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Device may reduce re-excision rate in breast cancer surgery
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SAN FRANCISCO — A novel device intended to provide surgeons with real-time detection of cancerous tissues at the margins of excised breast cancer specimens resulted in lower re-excision rates, according to results of a prospective study.
The findings could help patients avoid the risks associated with follow-up surgeries and also increase the likelihood that the cosmetic appearance of the breast will be preserved after lumpectomy, according to Susan K. Boolbol, MD, and colleagues.
“We estimate that 20% to 40% of the time, patients will need more surgery to achieve a margin of healthy tissue at the rim around the lump of cancer that has been removed,” Boolbol, chief of breast surgery at Beth Israel Medical Center, said during a press conference before her presentation. “They can wait up to a week for the pathology report to come back, which will tell them whether they need another surgery, and this can cause physical and psychological stress.”
The MarginProbe (Dune Medical Devices) can be placed on the tissue once it is excised.
“If it detects cancer cells close to the margins, we go back in and try to remove the cells,” Boolbol said.
In their study, Boolbol and colleagues evaluated the device on 83 patients with ductal carcinoma in situ (DCIS) and 155 patients with DCIS plus invasive breast cancer. Seventy-eight patients with DCIS and 179 patients with DCIS plus invasive breast cancer received standard surgery and served as controls.
Researchers conducted the study at 22 sites in the United States and Israel.
In the DCIS arm, 13% of patients assigned to MarginProbe were candidates for re-excision compared with 37% in the control group (P=.004).
Among patients with DCIS plus invasive breast cancer, 17% of patients assigned to MarginProbe were candidates for re-excision compared with 33% of control patients (P<.001).
“By using this probe in both subgroups, we can decrease the number of times that we go back to the operating room,” Boolbol said. “Also, importantly, there was no difference in amount of tissue removed.”
Further study is necessary, but the device could potentially affect the way lumpectomy is done, Boolbol said.
“This device may help us achieve the two goals of breast cancer surgery: to remove the cancerous tissue and keep the breast intact,” she said. “We do that by removing less tissue, but we do not want to have a high re-excision rate. This device has shown us, for the first time, that we can reduce the re-excision rate without taking out more volume.”
For more information:
Freedman BC. Abstract #144. Presented at: 2012 Breast Cancer Symposium; Sept. 13-15, 2012; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.
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Andrew D. Seidman, MD
As a medical oncologist who only treats breast cancer, I deal with many patients in that difficult and awkward time between first surgery and re-excision. This device could reduce anxiety, cost, time and effort by getting the surgery right the first time.
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