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Mehra Golshan, MD, MBA
Deputy Chief Medical Officer
Clinical Director of Breast Program, Yale Cancer Center
Deputy Chief Medical Officer for Surgical Services
Smilow Cancer Hospital
Yale New Haven Hospital
Professor of Surgery
Yale School of Medicine
New Haven, Connecticut
Goal: To improve success rates in breast cancer surgery and reduce repeat surgeries
Impact: Dr. Golshan is testing advanced imaging techniques used during surgery to reduce the need for additional surgeries, delays in breast cancer treatment, and patient anxiety.
What’s next: He and his colleagues will continue conducting two phase II clinical trials aimed at improving surgical results for women with early-stage breast cancer and determining the best technique of breast MRI in advanced breast cancers.
Breast conserving surgery is standard treatment for early-stage breast cancer and allows for less invasive breast reconstruction after surgery. It is not uncommon, however, for a patient to have to return to the operating room after initial surgery because the first surgery did not remove the entire tumor. Dr. Golshan is testing intraoperative mass spectrometry and magnetic resonance imaging as means to improve surgical outcomes. The cornerstone of his BCRF funded research is assessing imaging tools to determine their utility in helping surgeons clearly distinguish between benign and malignant tissue – this will ultimately serve to reduce repeat surgeries and improve outcomes for patients.
Full Research Summary
Research area: Identifying ways to improve surgical outcomes in breast cancer patients.
Impact: For patients with early-stage breast cancer, breast-conserving surgery (lumpectomy) along with whole breast radiation is a standard approach in treatment and allows for better cosmetic breast reconstruction. Re-excision rates following breast conserving surgery, however range between 15-40 percent despite advances in surgical and imaging techniques. Dr. Golshan’s innovative approach of combining intraoperative MRI (iMRI) with molecular analyses is already having an impact by reducing the need for breast re-excisions. This approach has many added benefits including decreasing delays in the initiation of cancer therapy after surgery, reducing the risk of infections and mastectomy rates in early breast cancer patients while relieving the psychological distress for patients– all of which will lead to reduced health care costs.
Current investigation: Dr. Golshan is testing intraoperative imaging and molecular technology to improve surgery outcomes. The cornerstone of his BCRF funded research is improving patient surgical outcomes by translating the technique of intra-operative tumor assessment with mass spectrometry and breast MRI to operating rooms around the world.
What he’s learned so far: Dr. Golshan and his colleagues have shown that iMRI is not only feasible for tumor margin assessment during breast conserving therapy, but it has the potential to reduce re-excision rates. In his own practice, there were no cases resulting in tumor re-excision for invasive disease and the re-excision rate for DCIS was reduced from 40 percent to 17 percent. Dr. Golshan’s studies also revealed that the tumor position within the breast varied significantly when comparing the standard MRI position of the breast (women lying face down) with the operative position (women lying face up), which can impact surgical resection and tumor margins. These findings suggest the need for inclusion of supine (face up) imaging as part of standard pre-operative breast surgical planning and has the potential for being a practice-changing finding for diagnostic breast MRI.
What’s next: In the coming year, Dr. Golshan will complete the phase II trials and optimize the use of iMRI for more accurate evaluation of surgical margins. His team will also develop a real-time visual overlay device to delineate the tumor in the breast for breast conservation procedures.
Mehra Golshan, MD MBA is a breast surgical oncologist and researcher, Deputy Chief Medical Officer, Clinical Director of Breast Program and Professor of Surgery at Yale Cancer Center, Smilow Cancer Hospital, Yale School of Medicine.
His primary clinical research interest focuses on minimizing the extent of surgery required for women with breast cancer through the use of neoadjuvant therapies and novel intra-operative techniques. The focus of the preoperative therapy trials is to target treatment for breast cancer and develop tumor profiles that will in the future lead to individualized tailored therapies for patients with breast cancer.
The cornerstone of his BCRF funded research is improving patient surgical outcomes through translating intra-operative tumor assessment with mass spectrometry (Dr. Nathalie Agar lab) and breast MRI to operating rooms around the world. In the United States, up to 40 percent of women who undergo lumpectomy will need a second operation to achieve clear margins. He and his colleagues are studying the use of these intra-operative diagnostic biomarkers and tools in the Advanced Multimodality Image Guided Operative Suite (AMIGO) at the Brigham and Women’s Hospital to determine if they can identify and remove residual tumor while the patient is under anesthesia, with the aim to improve patient outcomes.
BCRF Investigator Since
The Hale Family Award