MRI and Optical Scanning During Surgery Accurately Locate Small Breast Cancer Tumors
March 27, 2014
Physicians at the Dartmouth-Hitchcock Norris Cotton Cancer Center have collaborated with engineers from Dartmouth's Thayer School of Engineering to develop a new approach to breast-conserving surgery that simplifies the procedure for women whose breast cancer is too small to be felt. By combining magnetic resonance imaging (MRI) before surgery with optical scanning during surgery they are able to accurately locate small breast cancer tumors for removal. Their findings, "Supine Breast MRI and 3D Optical Scanning: A Novel Approach to Improve Tumor Localization for Breast Conserving Surgery," were recently published in Annals of Surgical Oncology.
"We have developed a technique that gives the surgeon, at the time of surgery, a 3-D picture of where the cancer is in the breast using MRI," said Richard J. Barth Jr., MD, section chief, General Surgery, associate professor of Surgery, Geisel School of Medicine, Dartmouth and member of the Norris Cotton Cancer Center. "This is the first time that optical scanning and MRI have been combined to localize breast cancer."
Currently, a wire is inserted into the breast before surgery to mark these small tumors. This technique requires a separate procedure, which can be uncomfortable for the patient and is not very accurate—cancer cells are left behind about 30 to 40 percent of the time, and additional surgery is needed to remove remaining cancer.
Barth says that this new method of locating breast tumors uses a pre-operative MRI as a map of the tumor and an optical scan to identify the tumor's size, shape, and location. Combined the two create an interactive 3-D image on a computer screen. Conceptually it is similar to a car's GPS. The uploaded maps would be the MRI, and the optical scan provides the "your are here" arrow for the surgeon. This more accurate picture of the tumor location and its edges allows for a more precise surgical excision.
Barth will soon be initiating a randomized prospective study of patients with non-palpable breast cancer to test whether the new method of localization with optical scanning and supine MRI results in a lower rate of positive margins than the old wire localization method.
This initial pilot study was funded by the Dartmouth Center for Clinical and Translational Research (SYNERGY). Co-authors on the study were Matthew J. Pallone, PhD; Steven P. Poplack, MD; Hima Bindu R. Avutu, MD; and Keith D. Paulsen, PhD.
About Norris Cotton Cancer Center at Dartmouth-Hitchcock
Norris Cotton Cancer Center combines advanced cancer research at Dartmouth and the Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center, at Dartmouth-Hitchcock regional locations in Manchester, Nashua, and Keene, NH, and St. Johnsbury, VT, and at 12 partner hospitals throughout New Hampshire and Vermont. It is one of 41 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu.