Healthcare Innovations • Sunday 26 July 2020


GO Wireless: a new innovation in breast cancer surgery localisation


With mammogram screening, more breast cancer is found at an early, nonpalpable stage


With a good response to neoadjuvant chemotherapy — that’s chemotherapy before surgery — a large cancer could shrink to nothing or a very small size. Surgeons need a good, reliable localisation method to remove such small non-palpable tumours or the concerning area. Te traditional way to do this is to


insert a wire through the breast skin, with end of wire pointing to the area, before surgery. Te wire obviously sticks out of the breast and can cause discomfort to patients. Tere’s a risk of migration movement, displacement, dislodging or bending the wire. Hence missing the target. Te wire is prefer- able placed there on the morning of surgery by the imaging department, requiring good time coordination between surgeon and radiologist. Radioactive seeds or liquids such


as Tc99 or I-125 have been used, but haven’t gained


popularity. Tere’s


radioactivity involved, even though it’s a minimal amount and the time of insertion or injection is limited by the radioactivity half life. Recent developments have intro-


duced wire-free, radioactive free seeds that use magnetic tracing, radiof- requency identification or the radar detection principle for localisation. Te small seeds are inserted under image control internally into the cancer. Te chance of migration is very minimal if any. More than one seed can be used in both breast lesions and axilla lymph nodes. Te seeds are detected by a hand-held probe with 360-degree sensitivity and connected with a real- time distance system that’s accurate to one millimetre. Te surgeon is helped by a digital number displaced on the system together with an audible sound tone to gauge the proximity from the tumour. Tis gives good precision to remove just the necessary amount of tissue and potentially may improve cosmesis. Te seed


insertion can


be inserted in a minimally invasive manner well in advance of surgery at a convenient time, even at the time of diagnosis and before neoadjuvant chemotherapy. Te patient won’t feel anything and can carry on with their normal activity without discomfort. Magseed uses surgical-grade stain-


less steel with magnetic trace. Te magseed is 5x1mm smaller than a grain. Despite some level of arte- fact with MRI, it’s MRI-compatible without causing any heating or move- ment. Magseed insertion now has been approved to 1,000 days prior to surgery. LOCalizer (Hologic) are miniature


radiofrequency tags with individual ID, using advanced Radiofrequency Identification Technology. Te system displaces the exact distance from the seed in millimetres. An individual ID number distinguishes different tags and is good for bracketing an area for excision. Te company is improving on the size of the seed and the ease of radi- ological deployment. LOCalizer is also MRI compatible. Cianna Medical has the Scout


system using radar localisation to one millimetre accuracy. Te reflector plate seed is MRI compatible and doesn’t cause artefact. Tere’s no time limit for the insertion.


THE CIANNA MEDICAL SAVI SCOUT RADAR LOCALIZATION SYSTEM, SHOWING THE CONSOLE, DETECTOR AND THE MARKER, WITH A SIZE COMPARISON AND X-RAY IMAGES INSIDE BREAST TISSUE. FOR MORE INFORMATION ON THE LEARNING CURVE OF ITS USE HTTP://SABCS16.POSTERVIEW.COM/NOSL/P/P1-11-06.


Tere’s continuous product improvement. Tese wireless radioactive free seeds could herald a revolutionary improvement in breast cancer treatment and may well become the gold standard for future breast lesion localisation


All these systems are reported in


studies to be safe and reliable with a high localisation rate and short learning curve. Tere’s continuous product improvement. Tese wireless radioactive free seeds could herald a revolutionary improvement in breast cancer


treatment and may well


become the gold standard for future breast lesion localisation.


Specialist clinics • 43


Christina Choy


consultant breast oncoplastic and reconstructive surgeon Kind Edward VII Hospital, Princess Grace Hospital, The Harley Street Clinic and The London Clinic


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