Undergoing any surgery can be difficult, but having to go back again can be un-nerving. Now a world class operating suite is sparing some patients a second trip under the knife.

"I've never been in a hospital, I've never had surgery, I've never had anesthesia so I was really nervous,” Jane Davis, Breast Cancer Patient, told Ivanhoe.

Jane Davis would’ve been part of the forty percent of US women to undergo a second surgery, but the AMIGO allowed her doctor to take an MRI during her lumpectomy; to make sure he had cancer free margins. “An MRI machine comes in from the ceiling and then looks at the area that I removed to see if I removed the tumor in its entirety,” Doctor Mehra Golshan, MD, at Brigham and Women's Hospital, told Ivanhoe.

The three room O.R. suite has an electronically controlled operating table mounted with an MRI compatible anesthesia delivery system and other advanced mobile imaging devices. Next door is a PET and CT room that scans the entire body.

“There is no other operating room where you can actually use an MRI or Pet Scan at the same time,” Doctor Golshan explained.

Surgical teams can view all of the patients' images on large LCD monitors making surgeries more precise. The AMIGO is also used for other treatments that include brain surgery, radiation treatment for prostate cancer and gynecological tumors.

BACKGROUND: Breast cancer is the second most common cancer among American women. About 1 in 8 (12%) women in the US will develop invasive breast cancer during their lifetime.  The American Cancer Society estimated that in 2012 approximately 226,870 new cases of invasive breast cancer will be diagnosed in women in the US. (SOURCE: http://breastcancersurgery.com/about-breast-cancer/)

RISK FACTORS: Factors that are associated with an increased risk of breast cancer include:

·         Radiation exposure - If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.

·         Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.

·         Having your first child at an older age. Women who give birth to their first child after age 35 may have an increased risk of breast cancer.

·         Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.

(SOURCE: www.mayoclinic.com/health/breast-cancer)

 

LATEST TECHNOLOGY: Up to 40 percent of women in the U.S. who undergo a lumpectomy to remove a breast tumor require a second surgery. That’s because surgeons often are unable to microscopically remove the entire tumor during the first surgery. Dr. Mehra Golshan, Director of Breast Surgical Services, at the Brigham and Women’s Hospital, is changing all of that with the Advanced Multimodality Image Guided Operating (AMIGO). "Using contrast MRI, an image is taken of the breast before the surgery and then again after the tumor is removed. We then use the images to ensure the entire tumor is removed, with clear margins, before the patient leaves the operating room,” said Dr. Golshan. The idea may be simple but the technology is one of a kind. “I am hopeful this innovative procedure will help create a platform for tests and studies that could be done in the operating room to eliminate repeat procedures for breast cancer patients and allow patients to shift their focus to healing and living their lives,” said Golshan. (SOURCE: http://healthhub.brighamandwomens.org/reducing-repeat-surgeries-after-breast-cancer)

 

Mehra Golshan, MD, Director of Breast Surgical Services, at the Brigham and Women’s Hospital,talks about a new treatment option for breast cancer.

The study you are involved in, what is it about?  

Dr. Golshan: Women who are newly diagnosed with breast cancer in the United States are either offered either what is called a mastectomy, which is removal of the entire breast or what is called breast conserving therapy or lumpectomy; where you remove the tumor with a rim of normal tissue and then you follow it with radiation.  When you do a lumpectomy, the challenge is to remove the entire tumor and leave a woman with a cosmetically acceptable result.  What ends up happening in the United States is about 40% of the time women have to come back for a second operation to get what is called clear margins or normal tissue.  In this study, we are using what is called, AMIGO, which stands for Advanced Multimodality Image-Guided Operating Suite at the Brigham and Women’s Hospital. When I perform a lumpectomy we remove the tumor and temporarily close, then, a MRI machine comes in from the ceiling and then looks at the area that I have removed to see if I have removed the tumor in its entirety and if there are any abnormalities that are identified, I can, while she is under anesthesia, target those areas and remove them. 

What is the obvious benefit to the patient?  

Dr. Golshan: It can potentially stop her from coming back a second time for an operation, which can be both physically and emotionally very difficult for a woman to go through. It increases risk of infection with a second operation; there is obviously the cost that is associated with it for the healthcare system, and it often leads to what is called delay in therapy so a woman will have to wait to start chemotherapy or has to wait to start radiation and these delays accumulate.  

What is the difference traditionally in what you would normally do compared to with AMIGO?

Dr. Golshan: Without AMIGO, you either use a mammogram or ultrasound to target the cancer and sometimes a radiologist will put a thin wire next to it for us to remove the cancer at the time of surgery.  The challenge is how much to remove and how can you tell normal tissue from breast cancer tissue and there is no test in pathology that we can do while she is asleep to say that we have removed the cancer in its entirety.  AMIGO allows us to use an MRI at the time of surgery; this helps to ensure that the tumor is completely removed.

How many people so far have participated? 

Dr. Golshan: We have enrolled nine women so far.  This is a very specialized operating room and suite and the operation takes longer than it does in the traditional operating room.  It is what is called a Phase I Clinical Trial so we are looking at what is called feasibility; are we able to do breast surgery inside an MRI, because no one else in the world has been doing this.