Physicians at the Dartmouth-Hitchcock Norris Cotton Cancer Center and engineers from Dartmouth College's engineering school have collaboratively developed a new approach to breast-conserving surgery. Dartmouth officials say the method simplifies the procedure for women whose breast cancer is too small to be felt.

By combining magnetic resonance imaging 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 the 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," co-author Richard J. Barth, M.D., said in a statement accompanying the research's publication."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 Dartmouth officials say 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 the 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’s similar to a car's GPS. The uploaded maps would be the MRI, and the optical scan provides the "you 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.

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