Cathy Graham Participates in Study of Minimally Invasive Excision of High-Risk Breast Lesions and Small Breast Cancers

February 2019

Cathy Graham, MD, director of breast surgery at the Glenn Family Breast Center of Winship Cancer Institute at Emory Saint Joseph's Hospital, is a member of a multi-institutional team that investigated a minimally invasive (MI) approach to diagnosing and managing high-risk breast lesions (HRLs), including atypical ductal hyperplasia, and small breast cancers, including ductal carcinoma in situ (DCIS), with the aim of lessening overtreatment of these conditions. For the study, the team collected patient data in an Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant registry called the Intact Percutaneous Excision (IPEX) Registry. The study was published February 12 by Annals of Surgical Oncology.

When core biopsies reveal HRLs or DCIS, radiologists often refer patients for standard surgical excision, though Dr. Graham and her colleagues suspect that MI excision could be just as effective. Procedures were performed and data collected for the IPEX Registry at Emory Saint Joseph's Hospital, Metro Surgical Associates, Nashville Breast Center, Chesapeake Regional Medical Center, Birmingham Breast Care, and the University of South Alabama.

The patients were women of 31-to-86 years of age who had either small invasive cancers, DCIS, or HRLs, which were removed using image-guided 12-20 mm radiofrequency basket capture. For this MI method, a small incision is made and a retrieval basket is deployed to circumscribe the affected region as radiofrequencies ablate the surrounding breast tissue. In the cancer patients, the surgical teams made a second pass using a 20 mm basket to obtain shaved margins. Standard imaging (specimen, breast) and histologic criteria were applied.

Of the 282 registered patients, 124 had DCIS (n = 52) or invasive cancer (n = 72) and 160 had HRLs. Among cancer patients, 101 (81%) had clear histologic margins [average lesion size was 11 mm for both invasive cancers (4-20 mm) and DCIS (1.5-20 mm)], and 29 patients had re-excision (six despite clear margins). Among 160 HRLs, two were upgraded to DCIS and had MI excision. Two other HRL patients had subsequent standard surgical excision (no cancer was found).

For diminutive HRLs, DCIS, and invasive cancers, Dr. Graham and her associates concluded that MI excision can achieve the same procedure goals as standard surgical excision. They also agreed that MI excision may reduce the discomfort and expense associated with standard treatment since it removes less tissue.

In addition to Dr. Graham, the research team included principal investigator Pat Whitworth, MD, Steven Schonholz, MD, Rogsbert Phillips, MD, Yara Robertson, MD, Antonio Ruiz, MD, Susan Winchester, MD, Jean Simpson, MD, and Chloe Wernecke, BA.