Breast cancer Intraoperative Margin Assessment using specimen PET-CT (BIMAP)

Area of Science:

• Nuclear Medicine
• Surgical Oncology
• Radiology

Background:

• Positive surgical margins in breast-conserving surgery (BCS) for breast cancer occur in 20% of cases, necessitating re-operations.
• Intraoperative margin assessment (IMA) is crucial to minimize positive margins and improve patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of specimen PET-CT imaging for intraoperative margin assessment in breast cancer patients undergoing BCS.
• To determine the sensitivity and specificity of specimen PET-CT in identifying positive surgical margins.

Main Methods:

• Forty-one patients undergoing BCS for breast cancer were included in the study.
• Specimen PET-CT imaging was performed using ß-CUBE/X-CUBE or AURA 10 systems with a low [18F]FDG dose (0.8MBq/kg) and 10-minute acquisition time.
• Seven physicians assessed margin status (positive, close, or negative) using PET-CT images, with histopathology serving as the gold standard.

Main Results:

• The proposed specimen PET-CT technique demonstrated 91% sensitivity and 86% specificity for detecting invasive ductal carcinoma (IDC).
• Of 9 positive margins identified by histopathology in 31 IDC cases, 88% were detected by all physicians using specimen PET-CT.
• Standard of care methods identified only 44% of these positive margins.

Conclusions:

• Specimen PET-CT imaging is a promising tool for improving intraoperative margin assessment in BCS.
• This technique has the potential to significantly reduce re-operation rates in breast cancer surgery.
• Further implementation of specimen PET-CT could enhance surgical precision and patient care in lumpectomy procedures.