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CompletedNCT04999917BrIMAUpdated Dec 5, 2025

Specimen PET-CT Imaging for Intraoperative Margin Assessment in Breast Cancer

An interventional study of high-resolution PET-CT specimen imaging. in Breast Cancer, Breast Cancer Invasive and Breast Cancer in Situ, sponsored by XEOS Medical. Completed at 1 site in Belgium. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-12-05.

Sponsored by XEOS Medical · Not applicable, Interventional, and Diagnostic

Phase
Not applicable
Study type
Interventional
Enrollment
206
Allocation
Not applicable
Ages
18 Years and older
Sex
Female
01

Study summary

Breast-conserving surgery (BCS) has become the standard-of-care for surgical management of the majority of women with early-stage breast cancer. Successful BCS entails excision of the tumor with an adequate amount of surrounding healthy breast parenchyma, such that negative resection margins are obtained. Despite efforts to obtain tumor-free margins, approximately 20-30% of women still require reoperation.

The rationale of this study is to examine the contribution of the adjunctive use of perioperative high-resolution PET-CT specimen imaging in early-stage breast cancer to the identification of all positive resection margins during breast-conserving surgery. Histopathological findings of the breast tumor specimen are applied as the gold standard.

After a successful screening phase and after informed consent is provided, the patient will enroll the study. The preparations for the BCS proceed following the routine protocol (i.e. as if the patient would not participate in the study). In addition to these standard preparations, on the day of surgery the patient will receive a study-specific injection with a low dose of a radiotracer substance (18F-FDG; 0.8 MBq/kg). Before injection, the blood sugar level will be measured by a small finger prick. If the blood sugar level is good, the radiotracer substance will be intravenously administered. The injection is given at the nuclear medicine department between 30 minutes and 3 hours before surgery. After the injection was given, the patient will be transferred to the operating theatre. The breast tumor will be removed in the same way as if the patient is not participating in the study. As soon as the tumor is excised, it will be imaged using the specimen PET-CT scanner in the operating theatre. While waiting for these 3D images, the surgeon will remove the lymph nodes, if applicable. The breast surgeon will then evaluate the 3D images of the removed breast tumor. In case of suspected positive margins, the surgeon will excise additional breast tissue to ensure that all tumor tissue is excised during this surgery. For scientific purposes only and if available, the cavity shaves and resected lymph nodes will also be imaged with the specimen PET-CT scanner. No clinical decisions that could affect further treatment will be based on this. After surgery, all excised tissues will be sent to the pathology department. This is standard routine and is also done for patients not participating in the study. A routine follow-up visit will be planned with the surgeon. During that routine visit, a staff member of the study team will ask additional study-related questions regarding possible complications. If the latter is not possible during the standard follow-up visit, a staff member of the study team will contact the patient by phone call 1-3 weeks after surgery. The study is completed after this follow-up visit or phone call.

02

Conditions studied

  • Breast Cancer
  • Breast Cancer Invasive
  • Breast Cancer in Situ

Keywords

  • PET-CT
  • margin assessment
  • breast conserving surgery
03

In context

Breast Neoplasms

12,544 studies on the registry are indexed under Breast Neoplasms; 2,892 are open to participants now.

This study's enrollment of 206 is above the median of 72 across 9,303 interventional studies indexed under Breast Neoplasms.

Browse Breast Neoplasms studies →

Lead sponsor

XEOS Medical is the lead sponsor of 2 studies on the registry; 1 is open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
Female
Accepts healthy volunteers
No

Inclusion criteria

  • females with an age over 18 years;
  • confirmed breast cancer (IDC, DCIS, ILC) with indication to undergo BCS;
  • a minimal tumor size of 1.0 cm (in at least one dimension):

    • IDC group: assessed preoperatively on ultrasound;
    • DCIS subgroup: assessed preoperatively on mammogram;
    • ILC subgroup: assessed preoperatively on ultrasound;
    • NAT subgroup: assessed after NAT and before surgery on ultrasound;
  • patients with IDC who have received NAT (i.e. chemotherapy, immunotherapy or endocrine therapy until eight weeks before BCS) may participate in the study;
  • vacuum-assisted core breast biopsy is allowed in the DCIS subgroup only;
  • able to understand treatment protocol and informed consent form;
  • estimated by the investigator to be compliant for study participation.

Exclusion criteria

Exclusion Criteria:

  • general or local contra-indication for BCS;
  • previous breast surgery;
  • inflammatory breast cancer;
  • radiotherapy of the ipsilateral breast;
  • vacuum-assisted core breast biopsy for all patients allocated to the IDC, ILC or NAT subgroup (vacuum-assisted core breast biopsy is allowed in the DCIS subgroup as long as the residual tumor size on mammogram is at least 1.0 cm);
  • patients with DCIS only or ILC, and that have received NAT;
  • blood glucose level over 200 mg/dL on the day of surgery;
  • pregnancy or lactation;
  • participation in other clinical studies with a radiation exposure of more than 1 mSv in the past year;
  • active bacterial, viral or fungal infection.
05

Study design

Phase
Not applicable
Primary purpose
Diagnostic
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
206 participants (actual)

Study arms

  • Experimental
    intraoperative high-resolution PET-CT imaging of resected breast tumor.

    Diagnostic Test: high-resolution PET-CT specimen imaging.

Interventions

  • Diagnostic testhigh-resolution PET-CT specimen imaging.

    A single intravenous injection of 18F-FDG (0.80 MBq/kg) is given between 30 minutes and 3 hours before tumor resection. Surgical resection of the breast tumor (= main specimen) under general anesthesia. The main specimen is imaged using the Aura 10 PET-CT Specimen Imager (XEOS Medical, Ghent, Belgium). In case of positive margins, the surgeon will perform oriented cavity shaving. The cavity shaves and lymph nodes (if any) are also imaged using the Aura 10 PET-CT Specimen Imager (for scientific purposes only). The main specimen and if applicable the cavity shaves and lymph node(s) are processed following standard-of-care routine: from tissue samples to HE-stained and IHC-stained sections. The histopathological margin status shall be reported according to the ASCO-CAP guidelines, and shall be compared to the PET-CT images of the resected specimens.

06

What researchers measure

Primary outcomes

  1. Perioperative addressing positive margins of the invasive component in IDC.

    The primary effectiveness endpoint is a measure of perioperative success in addressing positive margins of the invasive component with the adjunctive use of high-resolution PET-CT specimen imaging as detected by permanent pathology in the IDC subgroup.

    Time frame: Perioperative (day 0).

Secondary outcomes

  1. Perioperative addressing positive margins of the invasive component in breast cancer.

    A measure of perioperative success in addressing positive margins of the invasive component with the adjunctive use of high-resolution PET-CT specimen imaging as detected by permanent pathology in: * the total study population excluding the DCIS subgroup (IDC + ILC + NAT); * the ILC subgroup; * the NAT subgroup.

    Time frame: Perioperative (day 0).

  2. Perioperative addressing any positive margin in breast cancer.

    A measure of perioperative success in addressing any positive margin with the adjunctive use of high-resolution PET-CT specimen imaging as detected by permanent pathology in: * the total study population (IDC + DCIS + ILC + NAT); * the IDC subgroup; * the DCIS subgroup; * the ILC subgroup; * the NAT subgroup.

    Time frame: Perioperative (day 0).

  3. Perioperative success in obtaining final negative margins of the invasive component in breast cancer.

    A measure of perioperative success in obtaining final negative margins of the invasive component as detected by permanent pathology (1) by the additional use of high-resolution PET-CT imaging and (2) by additional use of standard-of-care in: * the total study population excluding DCIS (IDC + ILC + NAT); * the IDC subgroup; * the ILC subgroup; * the NAT subgroup.

    Time frame: Perioperative (day 0).

  4. Perioperative success in obtaining final negative margins in breast cancer.

    A measure of perioperative success in obtaining final negative margins (invasive and/or in situ component) as detected by permanent pathology (1) by the additional use of high-resolution PET-CT imaging and (2) by additional use of standard-of-care in: * the total study population (IDC + DCIS + ILC + NAT); * the IDC subgroup; * the DCIS subgroup; * the ILC subgroup; * the NAT subgroup.

    Time frame: Perioperative (day 0).

  5. Final positive margins of the invasive component after breast-conserving surgery.

    A measure of the number of patients with final positive resection margins of the invasive component after BCS in: * the total study population excluding DCIS (IDC + ILC + NAT); * the IDC subgroup; * the ILC subgroup; * the NAT subgroup.

    Time frame: Perioperative (day 0).

  6. Final positive margins of any margin after breast-conserving surgery.

    A measure of the number of patients with final positive resection margins (invasive and/or in situ component) after BCS in: * the total study population (IDC + DCIS + ILC + NAT); * the IDC subgroup; * the DCIS subgroup; * the ILC subgroup; * the NAT subgroup.

    Time frame: Perioperative (day 0).

  7. Diagnostic performance based on the invasive component of breast cancer.

    Sensitivity, specificity, positive and negative predictive value, failure rate and, interobserver reproducibility of high-resolution PET-CT imaging based on the invasive component of: * the total study population excluding DCIS (IDC + ILC + NAT); * the IDC subgroup; * the ILC subgroup; * the NAT subgroup.

    Time frame: Perioperative (day 0).

  8. Diagnostic performance based on any margin of breast cancer.

    Sensitivity, specificity, positive and negative predictive value, failure rate and, interobserver reproducibility of high-resolution PET-CT imaging based on any margin of: * the total study population (IDC + DCIS + ILC + NAT); * the IDC subgroup; * the DCIS subgroup; * the ILC subgroup; * the NAT subgroup.

    Time frame: Perioperative (day 0).

  9. Reoperation rate.

    The number of patients that require a second or a third surgery due to positive margins at initial primary breast-conserving surgery and the type of repeat surgery (BCS or mastectomy).

    Time frame: Follow-up visit (+/- week 2).

  10. Resected tissue volume.

    The volume (mm³) of resected main specimen, and possible cavity shaves after PET-CT imaging and possible cavity shaves after standard-of-care approach.

    Time frame: Perioperative (day 0).

  11. Detection of malignant cells in cavity shaves and resected lymph nodes.

    A measure of success in detecting malignant cells in resected lymph nodes and cavity shaves with the adjunctive use of high-resolution PET-CT specimen imaging as detected by permanent pathology.

    Time frame: Perioperative (day 0).

07

Study locations

1 site
  • Gynecology department
    Ghent, Flanders 9000, Belgium
08

References and documents

Publications

  • Goker M, Hahn M, Kraemer XE, Harrach H, Vanhoeij M, Vergauwen G, Van de Vijver K, De Man K, Schmidt F, Guergan S, Vergucht V, Di Micco R, Cisternino G, Gentilini OD. Specimen PET-CT Imaging for Intraoperative Margin Assessment in Early-Stage Breast Cancer: The BrIMA Nonrandomized Clinical Trial. JAMA Surg. 2026 Jun 17:e262090. doi: 10.1001/jamasurg.2026.2090. Online ahead of print. PubMed 42307959 ↗
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Dec 5, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04999917
Lead sponsor
XEOS Medical
Responsible party
Sponsor
First posted
Aug 11, 2021
Start date
Jun 17, 2022
Primary completion
Mar 27, 2025
Completion
Apr 3, 2025
Last update
Dec 5, 2025

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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