Radioguided Intraoperative Margins Evaluation (RIME): Preliminary results of a new technique to aid breast cancer resection

• Published in: European journal of surgical oncology 2007-12, Vol.33 (10), p.1150-1157
• Main Authors: Duarte, G.M, Cabello, C, Torresan, R.Z, Alvarenga, M, Telles, G.H.Q, Bianchessi, S.T, Caserta, N, Segala, S.R, de Lima, M.C.L, Etchebehere, E.C.S.C, Camargo, E.E
• Format: Article
• Language: English
• Subjects: 99mTc-sestamibi; Adult; Aged; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - surgery; Carcinoma, Ductal, Breast - diagnosis; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - surgery; Feasibility Studies; Female; Hematology, Oncology and Palliative Medicine; Humans; Magnetic Resonance Imaging; Mammography; Margin; Mastectomy, Modified Radical; Middle Aged; Neoplasm, Residual - diagnostic imaging; Radioguided surgery; Radionuclide Imaging; Radiopharmaceuticals; Surgery; Technetium Tc 99m Sestamibi
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2007.03.021

Abstract Aims Women undergoing breast-conserving surgery for cancer can present residual disease. We have developed a technique called Radioguided Intraoperative Margins Evaluation (RIME) that uses a radiopharmaceutical to distinguish normal and cancer tissues. The aim of this study was to assess whether RIME is a feasible technique, and if it could help in breast cancer resection with free margins, minimizing residual disease. Methods Twenty-three breast cancer patients programmed for mastectomy were selected. Before surgery, the patients were submitted to scintimammography with99m Tc-sestamibi to estimate the optimal time to begin radioguided surgery. Twenty patients were submitted to magnetic resonance imaging (MRI), to evaluate skin, deep fascia and to detect other tumor foci. At the beginning of the surgery, the same dose of99m Tc-sestamibi was intravenously injected into patients. Tumor resection was performed under guidance of a gamma-probe, characterizing the RIME technique. Finally, modified radical mastectomy was performed. Tumor and residual breast were histopathologically examined. Results The RIME technique was successfully performed in all patients. The principal tumor was removed by this technique and provided 82.6% of histologically free margins (mean margins, 4.8 mm). Additionally, 47.8% of patients were without residual disease. The mean size of residual carcinoma was 3.67 mm and generally located near the tumor bed (