Can supine breast magnetic resonance imaging help hit the target in extreme oncoplastic surgery?

Abstract

Objectives: To evaluate the clinical value of supine magnetic resonance imaging (MRI) for tumor localization in breast cancer patients with large or multifocal tumors detected by prone MRI, scheduled for oncoplastic breast conserving surgery (OBCS). Outcomes were compared with those of patients who underwent wide local excision (WLE) or OBCS without MRI guidance. Methods: Over a 2-year period, consecutive patients with large or multifocal disease scheduled for OBCS with MRI-only findings were invited to participate (Group-1). Supplementary supine MRI was performed, and tumor margins were marked in the surgical position. Consecutive patients with early, nonpalpable breast cancer who underwent WLE (Group-2) or OBCS (Group-3) were included for comparisons. The primary outcome was reoperation due to an insufficient margin. Secondary outcomes included surgical complications and delayed adjuvant treatment. Results: Altogether, 102 breasts (98 patients) were analyzed. All preoperative demographic data were comparable among the three groups. Multifocality, tumor-to-breast volume ratio, and the volume of excised breast tissue were significantly greater in Group-1 than in Groups-2 and 3. Operation time was longer and the need for axillary clearance or surgery for both breasts was more common in Groups-1 and 3 than in Group-2. Adequate margins were achieved in all patients in Groups-1 and 2, and one patient underwent re-excision in Group-3. Conclusions: Supine MRI in the surgical position is a new, promising method to localize multifocal, large tumors visible on MRI. Its short-term outcomes were comparable with those of conventional WLE and OBCS.

Extreme oncoplasty: past, present and future

“…Paulinelli considered the term “GC using WP resection” ( 9 , 16 ), and similar articles were selected based on modified techniques ( 22 ), case descriptions ( 26 – 28 ), and one institutional casuistic with systematic reviews ( 8 ). We found articles related to preoperative care ( 15 , 20 , 29 – 31 ), traditional indications ( 13 , 17 ), multicentric/multifocal tumours ( 14 , 23 ), increased indications ( 8 , 13 , 19 , 21 ), casuistic ( 14 , 17 ), and case reports ( 27 , 32 , 33 ). Quality of life ( 12 , 14 ) was also evaluated.…”

“…Clinical evaluation, preoperative radiological evaluation, intraoperative frozen section margins, intraoperative specimen radiography, and clipped cavity margins are helpful for patient selection and operative evaluation ( 29 , 31 ). Only one publication has considered the importance of breast nuclear magnetic resonance for surgical planning in the presence of multifocal/multicentric lesions ( 20 ).…”

Diagnostic performance of tomosynthesis, digital mammography and a dedicated digital specimen radiography system versus pathological assessment of excised breast lesions

“…Two-view mammography (CC and lateromedial) was routinely performed to confirm the position of each lesion relative to the guidewire, and the location of the lesion was ink-marked on the skin, including supine MRIguided localisation projections. 18 Tumours were excised en bloc from the subcutaneous area to the muscle, and the overlying skin was removed in patients with superficial lesions to achieve a healthy macroscopic surgical margin of ≥1 cm, in accordance with national guidelines, and hence achieve microscopically negative margins (defined as no "tumour-on-ink"). In ductal carcinoma in-situ (DCIS), the need for reoperation is evaluated in a multidisciplinary meeting whenever DCIS margins are less than 2 mm.…”

Image guidance system for breast conserving surgery with integrated stereo camera monitoring and deformable correction

“…In both of these positions, the breast positioning is considerably different from the surgical positioning where the patient lies supine with the ipsilateral arm extended and positioned away from the body. To address this, acquiring MR imaging with the patient in the supine position has been proposed, as this configuration is similar to the surgical presentation 3 . Breast MR imaging has been shown to have high sensitivity and accuracy when measuring tumor extent, which is required for the image guidance application 4 .…”