Women’s Imaging: Past the Wire
By Beth W. Orenstein
Radiology Today
Vol. 20 No. 12 P. 26

Wireless technology for breast lesions eliminates time and anxiety while improving precision.

Traditionally, before excising nonpalpable breast lesions, surgeons have had to place wires to guide them. “Not only are the wires uncomfortable for women, but they also must be placed the same day as the surgery, which makes for a really long day for patients,” says Valerie Gorman, MD, FACS, a breast surgeon at Baylor Scott & White Medical Center in Waxahachie, Texas.

In the past few years, the FDA has approved wire-free technology that surgeons can use to locate breast tumors and their margins. The technology’s wire-free localization reflectors can be placed well before surgery and have proven to be safe and highly accurate.

Gorman, who uses Health Beacon’s LOCalizer system, which is distributed by Hologic Inc, says it has been a game-changer for her and her patients. One of its biggest advantages, she says, is that it can be placed “at any point leading up to surgery, so it separates these procedures from each other. As a result, women no longer need to come in several hours before their surgery to get the wire inserted and then anxiously await their surgery in a pre-op room with the wire protruding from their breast. All of that added time, anxiety, and discomfort is eliminated.”

Another patient advantage to wire-free localization is the post-op cosmetic appearance. “Because I know exactly where the tumor is prior to surgery thanks to the LOCalizer system, I can better plan my incisions in advance and ensure they’re at a location where the scar is hidden,” Gorman says. “This gives my patients the best possible cosmetic results.”

Tanya W. Moseley, MD, medical director of the Julie and Ben Rogers Breast Imaging Center and professor of diagnostic imaging and breast surgical oncology at The University of Texas MD Anderson Cancer Center in Houston, uses the SCOUT radar localization system by Cianna Medical for segmentectomies and lumpectomies. It, too, can be placed any time prior to surgery. Like Gorman, Moseley agrees that localizing the tumor ahead of time is much better for patients because it shortens their surgery day and, therefore, helps relieve some of the associated stress.

Nodule GPS
Gorman and Moseley say wireless technology for tumor localization benefits physicians as well.
“The device kind of acts like a GPS, guiding me in the operating room so I can find exactly where the tumor is,” Gorman says. “Then, I can use our specimen radiography device in the operating room to confirm that I have removed exactly what I was looking for, confirming the LOCalizer Tag is there.”

One of the first questions that patients’ families ask Gorman when she sees them immediately after surgery is, “Did you get it all?” “Thanks to the LOCalizer system, I can confidently let them know that I removed the areas where the LOCalizer Tag was implanted, which also gives them peace of mind,” she says.

The SCOUT system is also helpful to the care team, Moseley says, because it eliminates the need for radiology and surgery to coordinate their schedules. Decoupling the procedures, Moseley adds, “improves efficiency and workflow in radiology and surgery.” She has noticed that use of the technology has improved on-time starts as well.

In recent studies, Gorman says, wireless guidance has been shown to decrease reexcision rates. Moseley says that thanks to precise localization, she has also seen reduced reexcision rates with the wireless guidance.

The physicians believe that wireless technology is not only better than wires but also better than other guide options such as radioactive or magnetic seeds. Radioactive seeds contain the active energy source I-125 and can be placed up to five days before surgery. Magnetic seeds are metallic, containing iron particles, and can be placed up to 30 days before surgery. However, Moseley says, radioactive seeds are incompatible with MRI and magnetic seeds have a large artifact on MRI. “The artifact makes a dark spot and affects the quality of the MRI by obscuring the nearby tissues,” she says. With the SCOUT, “there’s no obscuration of nearby tissues, which makes it possible to use MRI to gauge treatment response and guide surgical planning.”

Both physicians report that the wireless systems have been easy to learn. Moseley says the SCOUT’s team “will literally hold your hand through the entire process—start to finish.”

While the LOCalizer system is very different from a standardized wire, “it was intuitive to learn and easy to use,” Gorman says. “You can view the distance to the tag in millimeters with a reader that you can use prior to incision. It also features a thin-tipped pencil probe [a single-use, sterile surgical probe] that guides you toward the tag during operation. The screen will also display the individual identifying number for each tag.”

Beth W. Orenstein of Northampton, Pennsylvania, is a freelance medical writer and regular contributor to Radiology Today.