The Radiology Roundtable – Part One: Switching to wire-free localisation

As many surgeons will tell you, successful localisation of high-risk tissue is often dependent on the accuracy of the placement of the localisation device by their highly skilled radiologists.

With that in mind we brought together three of the UK’s finest for our first ‘Radiologist Roundtable’, to share their insights on transitioning to wire-free techniques and their experiences to date:  

  • Dr Katerina Ntailiani – Guy’s and St Thomas
  • Dr Mamatha Reddy – St George’s Hospital
  • Dr Chin Ng – Wycombe Hospital

Read on to find out what they had to say about the radiology issues of guidewires, how to start the process of evaluating and their preference amongst the seed localisation alternatives. 

Out with the old, in with the new

To begin the discussion, Dr Ntailiani, Dr Reddy and Dr Ng all shared their history of localisation devices, starting with their initial experiences of the guidewire. Both Dr Reddy and Dr Ng have only recently moved away from guidewires and explained their frustrations with this method.

“We were struggling to find capacity for our wire patients, and it was really derailing for our one-stop clinics having to find the wires on the day” said Dr Reddy. “I think we finally came to a realisation that our one-stop was not working”.

For Dr Ntailiani, the wire-free revolution started two years ago, when they adopted Magseed®, having evaluated it alongside Hologic’s LOCalizer tag. She explained how making the change had seemed revolutionary at the time but there had been no regrets.

“I was familiar with the wire-free technique from a previous in Manchester, where I was doing a fellowship. So when I joined the team at Guy’s I was very keen to bring this forward. As always, with any change, there was a bit of reluctancy, but when we trialed it everyone was very happy with it.”

Some of the key advantages of wire-free localization highlighted included:

  • Reduced pain and discomfort for the patient
  • Less chance of displacement
  • Better precision and more accurate removal
  • Greater flexibility with placement separated from the day of surgery

Implementing a new seed technique

Speaking about their own experiences, the group discussed the need to embrace the change, move on from decades-old habits and encourage involvement from the entire breast care team for it to be truly successful.

“You’ve got to get the whole team on board” Dr Reddy explained. “So if you don’t have your surgeons engaged, it will not work. We got the whole team on board, from radiographers, and radiologists to surgeons and theater staff”

Once a clear rationale for switching has been agreed by everyone, the implementation process is quick and simple, all agreed. 

“We had to reach a consensus between the radiology team and the surgical team, to decide which seed would work better. It’s always good to be exposed to different technologies and then decide which one the team feels is better.” said Dr Ntailani.

Lessons learnt from going wire-free

All three speakers agreed that the switch had been necessary, and that results had indicated it had been a success so far. But with so many wire-free alternatives to choose from, how did they go about choosing the one to take forward?

“We trialled Magseed and LOCalizer, at our unit” said Dr Ntailiani. “The majority was very much in favour of Magseed, because the LOCalizer introducer is quite large in comparison.” 

“We found it difficult to place it in very firm lesions, and the seed is bulkier. So sometimes we had problems with the seed bouncing away from where we wanted to place it. We don’t have this problem with the Magseed, which is technically much more easier to penetrate the tissues and deploy where you want it.”

At Dr Ng’s centre, they originally opted for the radiofrequency tag technology due to its visibility but their experience so far has not been plain sailing.

I can echo exactly what Dr Ntailiani has just said. The calibre of the LOCalizer needle is too big, and difficult to insert sometimes. The visibility, I have to say, is brilliant. You can see it all the time, and that’s the one good thing about it.” shared Dr Ng.

Has the wire now been retired for good?

Does this all mean an end to the guidewire at our three panelists hospitals going forward? We wanted to know if there were still any use cases where wires would still be of use going forward.

Actually we’ve done some close bracketing with Magseed, which has worked really well,” said Dr Reddy. “Where we might use wires is where the cost might be maybe more than we’d want to use for that particular case, where a wire would work just as well.“

“But from a technology point of view, actually I'm becoming much more converted to using seeds for bracketing.”Dr Mamatha Reddy, St George's Hospital