tumor immediately after BCT. What are the main findings?

Response: We describe supine pre- and postprocedural MR imaging protocols and workflow within the operating room.
The computed mean difference in tumor deformation metrics between supine and prone MR imaging examinations are as follows:
(a) increases in volume, 23.8% surface area, 6.5%, compactness, 16.2% and sphericity, 6.8%
(b) decrease in spherical disproportion, 211.3%

All tumors were closer to the chest wall on supine images than on prone images. What should readers take away from your report?
What recommendations do you have for future research as a result of this study?

Response: Supine MR imaging may aid in improving surgical planning by accounting for tumor displacement and deformation occurring between standard positioning for MR imaging and that for surgery to potentially allow for more complete tumor resection.

If validated in future large studies, intraoperative supine MR imaging could be expected to help detect a remnant tumor immediately after breast-conserving surgery to ensure negative surgical margins. Is there anything else you would like to add?

Response: The study was initiated and developed by the late Ferenc A Jolesz MD, former director of the MRI Division and the Image-Guided Therapy Program at BWH. The work was done in collaboration of surgeons, radiologists and scientists. Thank you for your contribution to the community.


Eva C. Gombos, Jagadeesan Jayender, Danielle M. Richman, Diana L. Caragacianu, Melissa A. Mallory, Ferenc A. Jolesz, Mehra Golshan. Intraoperative Supine Breast MR Imaging to Quantify Tumor Deformation and Detection of Residual Breast Cancer: Preliminary Results. Radiology, June 2016 DOI:10.1148/radiol.2016151472

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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