New Technologies Improve Patient Experience for Women with Breast Cancer

UH breast surgeons are early adopters of Magseed and Magtrace

Innovations in Cancer | Summer 2019

Breast surgeons at University Hospitals are early adopters of two new technologies that are leading to a better patient experience and better, more personalized care for women with breast cancer.

Magseed is a non-radioactive, stainless steel seed placed into the cancer under ultrasound or mammography guidance. The Magseed eliminates the need for a pre-surgery visit to radiology on the day of surgery to place a guide wire.

Jill Dietz, MD

“The patient doesn’t have to go anywhere else the day of surgery – it uncouples their visit to radiology from surgery,” says Jill Dietz, MD, Director of Breast Center Operations at UH Seidman Cancer Center; and Associate Professor of Surgery, Case Western Reserve University School of Medicine, who has pioneered the use of Magseed at UH when she began using it in 2017. “After the patient is asleep, we have a small probe that is called the Sentimag that helps us find the cancer. It’s more accurate for me then a wire, and it’s a better patient experience because the patient doesn’t need to go anywhere and have a wire sticking out of their breast the day of surgery.”

Magseed can remain in the breast for several months if the patient needs neoadjuvant chemotherapy prior to surgery, Dr. Dietz says.

At UH, Dr. Dietz estimates that breast surgeons have used Magseed in over 800 patients to date.

“Very quickly we’ve rolled it out to almost the entire UH network,” she says. “Basically most of our system has gone wireless. At 800 patients and counting, we may have the world’s largest experience with Magseed.”

Dr. Dietz was also recently the first breast surgeon in the United States to inject Magtrace – approved by the U.S. Food and Drug Administration in July 2018. Magtrace is a new, advanced technology for identifying the sentinel lymph node in women undergoing surgical treatment for breast cancer.

“It’s very interesting because it’s an iron oxide nanoparticle,” Dr. Dietz says. “You can inject it into the breast ahead of time or after the patient is asleep before surgery. It is taken up into the lymphatic system and goes to the sentinel node. It’s what’s called a dual tracer, so it can be observed both visually and auditorily using the Sentimag probe.”

Magtrace can replace the blue dye and radioactive particles that have been in use for sentinel lymph node location since the 1990s. The new technique eliminates the risk of side effects related to the dye and decreases the regulations involved with injecting the radioactive particle that were used with the older technique. This allows the injection to occur in any location and, for some patients, days ahead of their surgery.

For Dr. Dietz, the key advantages of Magtrace lie in the realm of patient experience.

“Our goal is to provide the best possible treatment for each patient with breast cancer while delivering the optimal patient experience,” she says. “Magtrace provides the same accuracy as older technologies for locating the sentinel node without the use of radioactive substances and decreases the number of procedures on the day of surgery.” 

One key advantage of Magtrace, Dr. Dietz says, is its ability to persist in the sentinel lymph node for 21 days.

“The Magtrace will go in the sentinel lymph node and stay there,” she says. “With technetium 99, that passes through the sentinel nodes. If you leave it too long, it will go to the second echelon of lymph nodes. The blue dye goes to the sentinel node, but after a while it just goes away.” 

This lasting quality of Magtrace gives the breast surgeon more options for patient care, Dr. Dietz says.

“The really great thing about Magtrace is that you can inject it the morning of surgery for a woman who has non-invasive breast cancer, you can do her surgery but not take her lymph node,” she says. We normally will check a lymph node at the time of a mastectomy for noninvasive cancer because it is hard to go back and find a node after the breast has been removed., Using Magtrace, we can come back to get the node if we find an invasive cancer and avoid a lymph node biopsy in most patients, which carries a 5 to 8 percent risk of lymphedema or arm swelling. If we find out a week later that there is invasive disease there, you can go back to the OR and still find the sentinel node with the Magtrace in it. The really important thing it is that we can save over 90 percent of patients in this situation from a node biopsy, which can’t be done with any other tracer.” 

For more information about how UH breast surgeons are using Magseed and Magtrace, please email Jill.Dietz@UHhospitals.org.