Magnetic marker localization for non-palpable breast cancer: Initial experience

B. Schermers, J.A. van der Hage, F.H. van Duijnhoven, C.E. Loo, H.A.O. Warmars, B. ten Haken, T.J.M. Ruers

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Introduction: Magnetic Marker Localization (MaMaLoc) was developed as a novel intra-operative localization technology for non-palpable breast cancer. It aims to replace other localization technologies. The MaMaLoc technology consists of a newly developed magnetic localization marker and a magnetic detector. We present the ex vivo and first in vivo experience with the technology.

Material and methods: The magnetic marker was first implanted into a chicken breast. Imaging was obtained to assess the visibility of the marker on ultrasound (US), mammography, computed tomography (CT) and magnetic resonance imaging (MRI), which is essential for the intended image-guided placement of the marker. Next, the marker was implanted into two breast amputation specimens. Two surgeons were then tasked to perform breast conserving surgery (BCS) on a simulated lesion in the breast specimen using a magnetic detector. They scored the performance of the magnetic technology based upon their experience with other localization technologies.

Next, an in vivo safety and feasibility study was designed. Fifteen patients with a unifocal lesion that were scheduled for primary BCS using a single iodine seed (Radioactive Seed Localisation, RSL) were included. Subjects received both the standard of care (RSL) and the experimental magnetic technology (MaMaLoc). Both iodine seed and magnetic marker were placed in a single session using US guidance. Up to 30 days after placement, BCS was performed.

During surgery, the ability to transcutaneously detect the magnetic marker using the magnetic detector was recorded. Semi-objective data regarding the technology were obtained from radiologists and surgeons, utilizing a 5-points Likert scale ranging from ‘Strongly Disagree’ to ‘Strongly Agree’ and a set of statements regarding convenience, logistics, clinical applicability etcetera and tailored to specific radiology- or surgery-specific characteristics.

Results: Ex vivo data showed excellent visibility on US and mammography, by far the two most used imaging technologies for guided marker placement. On CT, visibility was slightly impaired due to a small artefact. On MRI, a susceptibility artefact obscured a large area of 7 cm diameter.

Surgeons scored the technology better than wire-guided localization (WGL) and radioguided occult lesion localisation (ROLL), and at least comparable to RSL. The technology was therefore considered feasible.

At the date of abstract submission, the in vivo study was still ongoing and results will be presented at the ESSO 2016 congress.

Conclusions: Magnetic marker localization is a promising new technology to improve breast conserving surgery. It combines the benefits of RSL (planning flexibility, continuous re-assessment of surgical approach, accuracy, patient comfort) and of WGL: simplicity.
Original languageEnglish
Pages (from-to)S81-S81
JournalEuropean journal of surgical oncology
Issue number9
Publication statusPublished - 2016
Event36th Congress of the European Society of Surgical Oncology, ESSO 2016 - Budapest, Hungary
Duration: 10 Oct 201812 Oct 2018
Conference number: 36


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