In the second half of our ASBrS 2022 symposium, president-elect Susan Boolbol, MD moderated discussion among our panel of world-leading experts on the more advanced applications of seed technologies.
In part one, Dr’s Peled, Alvarado, De La Cruz, Paepke and Killelea shared their combined experiences of using multiple wire-free markers and the drawbacks of each that led them to Magseed®.
This time around, lymph node marking for targeted axillary dissection and being able to use multiple breast markers – including lymphatic tracers – in just one system are on the agenda, as they discuss why providing this versatility could be key for delivering better patient experiences.
One of the key considerations that has come to light for selecting a breast marker in recent years has been the suitability of markers for advanced surgery, such as lymph node placement.
Techniques such as Targeted Axillary Dissection have proven reduced false negative rates and surgery de-escalation in studies from centres including the University of Texas MD Anderson in Houston. With all the panel having used Magseed®, they were asked how this technique performs in the axilla.
“My personal opinion is the Magseed in the breast is good, but the Magseed in the axilla is better. The real benefit comes from the targeted axillary dissection”
Speaking of her experiences at MedStar Georgetown University Hospital, Dr Lucy De La Cruz agreed, explaining how her fellows have really benefited from performing TAD with Magseed® too:
“It works great for teaching. I allow the residents and the fellows to use it, and that is something that gives you confidence in them going through the tissue – that the technology is not going to fail”.
Unlike other seed localization platforms, the Sentimag® platform is unique in that it offers users the opportunity to also use Magtrace® to perform sentinel lymph node biopsy. Dr Boolbol decided to delve into this a little deeper and see what benefits had been seen from that extra utility.
“Our detection rate is higher and the procedure is more convenient” explained Dr Paepke. “There is no problem distinguish between the signal of the seed and the signal of the trace. You have the 9999 in yellow, then you have to remove the targeted lymph node and then where the signal is left, the sentinel lymph nodes.”
Anecdotal concerns have been raised around the possibility of Magtrace® staining the breast, similar to blue dye, as well as creating issues on MRI. However, Michael Alvarado, MD, explained how he had seen no issues at all at UCSF in California.
Speaking on future-thinking studies, he said “I know in Sweden, there are studies looking at [optimizing] injection techniques.”
“You don't have any issues with staining. You don't have issues with MRI and the transit time is great. So, I think that's potentially a great approach for the future.”
Having established all the pros and cons of existing localization technologies, the evening ended with Endomag CMO Mathew Stephens invited on stage to introduce the next generation Sentimag® platform and how it’s addressed many of the current issues with localization devices.
Speaking of the design process, Mathew explained the importance placed on listening to thousands of physicians and radiologists around the world, and having them feed in to the design to build a technology that’s better than anything which currently exists.
“We needed to understand everything that you do when you treat your patients. We needed to know all of your pain points to see if there is some way that we could help make your job just that little bit easier.”
“All that expertise and experience has gone into making the best system we can. Throughout this, we’ve continued to listen. We’ve been working very hard, and have something that we’re really proud of and hope you like” he said.
And with that, we finished with a sneak preview of what patients and physicians can expect from the next generation Sentimag® and the future for breast localization.
We’d like to thank all of the panelists that took part in the session, as well as our fantastic moderator, Dr Boolbol – plus all those who attended and got involved in the debate, both on the panel and in the audience.
We look forward to seeing you at ASBrS 2023 for more conversations around the future of breast surgery. ♦