Imaging advances for breast surgery

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Published: 31 Jan 2023
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Prof Mehra Golshan - Yale School of Medicine, New Haven, USA

Prof Mehra Golshan speaks to ecancer about his talk on imaging advances for breast surgery. 

He explains the process of women getting a breast MRI in the prone position. However, during surgery, the patient is led on the back, meaning the cancer looks different and is positioned differently than when lying on their stomach. 

He discusses the undergoing trials looking at the imaging of a woman's breast in the same position as when in the operating room.

First of all, I’d like to thank Professor Hesham El Ghazaly for inviting us to the 15th Annual Meeting and apologise for my voice – I lost that on my way to Cairo. So this morning I gave a talk about women who have had breast cancer and had what’s called a lumpectomy where we remove the tumour, they do radiation to the breast, but then the tumour comes back and what’s the standard and where is the future going? The standard has been, unfortunately, that the women have to have a mastectomy because we didn’t think we could do another lumpectomy with radiation. However, there is data that there is a subset of women who could undergo a repeat lumpectomy, basically having a second chance at saving her breast. Those patients that are best for this are those that have smaller tumours, that have actually had a longer period of time since their original surgery, where we could potentially remove the tumour again and do, instead of radiation to the entire breast, radiation to a small portion of the breast. That’s usually followed by anti-oestrogen therapy if it’s hormone positive and occasionally chemotherapy as well. The question ends up being how safe is it and what’s the best patient population. That’s where a lot of the trials and studies are looking towards the future.

Yesterday I got to speak about a couple of other things. One was some advances in breast imaging. The advances are… one of the ones that I spend a lot of time on is breast MRI. So women will often get an MRI either for a diagnostic to find the cancer or tell us how much cancer is in the breast, but all MRIs are done in what’s called the prone position so the woman is lying on her stomach and then they take the picture with the MRI. But when we operate, I’ve never operated on a woman’s breast on her stomach, it’s always on her back. When you turn the patient over and you actually do the MRI in the operative position there’s quite a bit of difference between where the tumour sits and how the tumour looks between prone versus supine. That’s some of the work that we’re doing back at my home institution in terms of being able to better define the tumour, its boundaries, and being able to do more successful surgery the first time.

The other area we’re looking at is if we remove the tumour can we tell in real time if the margins, or the edges around this, are clear. We’re using this technique called mass spectrometry, looking in real time to tell us the interface between where the tumour stops and normal breast tissue starts and being able to say that we have definitively removed the tumour in real time. One of the challenges is, if a woman has a lumpectomy, anywhere between 10-40% of the time they may have to come back a second time and we’re trying to prevent that from happening.