Breast surgeons’ use of wire localization devices dates back to 1966, when a bent wire was used under fluoroscopy guidance, said Valerie Gorman, MD, FACS, a breast surgeon at Texas Breast Center, in an April 2020 presentation.
Then in 1976–the same year Steve Jobs and Steve Wozniak founded Apple–the first use of a needle combined with a hook wire was introduced to help breast surgeons locate a lesion in a patient, wrote researchers in a September 2013 study. Early on, physicians learned that they should place the wire in a parallel fashion in order to avoid causing pneumothoraces in patients, said Gorman.
Fast forward to today. In her 2020 presentation, Gorman discussed ways that wire localization can be used by breast surgeons to pinpoint lesions. She credits wire localization with being safe, cost-effective, and a well-established procedure that can be done using mammography, ultrasound, or MRI guidance. Gorman also highlighted a newer tool in the breast surgeon’s toolkit for locating patient’s lesions: Namely, wireless localization.
Maximize Scheduling Flexibility during Breast Localization
Avoid stack ups and delays from wire-based localization complications
Here are the dos and don’ts of selecting a breast localization device:
Do pay attention to the delays that start in the mammography suite and can result in scheduling difficulties in the surgical suite.
This is important because when a woman has a wire inserted into her breast–often under compression–it can be a stressful experience. That only adds to an already stressful day for many patients.
In addition, if a patient accidently moves the wire, she has to head back to the mammography suite to have it reinserted. That’s where the domino effect of delays begins because delays in the mammography suite may throw off surgeries for the rest of the day.
Use of wireless localization, such as the LOCalizer™ Wire-free Guidance System by Marlborough, Mass.-based Hologic, can help avoid these delays. A wireless radio frequency identification (RFID) breast lesion system, LOCalizer will potentially enable precision and ease of use for breast surgery guidance.
The LOCalizer system includes:
- A miniature RFID tag with a unique ID number pre-loaded in a needle applicator
- A single-use surgical probe with a small, approximately 8 mm tip
- A portable handheld reader that can be used in a sterile (when enclosed in the system’s sterile drape) or unsterile environment
The RFID tag can be inserted several days before the scheduled surgery. That means the patient shows up on time for her surgical procedure–and a great deal of unnecessary stress can be avoided on the part of the patient, her breast surgeon, and the mammography team.
Don’t ignore the impact of delays in the stress levels of patients and breast surgeons.
It makes for a very bad day when a patient’s surgery is rescheduled due to a dislodged wire, said Gorman. A 2010 study revealed that more than half of elective surgical cases had at least one delay.1 Equipment failure was the most common cause of a delay, according to the researchers. In addition, they observed that surgical delays have a major impact on patient flow and resource utilization.
Healthcare leaders also have to be mindful about preventing burnout among clinical staff. Forty-one percent of surgical oncologists met the criteria for burnout and 57% didn’t experience professional fulfillment, according to a survey conducted in 2017.2
Patients arriving for their surgery are also likely to be experiencing stress. A 2012 study found that patients may experience increased anxiety as their cancer spreads or their treatment regimen becomes more intense.3
Pre-surgical planning, which can include the use of a wireless localization device, may have the result of reducing stress for breast surgeons and patients, alike.
Do look for a localizer tool that will allow precision during surgery.
Richard Fine, MD, FACS, a breast surgeon and director of education and research at Margaret West Comprehensive Breast Center in Germantown, Tenn., says that using the LOCalizer system allows him to leave more tissue behind. The benefit to his patients is a better cosmetic result, he said in a May 2019 video.
Specifically, Fine credits the precision of real-time insight–down to the millimeter–into the location of a tumor with creating a better result for his patients.
- Wong, J., Khu, K. J., Kaderali, Z., & Bernstein, M. (2010, June). Delays in the Operating Room: Signs of an Imperfect System. Canadian journal of surgery. Journal canadien de chirurgie. Retrieved September 27, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878989/
- Clinicaloncology.com, https://www.clinicaloncology.com/Breast-Cancer/Article/09-19/Study-Reveals-High-Level-of-Burnout-in-Breast-Surgeons/55926.
Baqutayan, Shadiya Mohamed Saleh. “The Effect of Anxiety on Breast Cancer Patients.” Indian Journal of Psychological Medicine, Medknow Publications & Media Pvt Ltd, Apr. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498772/.
Dr. Valerie Gorman Discusses the Revolution in Localization
Dr. Valerie Gorman discusses the history of localization and shares clinical experience with the advantages and disadvantage of different options