As mammograms have become more prevalent, we are able to detect breast cancer in earlier stages, often when a tumor is non-palpable, or too small to detect on a clinical exam. Additionally, as oncologic therapies have advanced, many patients can avoid a mastectomy if they respond well to medical treatments such as chemotherapy, hormonal therapy or targeted therapy prior to surgery.
Research has shown that complex surgery does not equate to improved survival and breast conserving surgery, or partial mastectomy, is an excellent option for many patients. However, this raises an important consideration: How is a breast tumor localized for removal if it’s non-palpable? In these cases, the surgeon must rely on imaging guidance. The tumor must be “seen” since it cannot be felt.
Breast radiologists play a critical role in helping the surgeon target and localize the tumor. For decades, the standard procedure for localization has been to place a needle and a long wire into the breast using a mammogram or ultrasound imaging on the day of surgery. Following placement, the wire then serves as a roadmap for the surgeon. With the curve of the wire adjacent to the tumor, this provides orientation and directional guidance so a tumor can be located for removal.
While effective, this also has its limitations: it can be challenging to shuttle the patient from radiology to the surgical suite on the same day; performing both procedures can make for a long day for patients, often turning outpatient surgery into an all-day affair; additionally, the wires are particularly frustrating for patients and staff, as they protrude awkwardly through the skin, and care needs to be taken so as not to dislodge them prior to going to the operating room.
There are several companies that have worked to develop innovative alternatives to wire localization. In 2020, the Department of Surgery at Baylor College of Medicine adopted the use of magnetic seed technology (“MagSeed”) for tumor localization in breast surgery. The magnetic seed is made of surgical-grade stainless steel and is smaller than a grain of rice.
The seed can be placed into the tumor at any time prior to surgery and remains in the breast unnoticed until it’s removed, along with the tumor, in the operating room. A magnetic sensing probe attached to a handheld device detects the seed within the breast and allows the location of the tumor to be identified.
Similarly, the SAVI SCOUT surgical guidance system involves the use of an implantable reflector, only slightly larger than the MagSeed, into the breast tumor. The reflector and the tumor can then be located using radar-based technology in a handheld probe.
These wire-free techniques offer several advantages over traditional localization. Since the seed or reflector placement is scheduled as an independent procedure, patients can get in and out of the hospital more efficiently on their day of surgery with decreased wait times and potentially decreased anxiety.
As there is no external component to the seed or reflector (as there is with the wire) the risk of dislodgement of the device is no longer a factor. Without the wire, the surgeon has greater latitude to approach the tumor as they deem most appropriate oncologically and cosmetically. The position of the breast incision is not influenced by the orientation of the wire and is completely at the discretion of the surgeon.
Breast cancer treatment involves critical interplay between numerous medical and surgical specialties to optimize outcomes. As our technology has advanced, treatment has been able to become more precise with decreased morbidity.
Learn more about the Breast Care Center at Baylor or call 713-798-1999.
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-By Jessica Salmans LaCross, instructor of surgery and physician assistant in the Division of General Surgery at Baylor College of Medicine