Concept for using magnetic particle imaging for intraoperative margin analysis in breast-conserving surgery

Erica E Mason,Clarissa Zimmerman Cooley,Lawrence L Wald,Priscilla J Slanetz,Eli Mattingly,Konstantin Herb,Monika Śliwiak,Sofia Franconi

doi:10.1038/s41598-021-92644-8

Abstract

Breast-conserving surgery (BCS) is a commonly utilized treatment for early stage breast cancers but has relatively high reexcision rates due to post-surgical identification of positive margins. A fast, specific, sensitive, easy-to-use tool for assessing margins intraoperatively could reduce the need for additional surgeries, and while many techniques have been explored, the clinical need is still unmet. We assess the potential of Magnetic Particle Imaging (MPI) for intraoperative margin assessment in BCS, using a passively or actively tumor-targeted iron oxide agent and two hardware devices: a hand-held Magnetic Particle detector for identifying residual tumor in the breast, and a small-bore MPI scanner for quickly imaging the tumor distribution in the excised specimen. Here, we present both hardware systems and demonstrate proof-of-concept detection and imaging of clinically relevant phantoms.

Highlights

Breast-conserving surgery (BCS) is a commonly utilized treatment for early stage breast cancers but has relatively high reexcision rates due to post-surgical identification of positive margins
To gain regular clinical utility, an intraoperative margin assessment technique must provide sensitive and specific information about the margin status, and be fast and easy to use in the operating room
The problem of positive margins and reexcisions in BCS has been approached with numerous techniques[10,17,18,19,20,21,22,23], addressing both macroscopic tumor localization and microscopic margin assessment

Summary

Introduction

Breast-conserving surgery (BCS) is a commonly utilized treatment for early stage breast cancers but has relatively high reexcision rates due to post-surgical identification of positive margins. We assess the potential of Magnetic Particle Imaging (MPI) for intraoperative margin assessment in BCS, using a passively or actively tumor-targeted iron oxide agent and two hardware devices: a hand-held Magnetic Particle detector for identifying residual tumor in the breast, and a small-bore MPI scanner for quickly imaging the tumor distribution in the excised specimen We present both hardware systems and demonstrate proof-of-concept detection and imaging of clinically relevant phantoms. The need for secondary surgery can be reduced with the use of an intraoperative tool that enables the surgeon to iterate tissue removal and margin analysis in real time, enabling greater confidence of clear margins[10,16]

Results

Discussion

Conclusion