Specimen PET-CT Imaging for Margin Assessment—Ready for Prime Time?
Mené auprès de 148 femmes atteintes d'un cancer du sein de stade précoce (âge médian : 65 ans ; taille tumorale médiane avant opération : 17 mm), cet essai clinique non randomisé évalue l'efficacité, du point de vue du taux de succès intra-opératoire de prise en charge des marges de résection positives, d'une tomographie numérique TEP-18F réalisée sur pièce opératoire
Breast cancer is the most common malignancy in women, and breast-conserving surgery followed by radiation therapy is the standard of care since such groundbreaking studies like the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-06 trial. In order to minimize reoperation and to reduce locoregional recurrence, surgeons must achieve a negative margin. This has been defined by no tumor on ink for invasive cancer and greater than 2 mm in DCIS as defined by the Society of Surgical Oncology and the American Society for Radiation Oncology (SSO-ASTRO) consensus guideline on margins. Various techniques have been used for intraoperative margin assessment. These include frozen section analysis, cavity shaved margins, optical tomography, fluorescence imaging, mass spectrometry–based instruments (eg, the MasSpec Pen [MS Pen Technologies] and iKnife [Waters Corporation]), radiofrequency spectroscopy (MarginProbe device [Dilon Technologies Inc]), and artificial intelligence-enhanced imaging. Göker and colleagues have championed specimen positron emission tomography (PET)–computed tomography (CT) imaging technology for intraoperative margin assessment. They performed a prospective, multicenter study to determine whether specimen PET-CT can enhance intraoperative margin assessment in BCS. They found that specimen PET-CT improved the assessment of positive margins in these patients. Study participants received a preoperative injection of 18F-fludeoxyglucose, which may interfere with sentinel lymph node mapping. This is an interesting technique; however, as stated previously, there are a number of competing and new methods in this field. I feel that future studies using PET-CT imaging should be a prospective randomized clinical trial and be compared with other techniques such as radiofrequency spectroscopy, fluorescent imaging, or cavity shaved margins. Also, the cost of PET-CT scan is not stated in the article. Because this study was performed in Europe, would the cost of the unit be more or less expensive in the US? Being able to assess and obtain clear margins is one of the holy grails in breast surgery. PET-CT imaging is one of the emerging methods, but only more vigorous studies and time will determine if it is the answer to our quest.
JAMA Surgery , éditorial, 2026