Magnetic Resonance Imaging (MRI) is useful in detecting breast tumors and in cancer evaluation but its current pre-operative use in breast conserving surgery isn't helping patients as it should.
Traditionally, patients who are scheduled to undergo breast-conserving lumpectomy for breast cancer undergo a breast MRI prior to surgery to help inform the surgeon about the size, shape, and location of the tumor. The issue is that MRIs are performed with the patient lying face down, but then the surgery is performed with the patient lying face up.
A small phase 1 clinical trial from Brigham and Women's Hospital evaluated the differences between pre-operative prone and supine MRI exams in 12 women undergoing lumpectomy for breast cancer. Researchers demonstrated that considerable deformity of the breast and tumor position occurs when patients are imaged in the prone position. Between April 2012 and December 2014, a total of 15 women were enrolled in the trial in the Advanced Multi-Modality Image Guided Operating Suite (AMIGO).
Patients in the study underwent standard diagnostic MR imaging in the usual prone position as an outpatient preceding surgery. Twelve patients underwent lumpectomy and post-surgical supine MRI during the operation. Half had pre-procedure supine imaging. Researchers measured differences found in size, position, and shape of tumor between prone and supine imaging. Researchers found that specifications of the tumor, including size and location in the breast, were substantially different depending on the position of the women when she had her MRI. All patients underwent successful removal of their tumor with clear margins for invasive breast cancer.
"Accounting for change in size and shape caused by displacement and deformation of the tumor between standard imaging in the prone position and operative supine position, our analysis highlights that supine MRI before surgery may provide surgeons with more detailed and accurate information and could lead to effective tumor removal," stated Eva C. Gombos, MD, radiologist at BWH and lead author of the study. "If validated in future large studies, intra-operative, and, more importantly, pre-operative supine MRI could be expected to help the surgeon in accurately planning removal of the tumor and reducing the need for re-operation which negatively impacts the patient emotionally, delays post-operative therapy and increases infection rates and cost."
Published in Radiology. Source: Brigham and Women's Hospital