Lee Riley, MD, Director of the Breast Disease Management Team for St. Luke’s University Health Network, Bethlehem, PA, offers perspective on the key factors in selecting a wire-free technology for breast tumor localizations.
What are some of the deciding factors behind your decision to move beyond wires to a wire-free technology for breast tumor localization?
The gold standard for almost the past 40 years had been a wire localization performed the morning of surgery. It has served us well, but there are a lot of problems with it.
One of the problems is that sometimes the wire may be a long way from where the tumor is and you have to make an incision that creates cosmetic problems for the patient. You can end up taking out a lot more tissue than you might have if you knew exactly where the tumor was. Wire-free technology is more accurate and precise – so that helps me as the surgeon to do what I think is a better job.
I think from the patients’ perspective, a wire-free alternative is a better overall experience. You just go to sleep and you get the tumor out. You don’t need to have a pre-procedure and the extra anxiety associated with that. I think all the different wireless techniques help improve patient satisfaction but there are other factors to consider.
What are the factors – or a checklist of sorts – that a clinician should consider in selecting a wire-free technology?
There are several – I think foremost you should be thoughtful about MRI. There are some technologies where you cannot have an MRI after an implant and you never know when you’re going to need an MRI in the future or preoperatively. So, if you put in an implant or clip and then can’t use an MRI that’s a problem.
Check the distance capabilities. How far away can you detect the implant? With the radar technology you can detect up to 6cm, as you know, and that’s a pretty long distance. I think we can get to almost anywhere from 6cm with the technology With good distance capabilities, I have an idea in my mind’s eye exactly where to make the incision, where to go in, take the tumor out, confirm it right there and know I’ve got it.
I’d also ask ‘Is the implant stable?’ It is important to have confidence that the implant will not migrate. They are small but will they anchor into the tissue?
The last factor is simplicity. There is a radioactive way to do this, but if that radioactive seed gets lost in the operating room you can have problems. Having no radiation involved just makes it a lot simpler.
The SCOUT reflector can be placed long-term, meaning there is no restriction on the amount of time the reflector can remain in the breast. What benefits do you foresee that that might have?
The ability to place reflector at any time is monumental. It gives physicians so much more flexibility in our treatment planning and timing and will ultimately improve patient care and satisfaction.