To find a lump in your breast can be one of the scariest moments of your life. A flood of questions entering your mind, only to be met with a sea of emotion; paramount among them worry. Even if the lump is determined to be a benign mass, the prospect of surgery can be anxiety-inducing. It is with this in mind that Dr. Eunice Cho, a breast surgeon with the MultiCare Regional Cancer Center, began using an innovative technique for lumpectomies at MultiCare Auburn.
Cianna Medical’s Savi Scout radar localization system is used to precisely locate and guide the removal of targeted tissue during a lumpectomy or surgical biopsy procedure. Savi Scout was developed to make breast cancer surgery easier for patients and more efficient for the healthcare system. Dr. Cho has been utilizing the Savi Scout since early September.
Finding and Localizing a Lump
A mammogram or ultrasound is performed to establish whether a lump is a fluid-filled cyst or a solid tumor. This imaging also allows the radiologist to determine the location and size of the lump. While a mammogram or breast ultrasound can be used to assess a mass in your breast, it can’t be used to discern if the lump is cancerous.
If a lump is found during a mammogram or ultrasound, the radiologist places a 2mm clip marker at the location of the lump. A portion of the lump is extracted for biopsy at the time of imaging. Once the results of the patient’s biopsy are returned, the patient works with their doctors to create a treatment plan. As a breast surgeon, Dr. Cho works very closely with patients’ Oncologists to ensure their treatment plans result in as best an outcome as possible.
The most common practice for lumpectomies presently utilize a localization procedure performed on the day of surgery. This localization is done to help the surgeon find exactly where to remove abnormal tissue or cancer that cannot be palpated. Traditionally an eight-inch wire with a hook is inserted into the breast and placed next to the target. Once the wire is placed, a mammogram or ultrasound is done to confirm placement.
One of the concerns with wire localization is the potential for movement. The placed wire protrudes from the breast of the patient once positioned. While patients go directly to surgery after the wire has been set, radiology and surgery are in two separate locations.
Savi Scout Changes the Process
Savi Scout works similarly to the wire localization. Radiology places the Savi Scout reflector, approximately the size of a grain of rice, next to the clip that was placed at the time of imaging. The placement of the Savi Scout reflector is less intrusive, placed by making a small cut on the breast for insertion. Once placed, imaging is done to confirm placement, as well as Savi Scout radar confirmation.
The Savi Scout reflector can be placed at any time before surgery and has less potential for migration. This advanced placement allows for less stress on the patient of surgery day. The patient’s days are also shorter. Additionally, Dr. Cho can schedule early morning surgeries, as she does not have to wait for the wire localization to be performed by Radiology.
With the ability for prolonged placement of the Savi Scout reflector, the goal is to skip the step of placing the small clip and go directly to placing the Savi Scout reflector if what is found on the imaging is suspicious enough. “A lot of times you can look at imaging and you’re almost certain that it is going to be cancerous, but you don’t have a diagnosis,” said Dr. Cho.
Once the biopsy is performed and the mass is confirmed as cancerous, the patient determines their treatment plan. With the Savi Scout reflector in place, it will allow the patient to go directly to surgery. The Savi Scout reflector can also remain in place throughout chemotherapy.
Scouting Abnormal Tissue in Surgery
During surgery, Dr. Cho uses the Savi Scout guide to locate the reflector using real-time distance measurement guidance in a metal detector type manner. According to Cianna Medical, the Savi Scout guide “emits 50 million pulses per second, to lock on to the reflector’s position.” This sonar like feedback allows Dr. Cho to know the exact location to the target tissue during surgery.
After removing the tissue, Dr. Cho confirms the Savi Scout reflector has been removed using both an x-ray and the Savi Scout guide. There are times with wire localization that the wire has moved, and the marker clip is not recovered during surgery. Repeated attempts to remove the affected tissue, and clip, are then required.
Benefits Beyond the Breast
One of the highlights of Savi Scout for Dr. Cho is its application for lymph node surgery. If breast cancer spreads, it typically goes first to nearby lymph nodes in the underarm. Historically, when patients have cancer in their lymph nodes, all the lymph nodes would be removed. The procedure to remove the lymph nodes is called an axillary lymph node dissection (ALND). Total removal of the lymph nodes often results in long-term damage or injury including nerve damage, lymphedema (arm swelling), and chronic pain.
With positive responses to chemotherapy being more common, not all of the lymph nodes need to be taken – when possible. The lymph node is removed once imaging shows no cancer present and is examined under a microscope. According to Dr. Cho, the Savi Scout will allow for precise identification of the lymph node that initially contained cancer. This precision enables that specific lymph node to be removed and examined to confirm the cancer cells responded to chemotherapy.
Like the breast, localization via wire is an option for the lymph nodes. Placement of a localization wire is different in the armpit, according to Dr. Cho, “we have blood vessels in there, nerves in there; so there is a higher potential risk of complication. The lymph nodes in most patients can be five to six inches deep, and the lymph nodes are tiny, so it has more possibility of moving.”
“The Savi Scout has been approved to put in the lymph node,” continued Dr. Cho, “so now, if the patient has a Savi Scout reflector in, I can go to the operating room and use the [Savi Scout guide] to make sure I get the lymph node out.”
The Cosmetic Side of Breast Surgery
Dr. Cho is someone who takes the patient’s cosmetic care into great consideration. A recipient of the Breast Cancer Surgery Hidden Scar Certificate of Training, she is willing to take the time and care to find alternative surgical methods to place the patient’s incision in a location that is hard to see. While at times causing more work in the operating room, this results in little to no visible reminder of the surgery or their cancer.
The Savi Scout is an additional tool in assisting in the cosmetic care of surgical patients. While the surgical procedure remains the same, the Savi Scout allows for better surgical planning. According to Cianna Medical, the Savi Scout can come within a ±1mm accuracy of the reflector. This accuracy means Dr. Cho is likely to remove less unnecessary tissue during a lumpectomy, which may improve cosmetic results.
Dr. Cho has performed breast surgery using the Savi Scout with three patients since September. Though it is hard to compare as these patients did not also have surgery with wire localization, Dr. Cho shared that the procedures went very smoothly. “I believe that having a wire protruding out from their breast can cause anxiety and result in some patients not wanting to look at their own breast. Having no external wire will certainly be beneficial for many patients emotionally.”
Patients do have a choice between localization via wire or Savi Scout. Though new technology, if the patient chooses the Savi Scout, it is at no additional cost to them.
From General Surgeon to Breast Surgeon
If you ask her, Dr. Cho will tell you that three years ago she had breast surgery handed to her when the principal breast surgeon at MultiCare Tacoma General Hospital was retiring. Previously she’d been a general surgeon with MultiCare for approximately seven years and hadn’t considered the specialty. Initially, she didn’t want to lose other abilities. However, considering further, Dr. Cho found breast surgery to be an excellent opportunity to connect with women.
As a breast surgeon, you have a longer relationship with your patients. Dr. Cho sees her patients every six months for three years, then annually for two years for a total of five years. She gets to know to know her patients on a personal level over that time. Dr. Cho finds the bond that is formed with her patients very rewarding. In general surgery, she often would never see a patient again.
Early detection is the best defense against breast cancer. Women and men should perform monthly breast self-exams. According to the Johns Hopkins Medical Center, “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important.”
Women age 45-54 should get annual mammograms and can switch to bi-annual mammograms after the age of 55. Women with family history of breast cancer, or who have a determined increase risk of breast cancer, should begin getting annual mammograms earlier. Consult your physician to determine your best treatment plan if you have a family history of breast cancer or are concerned about your risk of breast cancer.
With advancements in medicine and medical technology, like the Savi Scout, finding a lump or receiving a cancer diagnosis isn’t a death sentence anymore. Surgeons like Dr. Cho remain on the forefront of these advancements to ensure the highest quality treatment for their patients. “Having a diagnosis of cancer is difficult, no matter what. You can tell [the patient] you have a very benign, slow-growing form of cancer that isn’t going to impact your lifespan. So, we try to make it as smooth as possible. As easy as possible,” Dr. Cho explained. “We try to keep it simple for the patient while being thorough.”
Dr. Eunice Cho, MD, is a board-certified general surgeon specializing in breast surgery. She has additional training in critical care and endocrine surgery. She received her medical degree from the University of Michigan Medical Center and is a member of the American College of Surgeons. Dr. Cho currently practices at the MultiCare Regional Cancer Center, seeing patients in both Auburn and Tacoma.
MultiCare Regional Cancer Center is a network affiliate of the Seattle Cancer Care Alliance. “This partnership gives South Puget Sound residents convenient access to the latest clinical trials and world-renowned expertise.” The Savi Scout is currently available at MultiCare Auburn Cancer Center. Dr. Cho confirmed the Savi Scout would soon also be available at MultiCare Tacoma Cancer Center.