Author: Richard J Barth, Brook Kennedy Byrd, Roberta DiFlorio-Alexander, Misty J Fox, Venkat Krishnaswamy, Keith D. Paulsen, Timothy B Rooney 👨🔬
Affiliation: Cairn Surgical Inc., Dartmouth Health, Thayer School of Engineering, Dartmouth Hitchcock Medical Center, University of Virginia Health, CairnSurgical Inc. 🌍
Purpose: Supine breast MRI enables precise surgical planning with demonstrated benefit in decreasing positive margin rates during BCS. However, acquiring supine breast MRI scans in a secondary imaging visit is both clinically inefficient and financially infeasible. The ability to acquire prone and supine contrast-enhanced breast MRI in a single imaging session would reduce costs and improve accessibility for all patients. To support this goal, this study aimed to evaluate the segmentability and non-inferiority of an investigational prone-to-supine breast MRI protocol compared to an independent supine MRI protocol.
Methods: Thirty-nine breast cancer patients had standard prone breast MRI followed immediately by a second contrast injection in the supine position to obtain supine breast MRI (double bolus P2S). A control group of 35 patients received a prone exam and an independent supine exam in two separate imaging sessions. Tumor-to-fibroglandular tissue contrast ratios, a measure of tumor enhancement that informs the ability to segment the tumor margins, were statistically compared between cohorts. Two radiologists independently rated the ability to segment the breast cancer margins in the independent and double bolus supine breast MRIs.
Results: There were no significant differences in the mean tumor-to-fibroglandular contrast ratios between the control independent and the double bolus P2S supine exams. There was excellent agreement between both readers regarding the ability to segment the tumors in the independent and double bolus supine MRIs with kappa scores of 1.00 and 0.95 respectively.
Conclusion: A double-bolus, prone-to-supine breast MRI obtained in a single imaging session provides adequate tumor enhancement for pre-operative surgical guidance compared to independent supine MRI obtained in a separate imaging session.