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Improving Breast Lesion Localization
BY CHRISTINE DAUPHINE, MD, FACS
While mammograms and other imaging methods have greatly improved detection rates of breast cancers over the past few decades, techniques for breast lesion localization have largely remained stagnant. With earlier detection of breast lesions, localization procedures have become necessary in up to 50% of all lumpectomy and surgical biopsy procedures to ensure accurate removal of the target lesion.
Despite the augmented need for more efficient, innovative technologies to provide a smoother localization experience for patients and health care teams, many still use wire localization as the standard, despite inconveniences and inefficiencies. It is imperative, in this era of outcomes-based health care, to evolve our localization approaches and improve the process from start to finish for patients, surgeons, and radiologists alike.
Inefficient Traditional Method
Wire localization often creates inconvenient logistical problems for the patient and provider, as the wire must be placed immediately before surgery. Patients also typically undergo multiple procedures in a day: first, a visit to the radiologist for placement of the wire and, later, surgical removal of the lesion.
The added disadvantage of coordinating schedules between the radiologist and surgeon can amplify the complexity of the entire process. For example, same-day localization generally prevents health care organizations from slating these cases first on the operating room schedule and can often require radiologists to arrive earlier for procedures.
This method also leaves an exposed wire protruding from the breast, possibly increasing the risk of infection and the potential for inaccurate localization, if the wire dislodges. The exposed wire and its potential for movement can be extremely stressful for patients. One small glitch in this inefficient and unforgiving process could delay the entire procedure.
Emerging Technologies
Technological advancements stand to make localization simpler, safer, and more accurate, enhancing care coordination and improving collaboration between radiologists and surgeons. Moreover, they also promise to propel continued innovation in breast cancer detection and surgery, including streamlining sentinel lymph node procedures and enabling surgeons to improve cosmetic outcomes.
Some health care organizations have turned to newer implantable devices, such as radioactive seeds or other nonradioactive tags, instead of wires, to mark breast lesions. The newest of the fully implantable nonradioactive markers incorporates a wireless radiofrequency identification (RFID) technology that can be detected by a handheld reader, recently approved by the FDA. These devices have the potential to become a new standard of care in localization.
Localization leveraging RFID technology allows lesions to be marked with implantable RFID tags up to 30 days before surgery. This gives patients the opportunity to go home and return to the hospital on the day of the operation, making scheduling between the radiology and surgery departments far easier.
At Harbor-UCLA Medical Center, we recently evaluated the safety and performance of localizing nonpalpable breast lesions using a method involving RFID technology. Our pilot study showed that the RFID tags successfully located nonpalpable breast lesions. Moreover, we observed that this advanced localization approach could make breast surgeries simpler, more precise, and more convenient for radiologists and surgeons.
During the study, we marked nonpalpable breast lesions with RFID tags and then used the handheld detection probe to locate the implanted RFID tags; this offered a particular advantage compared with wire localization. It is often difficult to predict the location of a nonpalpable lesion that is localized with flexible wires, especially when the lesion is deep within the breast. With the RFID tags, an LED screen indicated the distance to the tags, while an audible tone helped guide us during dissection. Additionally, each tag had a unique identification number, making it easier to distinguish bracketed tags and immediately confirm excised lesions. The ability to determine the distance to the tags with the detector probe allowed the possibility of making more cosmetically friendly remote incisions.
Future Directions
Our experience in evolving our localization approach helped to streamline collaboration between radiologists and surgeons, ultimately making lumpectomies and surgical biopsies more efficient and creating a better patient experience.
As breast surgery techniques evolve, so should technologies and approaches for breast lesion localization. Traditional localization methods are becoming outdated, and the drawbacks significantly outweigh the benefits. We need a new gold standard: procedures that are more efficient, accurate, and patient-centric for better care coordination and outcomes.
— Christine Dauphine, MD, FACS, director of the breast clinic and vice chair of surgical education at Harbor-UCLA Medical Center, specializes in breast surgery and is one of the first surgeons to use Faxitron Bioptics, LLC's new LOCalizer wireless radiofrequency identification breast lesion localization system.
