title: Pilot study to evaluate feasibility of image-guided breast-conserving therapy in the advanced multimodal image-guided operating (AMIGO) suite.
abstract: BACKGROUND
  The rate of reexcision in breast-conserving surgery remains high, leading to delay in initiation of adjuvant therapy, increased cost, increased complications, and negative psychological impact to the patient.1 (-) 3 We initiated a phase 1 clinical trial to determine the feasibility of the use of intraoperative magnetic resonance imaging (MRI) to assess margins in the advanced multimodal image-guided operating (AMIGO) suite.
  
  
  METHODS
  All patients received contrast-enhanced three-dimensional MRI while under general anesthesia in the supine position, followed by standard BCT with or without wire guidance and sentinel node biopsy. Additional margin reexcision was performed of suspicious margins and correlated to final pathology (Fig. 1). Feasibility was assessed via two components: demonstration of safety and sterility and acceptable duration of the operation and imaging; and adequacy of intraoperative MRI imaging for interpretation and its comparison to final pathology. Fig. 1 Schema of AMIGO trial
  
  
  RESULTS
  Eight patients (mean age 48.5 years), 4 with stage I breast cancer and 4 with stage II breast cancer, were recruited. All patients underwent successful BCT in the AMIGO suite with no AMIGO-specific complications or break in sterility during surgery. The mean operative time was 113 min (range 93-146 min).
  
  
  CONCLUSIONS
  Our experience with AMIGO suggests that it is feasible to use intraoperative MRI imaging to evaluate margin assessment in real time. Further research is required to identify modalities that will lead to a reduction in reexcision in breast cancer therapy.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA, mgolshan@partners.org.
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Sagara
authors.forename: Barbara
authors.initials: B
authors.lastname: Wexelman
authors.forename: Fatih
authors.initials: F
authors.lastname: Aydogan
authors.forename: Stephen
authors.initials: S
authors.lastname: Desantis
authors.forename: H
authors.initials: H
authors.lastname: Elise Min
authors.forename: Kirby
authors.initials: K
authors.lastname: Vosburgh
authors.forename: Jayender
authors.initials: J
authors.lastname: Jagadeesan
authors.forename: Diana
authors.initials: D
authors.lastname: Caragacianu
authors.forename: Eva
authors.initials: E
authors.lastname: Gombos
authors.forename: Ferenc Andras
authors.initials: FA
authors.lastname: Jolesz
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D015412:Mastectomy, Segmental; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D010865:Pilot Projects; D011379:Prognosis; D025321:Surgery, Computer-Assisted