Casting a light on lumpectomy

Laurel Soot, M.D.
Regional clinical director of breast health, Providence Cancer Center

Scott Prahl, Ph.D., and Amanda Dayton
Oregon Medical Laser Center

As many as 350,000 lumpectomies are performed in the United States each year, and about 30 percent require additional surgery due to positive margins. Many of these lesions are non-palpable, which makes surgical treatment challenging.

The Ruth J. Spear Breast Center, part of Providence Cancer Center, is developing practical devices to help locate and remove these lesions.

During lumpectomy, non-palpable lesions are found using a Kopans wire, which uses ultrasound or radiographic guidance. We have modified the standard wire to include an optical fiber. Our wire is connected to a red light source in the operating room. When inserted, the tip of the fiber illuminates the tissue, helping to locate the lesion. The light also provides a guide for resection.

We completed a small, hospital-approved study to test our device. In the study, all patients were treated with standard wire localization, except the tissue was illuminated during surgery. In each patient, the glow ball surrounding the lesion was visible, and it helped in locating and removing tumors in the eight patients treated. Seven of the eight patients had negative margins.

A larger prospective study is planned to evaluate margin status of wire-guided versus light-guided procedures.

 The potential patient benefits are:
• Less tissue damage because the lesion is easier to find
• Fewer procedures (30 percent of lumpectomies result in positive margins)
• Better cosmetic outcome
• The option of partial breast irradiation due to more spherical cavities

With further evaluation, the optical wire has the potential to replace the wire used in roughly 100,000 lumpectomies each year.