Hospitals can now use magnetic technology to improve the accuracy and speed of the procedures.
Patients living with breast cancer often face long, gut-wrenching wait times for surgeries (during the pandemic that wait could last 22 weeks), not to mention invasive and not-always-accurate testing before the procedure to determine where to operate and how much breast tissue to remove. New technology is now helping to reduce those delays, while at the same time improving the accuracy and clinical outcomes.
"With the advent of more and more detailed mammography, we're finding lesions that are super, super small – cancers that are really tiny that we cannot feel," says Courtney Fulton, MD, a breast surgical oncologist and general surgeon at Community Hospital in Grand Junction, Colorado.
Such super-small cancers are typically found using localization, a procedure used to mark the breast before surgery to guide the surgeon in locating the abnormality, Fulton says.
"The traditional way to do that, the day of surgery, is to stick a tiny stainless steel wire, with a hook on the end of it, into the patient's breast, around the lesion and sticking out of their skin," she says.
This method has "a whole lot of problems," Fulton says. "Mostly that the patients are then sitting waiting for the surgery with a wire sticking out of them." There’s also a problem with accuracy, she says, leading to unnecessary surgeries, removal of too much healthy breast tissue, and the possibility of missing cancer cells.
Courtney Fulton, MD, breast surgical oncologist and general surgeon at Community Hospital. Photo courtesy Community Hospital.
Add to that the dangers caused by waiting. According to a 2020 BMJ study, delays in breast cancer treatments could lead to 5,100 excess deaths in the U.S., fueling the push for innovative ways to reduce those delays.
A new generation of localization devices is improving accuracy and providing more convenience to patients, Fulton says. They’re wire-free and can be implanted in patients up to 30 days in advance.
An example of this new technology is the wire-free localization technology platform developed by MOLLI Surgical and approved by the US Food & Drug Administration earlier this year. The non-radioactive and solid magnet technology measures 3.2 mm in size, and is designed to allow both radiologists and surgeons to detect the smallest lesions. The accompanying wand allows Fulton to get into small spaces and take only the tissue she needs to remove.
"It's super small," she says. "We're removing lesions that are a few millimeters in size sometime. You don't want a localization device that's 10 times the size of the thing that you're removing."
"It's about advancing the science of getting breast cancers out of patients quicker and easier for the patients and the surgeons," she adds.
Some localization alternatives rely upon radioactive seeds instead of magnetic ones, which have their own problems.
"You have to be very diligent about tracking radioactive substances around the hospital, and it's kind of a pain in terms of paperwork," Fulton says.
Magnetic devices like MOLLI are sensitive to any other surgical instruments that themselves are magnetic.
"We had some issues with our sterilizer that was making our instruments too magnetic, so we revamped our demagnetizing process," Fulton says. "Now I test all my instruments at the beginning of the case, to make sure they won't interfere, and then I'm good to go. We've got it pretty much down to a good science now."
The only patients for whom this technology wouldn’t be used are patients with a severe allergy to nickel. The device also isn’t needed if the lesion is palpable, though it can also help surgeons find other sites, such as lymph nodes.
Fulton has treated 30 patients with the technology in less than a year. Because it can be implanted up to 30 days ahead of time, it can be inserted when patients come into the clinic for preoperative bloodwork, not necessarily requiring an extra visit.
While it’s hard to measure how this technology improves accuracy, Fulton says she feels better about her ability to get all the cancer. Still, "even with all the technology and everything, you still have microscopic cancer at the edge of what you take out," she adds.
About half of Fulton's practice is cancerous and benign breast surgery. Melanoma skin cancers are another focus of hers, as well as regular general surgery including hernias and gall bladder surgeries.
"In the breast community, everyone's very excited about this kind of technology," she says. "There's still tons and tons of hospitals using wire localization, the old-fashioned way."
As the pandemic wanes and curbs on in-person treatment end, Fulton is getting busier. She’s seeing a backlog not only because there’s a limited number of healthcare providers like her able to do these procedures, but also because people are reluctant to get mammograms.
"This month, I was very, very busy with breast cancers," she says. "I was seeing multiple breast cancers a day in [the] clinic and we were trying to get them all into surgery really fast, because these patients have been waiting. So we're trying to get everyone scheduled quickly. [The new technology] definitely helps with that."
“In the breast community, everyone's very excited about this kind of technology. There's still tons and tons of hospitals using wire localization, the old fashioned way.”
Courtney Fulton, MD, oncologist and surgeon, Community Hospital
Scott Mace is a contributing writer for HealthLeaders.
Magnetic "seed" technology helps quickly locate abnormalities for surgeons.
The technology replaces older wire methods and can be implanted up to 30 days in advance, aiding in scheduling and rescheduling.
Better accuracy means surgeons don't have to remove as much healthy breast tissue.