Eva Gombos, MD: Intraoperative Supine Breast MRI in the Advanced Multimodality Image Guided Operating (AMIGO) suite

Eva Gombos, MD

Staff Radiologist
Department of Radiology
Director of Breast Imaging Research
Brigham and Women’s Hospital
Assistant Professor of Radiology
Harvard Medical School

Abstract

About 15–30% of patients undergoing breast-conserving surgery (BCS) have positive margins, requiring re-excision to achieve clear margins. While pre-operative breast MRI is highly sensitive in assessing cancer extent, its effectiveness in reducing positive margins is not proven. One possible reason is the difference in breast shape and relative tumor location between the prone diagnostic MRI position and the supine surgical position.
In Phase 1, we developed an intraoperative supine MRI (isMRI) protocol in the AMIGO suite at Brigham and Women’s Hospital and demonstrated its feasibility during breast-conserving surgery (BCS). In a 15-patient study, isMRI was safe, sterile, and high-quality, revealing significant tumor deformation and position change between prone and supine positions. No residual tumors were detected post-surgery.
In Phase 2, a 43-patient study showed that isMRI had 80% accuracy and 93% specificity in detecting residual tumors at margins, reducing re-excision rates from 18% to 13%.
These results support isMRI’s potential to assess tumor location and deformation and guide real-time surgical decisions, improving outcomes and reducing repeat surgeries.

Short Bio

Dr. Eva Gombos is a board-certified Diagnostic Radiologist at the Brigham and Women’s Hospital (Mass General Brigham) and the Dana Farber Cancer Institute; and Assistant Professor of Radiology, Harvard Medical School.
Born in Hungary, she earned her MD from Semmelweis University in Budapest. She completed her residency in Diagnostic Radiology at the Kaplan Medical Center in Israel (1995), where she also subspecialized in Breast Imaging and served as Acting Section Head of Breast Imaging (1997-1998). She completed a Breast Imaging fellowship (1999-2000) and a residency/fellowship in Surgical Pathology (2000-2004) at the Mount Sinai Medical Center in Miami, FL. In 2004, she joined the Brigham and Women’s Hospital’s Breast Imaging Section, where she has been the Director of Breast Imaging Research since 2007.
She received an AUR GE Radiology Research Academic Fellowship (2008-2010) to study breast MRI, its diagnostic use and interrelation with other diagnostic specialties, particularly anatomic and molecular pathology. Her research interests focus on breast cancer imaging, particularly breast MRI, response assessment and radiology-pathology correlation.