Technology lets patients with DCIS keep lymph nodes
In August 2021, Lauren B res lin, a now 30- year-old landscape development manager from Robinson, was told she likely had duc-t al carcinoma in situ (DCIS), also known as Stage 0 breast cancer. She remembered her grandmother crying ,“I just can’t believe you have togo through this .” Her grandmother, now 88, had lost both her breasts and 12lymph nodes when she was given a breast cancer diag-nosis decades ago, at age42.
If breast cancer spreads, it typically goes first to a few nearby lymph nodes under the arm, known as sentinel nodes. Surgeons used to remove them rou-tinely as a precaution. But for many patients, the loss of lymph nodes brings a host of chronic side effects, said Suzanne Coopey, a breast surgeon who directs breast surgery for the Alle-gheny Health Network.
Thanks to magnetic sensing technology, Bres-lin was able to keep her lymph nodes, eliminating the risk of ly mph edema, a possible effect of ly mph node removal.
Lymph node removal can contribute to los so farm function and the need for physical therapy after mastectomy. Though most patients regain full range of motion in their shoul-ders, Coopey noted that some patients “can get cording or axillary web-bin g where it does get re-ally tight and hard to get full range of motion .” Stretching the arm above shoulder level can induce sharp pain.
In patients with lymph edema, the body can not efficiently drain fluid from tissue in the arm .“They have to wear a compression sleeve all the time ,” Coopey said. “They have to have a compres-sion pump at their house to help manage the fluid that builds up in their arm.”
Breslin was aware of the risk because of her family history. After testing posi-tive for a breast cancer gene mutation, her mother, Janet Breslin, un-der went a prophylactic double mastectomy with-out the need for ly mph node removal. Breslin also tested positive and planned to have the same proce-dure as her mother. But af-ter her first mammogram, the doctors told her she had cancer, which could have spread to her lymph nodes.
She worried doctors would say ,“We got all your cancer, but now you have to worry about ly mph edema for the rest of your life .”
When Breslin faced her double mastectomy in Sep-tember 2021 at Allegheny General Hospital, her sur-geon told her about Mag-trace .“I think I was the first patient of he rs that she used it on ,” she said.
In fall 2021, Allegheny Health Network rolled out the magnetic sensing tech-nology Mag trace. Ap-proved by the Food and Drug Administration in 2018, the technology buys surgeons and patients time to assess whether it is necessary to remove ly mph nodes rather than taking them out when con-ducting a mastectomy.
Of the 1.7 million new cases of breast cancer diag-nosed globally each year, roughly 20% are DC IS, in which cancerous cells are found in the milk duct soft he breast but have not in-vaded the blood stream or lymphatic system.
Removing the tumor it-self successfully treats many patients, but others have to lose one or both breasts entirely depend-ing on the extent of their cancer.
Previously ,“it was auto-matic that these lymph nodes would be removed, justin case there was inva-sive cancer found ,” Coopey said. But only about 15% of mastectomies for DC IS turnout to be invasive cases requiring the lymph node biopsy, she said.
For the 85% of mastec-tomy patients like B res lin whose cancer is truly non-invasive, Mag trace allows surgeons to avoid remov-ing the lymph nodes. It uses a magnetic dye with particles that flow to the sentinel nodes and stays there for 30 days. A pathol-ogist can determine the in-vasiveness of the cancer by examining removed breast tissue.
Then if the cancer is found to be invasive, the surgeon can go back and find the magnetized nodes by listening for the rising pitch of a probe as it close sin on them, much as one would find objects with a metal detector. The tech-nology is pending FDA ap-proval for lumpectomies.
In a 2019 study of the Mag trace technology in Sweden ,78% of 189 women with DC IS undergoing lumpec tom y or mastec-tomy were spared from having a sentinel lymph node biopsyun necessarily .
“I think it’s going to take a lot of stress off the patient side of things ,” Breslinsaid. “It’s going to decrease the amount of ly mph edema that women are going to have after a mastectomy, and I just think that’s potentially life changing for a lot of women .”