MarginProbe® Gives Patients the Best Chance for Only One Lumpectomy Procedure for Both Invasive and DCIS Breast Cancers
Dr. Vincent Reid is the Chairman of Surgery and Head of Surgical Oncology Services at Mercy Medical Center in Cedar Rapids Iowa. He also serves as Assistant Professor of Surgery at University of Iowa. Dr. Reid is a firm believer in the success of MarginProbe in improving the results of breast cancer surgery. He was one of the first users of MarginProbe in the country, and he currently handles approximately 5 cases weekly using MarginProbe.
With over 250 cases completed to date using the MarginProbe system, Dr. Reid has some definite opinions on this cancer-fighting tool and its effectiveness as part of the treatment regimen for both DCIS and invasive breast cancers.
How and Why MarginProbe is used
Dr. Reid outlined the importance of margins when removing cancerous tissue from the breast, explaining that the margin determines whether all of the cancer is taken out, or if additional tissue needs to be removed to protect the health of the patient. “Basically, once you remove the lump, it’s never a perfect circle,” he said. “There are roughly 6 margins, including the anterior margin, which is closest to the skin, with the other margins closer to the chest wall.”
“In the previous procedure for determining margins during surgery, I would take an x-ray image of the lump in the operating room,” he continued. “I would then consult with the radiologist and get their opinion on whether the margin is close or not based on the imaging. On top of that, I would need to shave additional margins to try and ensure success. But this process never worked exceedingly well much of the time, because depending on the orientation of the breast cavity, one margin may end up thicker than the other. What we were doing was a random excision of all the 6 margins.”
The problem with this random process was that often it would later be determined that additional surgery was needed (re-excision) in order to ensure that all cancerous tissue was safely removed.
But Dr Reid feels much more confident determining margins today than in the past. “In comes MarginProbe, and we are now able to check the tissue interoperatively,” stated Dr. Reid.
“MarginProbe gives me the ability to not blindly take all the margins,” he explained. “Based on MarginProbe criteria, we determine what margins are positive or close. We can then do a directed shaving on just the margins that need it. Before, I might have taken 6 margins randomly. Now, I’m taking 2-3 margins. As I’m taking fewer margins the overall volume of tissue removed is less.”
Dr. Reid performed a clinical study utilizing MarginProbe and comparing the results before adopting the system. He achieved a 75% relative reduction in re-excision procedures and a 40% relative reduction in the volume of tissue removed from the shavings.
Patient Feedback to MarginProbe
Dr. Reid discusses MarginProbe with patients during the informed consent part of the visit. But he finds that many patients already know about it the system due to its reputation and through the patient’s own research.
“Re-excision results in costs to the patient and impacts cosmetic outcomes,” he said. “Patients often understand this, so when I provide patients with the national re-excision rate, and I provide them with my own re-excision rate, both before and after using MarginProbe, they see the value of this approach..”
Dr. Reid shared a specific example of the day-to-day benefit that MarginProbe can provide. “I had a patient just the other day with a cancer that would normally require a mastectomy, but she did not want a mastectomy,” he explained. “She was at the upper limit of where we would do a lumpectomy, but I was still comfortable with proceeding due to MarginProbe.”
“During the surgery, the MarginProbe did identify a positive margin that I feel I would have missed with an x-ray,” he continued. “With MarginProbe, I was able to remove that margin and avoid a second surgery—which is a big deal.”
Why is it “a big deal?” Dr. Reid cited reasons such as saving patient time, money and headaches that are associated with having to submit to another surgical procedure. But he feels there is another reason that is much, much more important to a patient’s overall sense of well-being. “I think an important point to note is the psychological impact of telling a patient you have to go back for an additional surgery,” he explained. “It doesn’t matter if it’s a quick operation or that the additional tissue to be removed is small. Once you tell a patient that they have to go back in for re-excision, all they hear is, ‘I still have cancer.’”
“A significant portion of these patients will insist having a mastectomy, even if that option is really overtreatment,” he continued. “The piece of mind of knowing the cancer was removed the first time, outside of the clinical data, is worth the cost of using MarginProbe.”
The Future of MarginProbe
Dr. Reid is currently evaluating MarginProbe’ effectiveness when used in concert with DaVinci®, a robotic surgical system that promises a much less invasive and more successful approach to breast cancer surgery. So far, he has found no negative impact using this technology with MarginProbe. “If there is something new that can positively impact patient outcomes, including both the clinical oncology and cosmetic outcomes, I think it’s important to be able to offer that technology to your patients,” he declared.
One thing seems certain. MarginProbe is a regular part of Dr. Reid’s surgical procedures.“All of my lumpectomy cases are routinely booked with MarginProbe,” he said. “It is a rare case that this effective tool is not used. From a clinical standpoint, MarginProbe is now a part of my practice. I’m a long-term user and I’ll continue to use it as I believe in the data and I’ve seen the way it impacts my patients.”
Vincent Reid, MD, FACS
Mercy Medical Center