An RFID localizer is used to help guide breast surgeries at William E. Kahlert Regional Cancer Center. (Karl Merton Ferron, Baltimore Sun video)
When Tammy Taylor first needed a biopsy of a growth detected in one of her breasts, she had to endure an uncomfortable but long-standard procedure for marking the location of the growth for the surgeon: wire localization.
“They stick the needle in you and then you walk to the operating room, or should I say, be wheelchaired with a wire hanging out, showing the doctor where to cut,” the Reisterstown resident said. “Imagine having a little wire sticking out of you that goes ‘Boing, boing!’ ”
Taylor talks about the procedure with a laugh today, but she can still recall the discomfort she felt 25 years ago, and feels fortunate that the growth turned out to be benign.
This method was never ideal for patients, but had long been the best way to ensure the surgeon could do their job, according to Dr. Dona Hobart, medical director of the Center for Breast Health at Carroll Hospital in Westminster.
“They literally used to stick a Dixie cup on top of it to protect the wire — awkward,” Hobart said. “Awkward, not pleasant, painful.”
So in April when Taylor learned of another growth in her breast that would need a biopsy, she was pleased to learn from Hobart that there was a new, far less invasive alternative to the wire method. Hobart had pushed for Carroll Hospital to adopt the LOCalizer, a system produced by Faxitron that uses radio frequency identification tags to locate small tumors within breast tissue, and it was the first hospital in Maryland to adopt the technology.
Instead of a wire being inserted and then hanging from the breast, a small tag that “looks about like a grain of rice” is inserted, and Hobart then uses a small pencil-like receiver that allows her to home in on the tumor with greater accuracy than can be done using other methods.
“It will say, you are 2.2 millimeters away or you are 5 centimeters away. That’s what’s really beneficial,” she said. “Then you can measure how much you want to take out based on how far away you are from the tag.”
The need for this type of solution comes from the success of modern mammography, which Hobart said can now identify tumors in breast tissue that are too small to feel. Once confirmed in a biopsy, those tumors must be marked in some fashion so that a surgeon like Hobart can remove them and only the necessary tissue around them.
Wire localization is one method, but with obvious drawbacks for patients, as Taylor can attest. Yet it’s a procedure that’s still being used in many hospitals, Hobart said, though Carroll Hospital phased it out in 2014 in favor of a method called radioactive seed localization.
“We were the first people in the state of Maryland to get it. We used a little tiny radioactive iodine seed to localize these tumors,” she said of the method her hospital used before the LOCalizer. “They are the same seeds used to treat prostate cancer, but when they treat prostate cancer, they use 150 of these things. We used one.”
This had many advantages, according to Hobart, primarily sparing the patient the discomfort of having a wire implanted in their breast. The seeds could also be implanted up to five days ahead of time, so that surgery and the marking of the tumors need not take place on the same day.
“It was great,” she said. “But like everything, it was great then and now there is new stuff.”
Each LOCalizer emits an individual signal, allowing accurate mapping of multiple tumors if necessary, Hobart said, while the seed’s radioactive signal simply registers more or less strongly on a hand-held Geiger counter.
“I equate the seeds to like when you are saying, ‘You’re hot’ or ‘cold,’ ” she said. “This is like giving you GPS coordinates.”
And while the seeds did not emit enough radiation to be dangerous, according to Hobart, they were highly regulated and could not be left in a patient for more than five days.
“This thing can be put in up to 30 days ahead of time and pretty soon it will be able to stay in forever if need be — if it gets put in and a patient gets a cold and we have to delay their surgery, it’s not tragic,” Hobart said of the LOCalizer. “With the seed, we had to get it out.”
Hobart has performed about 20 surgeries since the start of 2018 using the new technology, something made possible, she said, by funding through the Carroll Hospital Foundation. The LOCalizer, at least for now, is more expensive than other techniques.
“We are really fortunate here because our foundation provides support for things that are really good for the patients,” she said.
And while Carroll Hospital is the first in the state to use this new surgical technique, Hobart is certain it is the next big thing in breast cancer surgery.
“I think it’s going to take off,” she said recently. “I had correspondence with a surgeon in the Netherlands just yesterday asking me about it.”
The proof is in the patient experience, and Taylor’s could not have been more different now than 25 years ago.
“No stitches involved at all, and when it was done, I actually said to them, ‘That’s it? We’re done?’ I was shocked it was that quick,” she said. “I was probably in there maybe 20 minutes. It was great, the whole procedure was perfect.”
After a lumpectomy in May, Taylor is undergoing 30 days of follow-up radiation treatments and is happy about the treatment she received at Carroll Hospital.
“The way they did it to put the sensor in, that was a breeze,” she said. “They really do have a good program. That’s why I chose it.”