GPS-Like Technology Is The Way Of The Future For Breast Cancer Lumpectomy Surgery, Experts Tell Us

A lumpectomy, which is where you remove only the part of the breast that has the cancer typically requires a pre-op (or pre-surgery) insertion via a needle in the breast of a small thin wire that the surgeons use to guide them for their surgery. This can be an anxiety ridden experience for someone already facing enormous life changes.

We spoke to experts on the current options for wireless approaches to localization and if you should be asking about this technique as part of your treatment plan.

Lumpectomy Protocol

Dr. Linda Moy, a radiologist at NYU Langone Health who specializes in breast imaging, gave us a brief run down of how treatment for breast cancer has progressed.

“Traditionally, when a woman had breast cancer she [would need a] mastectomy, which was to have the breasts removed, but now for the past 40-50 years, we know instead you can do what is called a lumpectomy, where you go ahead and remove only the part of the breast that has the cancer,” said Dr. Moy.

Should I Have a Lumpectomy or Mastectomy?

“If we can go ahead and the surgeon can feel this lump, then that is terrific. Then they don’t need a radiologist to guide them in any way. However, most of these cancers because we are using mammograms and finding these things early we can’t feel them. So we need a way to guide the surgeon to the right spot so that small cancer is removed, the least amount of normal tissue is removed to give the patient a good cosmetic results and know that we’re not leaving any cancer behind.”

The typical protocol would be a patient would come in prior to surgery (same-day) and a radiologist will place a needle into the breast and they will place a very small, thin wire which the surgeon then uses to guide them for surgery. But given scheduling difficulties for both doctors and patients, delays can happen and two procedures in one day is very overwhelming to the patient.

This has led to these new techniques that could change lumpectomy protocol for the better.

Three Different Types

Right now, there are three modalities, or types of wireless localizations being offered, according to Dr. Michelle Specht, a breast surgeon at Massachusetts General Hospital who spoke to SurvivorNet in an interview.

The first is called the SAVI SCOUT, which is based on radar technology.

“So what happens is, like each one of those modalities, there’s a little seed that gets placed. And for the SAVI SCOUT that seed emits a radar signal and it gets placed by the radiologist before the day of the operation,” said Dr. Specht.

She added that the SAVI SCOUT can really be placed any day prior to surgery, which is one of the main benefits of this technology. Traditionally, a wire would need to be placed the same day as surgery.

Then in the operating room the surgeon looks for the seed using a special probe that detects that radar signal, “it actually uses an infrared device to kind of click on the signal and excise it.”

Dr. Specht said she didn’t prefer the SAVI SCOUT because the probe used in the operating room was rather big (about the size of a nickel) and a surgery such as a lumpectomy is all about precision and you can remove less tissue and make a smaller incision.

The second type is called the Magseed, which is a magnetic stainless-steel bead the size of a rice grain.

“Magseed’s limitation is that it emits a magnetic field and so in the initial version of it you couldn’t use metal instruments, which is something that all surgeons use. So we were buying instruments that were plastic and disposable and the probe itself had a really big head to it,” said Dr. Specht.

“So again, we were limited and making small incisions and being precise about excising it, so that was not our favorite.”

Lastly is the LOCalizer, or also known as a miniature radio frequency identification (RFID) tag, which Dr. Specht said she favors. The LOCalizer uses radio frequency technology to accurately pinpoint the tumor.

“The probe is small. It works on radio frequency, so it kind of gets rid of the logistics associated with nuclear seeds,” said Dr. Specht. “Its disadvantages is it’s a little bit big. Compared to the Magseed and the SAVI SCOUT, the size of it is a little bit bigger. So therefore when the radiologist introduces it into the breast they need to use a bigger needle to get it in. But patients really haven’t noticed it very much and the introducer hasn’t caused any scarring.”

What Are The Benefits?

According to the experts, the big advantages to these wireless approaches is you don’t have to have two procedures in one day and a much better chance of keeping your surgery on schedule.

“The other advantage to patients, which I really emphasize is that on a day of an operation you can’t eat anything, right? You’re having anesthesia so you can’t have anything after midnight. And can you imagine like being NPO (nothing by mouth), dehydrated, they put you in a mammogram machine. They numb it up, they stick a needle in, put a wire in like there’s a high yield of fainting.”

Echoing similar sentiment, Dr. Moy adds, “everything is a little bit easier for the patient, it’s a little less anxiety provoking and so forth.”

While having the procedure done several days prior to surgery is nice, Dr. Moy says it would likely be best for the patient if it can be done just one day or two days prior to surgery to minimize anxiety.

However, “I think in terms of making the whole procedure, better for the patients, that this is definitely an advantage,” she said.

The main disadvantage at this point is the cost, according to experts. These new technologies are still very expensive and are likely not available on a widespread level.

One article in the Journal of Breast Imaging listed the SAVI SCOUT’s “initial cost associated with purchasing reusable consoles and probes for radiology and surgery suites as tens of thousands of dollars.”

In addition, the ongoing costs associated with Magseed individual devices average $400, according to the article.

Do I Qualify For Wireless Localization?

No one breast cancer tumor is alike. But for this specific technique the smaller the tumor the more beneficial.

Dr. Specht says, when you meet someone who has cancer they either have a tumor you could feel that’s big, or it’s one that’s been picked up on a mammogram or ultrasound or an MRI, and it’s not palpable. Palpable meaning something you can feel without the use of a test.

Since this technology is mostly beneficial for picking up smaller tumors, it can be most beneficial for those early-stage breast cancers. But really any tumor is good for this technology.

Another factor is where the tumor is located on the breast. The Magseed, for example, if the tumor is too deep within the breast the magnetic field probe might not be able to hear that signal.

“So there is nothing about the particular needle, the particular cancer type, it’s probably more about the location of where the tumor is,” said Dr. Moy.

What Should I Ask My Doctor?

If you have been diagnosed with early-stage breast cancer and are planning to have a lumpectomy surgery, it is worth asking about these wireless localization techniques.

How to Choose a Surgeon Does Volume Matter?

You should ask your doctor:

• Does this facility offer any wireless localization techniques, such as Magseed or LOCalizer or SAVI SCOUT?
• Would my tumor benefit from wireless localization?
• Is the size of my tumor small enough that it would benefit from wireless localization?
• Can I have the wireless localization insertion as close to my surgery as possible?

Learn more about SurvivorNet's rigorous medical review process.

---