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Possibly Less Surgery

Posted 1/5/2013

Posted in

  Although I have learned from long experience to be quite skeptical about news items, this is hopeful. The FDA has just approved a device that should help breast surgeons learn, during surgery, whether all the cancer has been removed. Other language: to ascertain whether clean margins have been achieved. If this really works as advertised, it should greatly reduce or even eliminate the need for women to return for additional surgery to achieve clean margins--something that, up until now, can only be learned in the pathology lab.

This device is already being used in Europe and has done well in careful surgical clinical trials in the US. Note that it will not totally eliminate the need for more surgery. A surgeon will still have to use her judgment about how much tissue can be taken. Picture scraping (probably not the right word, sorry) more and more tissue around the edges/margins of the tumor bed, trying to get to healthy cells. In some cases, at some point, it will become obvious that more cannot be excised.

There is always a balance between the size of the tumor and the size of the breast. It is possible to take more tissue out of a big breast and still be left with something that looks reasonable than it is out of a small breast. Thankfully, surgeons no longer can go ahead during the operation and do a mastectomy if that becomes the necessary decision. (Note: I suppose this still could be legal and good practice if a careful discussion has happened between the patient and the surgeon, and the woman feels strongly that she only wants one surgery, no matter what the outcome.) Can imagine there will always be cases when clean margins cannot be achieved, and the woman will have to return for a larger surgery, a mastectomy.

This is an article from MedScape with the link to read more:

A device for use during breast cancer surgery to check if margins are clear of cancer has been approved in the United States by the US Food and Drug Administration. The product has been available in Europe since 2008. 

The MarginProbe system.

The new device, MarginProbe (Dune Medical Devices Inc), consists of a single-use probe that analyzes breast tissue removed during a lumpectomy. Using radiofrequency spectroscopy, the probe analyzes "electromagnetic signatures" at the margins of the surgically removed breast tissue and compares them to an internal library of signatures taken from both healthy and cancerous tissue. Within the space of 5 minutes, the probe provides an assessment of the excised tissue, indicating whether or not it is cancerous.

If cancer is found, the surgeon can then remove more tissue in the same procedure, which reduces the need for repeat surgery.

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