Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar;26(3):399-405.
doi: 10.1111/tbj.13480. Epub 2019 Sep 17.

Real-time electromagnetic navigation for breast-conserving surgery using NaviKnife technology: A matched case-control study

Gabrielle Gauvin  1   2 , Caitlin T Yeo  1 , Tamas Ungi  3 , Shaila Merchant  1 , Andras Lasso  3 , Doris Jabs  4 , Thomas Vaughan  3 , John F Rudan  1 , Ross Walker  1 , Gabor Fichtinger  1   3 , Cecil Jay Engel  1
Affiliations

Real-time electromagnetic navigation for breast-conserving surgery using NaviKnife technology: A matched case-control study

Gabrielle Gauvin et al. Breast J. 2020 Mar.

Abstract

Breast-conserving surgery (BCS) is a mainstay in breast cancer treatment. For nonpalpable breast cancers, current strategies have limited accuracy, contributing to high positive margin rates. We developed NaviKnife, a surgical navigation system based on real-time electromagnetic (EM) tracking. The goal of this study was to confirm the feasibility of intraoperative EM navigation in patients with nonpalpable breast cancer and to assess the potential value of surgical navigation. We recruited 40 patients with ultrasound visible, single, nonpalpable lesions, undergoing BCS. Feasibility was assessed by equipment functionality and sterility, acceptable duration of the operation, and surgeon feedback. Secondary outcomes included specimen volume, positive margin rate, and reoperation outcomes. Study patients were compared to a control group by a matched case-control analysis. There was no equipment failure or breach of sterility. The median operative time was 66 (44-119) minutes with NaviKnife vs 65 (34-158) minutes for the control (P = .64). NaviKnife contouring time was 3.2 (1.6-9) minutes. Surgeons rated navigation as easy to setup, easy to use, and useful in guiding nonpalpable tumor excision. The mean specimen volume was 95.4 ± 73.5 cm3 with NaviKnife and 140.7 ± 100.3 cm3 for the control (P = .01). The positive margin rate was 22.5% with NaviKnife and 28.7% for the control (P = .52). The re-excision specimen contained residual disease in 14.3% for NaviKnife and 50% for the control (P = .28). Our results demonstrate that real-time EM navigation is feasible in the operating room for BCS. Excisions performed with navigation result in the removal of less breast tissue without compromising postive margin rates.

Keywords: breast cancer surgery; breast-conserving therapy; image-guided surgery; surgical oncology.

PubMed Disclaimer

References

REFERENCES

    1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108.
    1. Black DM, Hunt KK, Mittendorf EA. Long term outcomes reporting the safety of breast conserving therapy compared to mastectomy: 20-year results of EORTC 10801. Gland Surg. 2013;2(3):120-123.
    1. Chen K, Li S, Li Q, et al. Breast-conserving surgery rates in breast cancer patients with different molecular subtypes: an observational study based on surveillance, epidemiology, and end results (SEER) database. Medicine. 2016;95(8):e2593.
    1. Hennigs A, Fuchs V, Sinn H-P, et al. Do patients after reexcision due to involved or close margins have the same risk of local recurrence as those after one-step breast-conserving surgery? Ann surg oncol. 2016;23(6):1831-1837.
    1. Dua SM, Gray RJ, Keshtgar M. Strategies for localisation of impalpable breast lesions. Breast. 2011;20(3):246-253.

Publication types

LinkOut - more resources