'Seed' makes breast cancer surgery simpler

Breast cancer surgery at Sydney Adventist Hospital will be more precise and comfortable for patients following the arrival of a new radar system for locating tumours.

New South Wales' largest private hospital is the first in the northern Sydney region to offer the Scout implantable marker device.

It replaces the traditional 'hookwire' method for guiding surgeons when removing cancerous and pre-cancerous growths, using a small reflector 'seed'.

"With the hookwire, it can sometimes be hard to tell exactly where the cancer is because the wire can be quite long and you don't know how deep the wire is inside the breast," said Associate Professor Nicholas Ngui, a breast cancer surgeon at the hospital, also known as the San.

"However with the Scout system, it will tell you exactly how far the reflector marker is from the tip of the probe – to the millimetre – and we can make the incision based on real-time information about where the actual cancer is," he added.

About one-third of breast cancer patients have non-palpable cancers which cannot be felt, so traditionally a hookwire would be put into the lesion using ultrasound in the radiology department early on the morning of the surgery.

It would stay in place until the theatre operation to remove the tumour, often causing patients discomfort from having a wire protruding from their breast, and the risk of it dislodging.

"The Scout device involves a small reflector 'seed' the size of a staple being inserted into the breast cancer in the days or weeks leading up to surgery, and stays in place until surgery," A/Prof Ngui said.

"This acts as a marker so you can find the lesion. The Scout reflector seed is inert; it is not powered by battery and has no radiation.

"On the day of surgery to remove the cancer, we use a hand-held device – similar to a probe or wand – which emits radar, and the reflector seed reflects that radar signal and tells you exactly where the cancer is."

A/Prof Ngui said the Scout system could help surgeons to get clearer margins around the cancer and preserve healthy breast tissue.

"With the hookwire, we sometimes had to take out tissue along the wire if you weren't sure exactly where the lesion was. With Scout, the reflector marker seed is right in the middle of the cancer, and so the surgery is much more accurate," he said.

"Using the Scout probe we get like a 3D map of how far away the margin is in all directions, and if the probe shows that the margin is only one millimetre away, then we can take an extra shave of breast tissue from that spot. Scout gives you real-time feedback as to whether the margins are sufficient or not."

A/Prof Ngui said Scout could also be used when removing lymph nodes, which is often needed for breast cancer patients who have systemic chemotherapy before surgery.

"If they have positive lymph nodes before they start chemotherapy, a Scout reflector marker is placed inside the involved lymph node and just stays there during chemo," he said.

"Often the cancer cells disappear after chemo, but the affected lymph node still has to be taken out. And even if you can't feel the lymph node anymore, the node can still be located because it has the Scout marker seed in it and can be easily found and removed."

Read more: Hospitals share new breast cancer radar for patients' sake

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