A new piece of equipment acquired for the PA Hospital by the PA Foundation is set to help thousands of breast cancer patients.
The Savi Scout Guidance Console was made possible through funding acquired by the Foundation from the Sheila and Bernard Joel Life-Saving Medical Equipment Foundation and will be used in the treatment of the hospital’s breast cancer patients as well as in melanoma patients whose cancer has become metastatic.
The console is used to implant a tiny reflector chip next to the lesion or tumour, enabling precise surgical guidance when the patient needs to have the tumour removed. The primary advantage of this approach is it will replace the current hook wire method which can be painful and uncomfortable for patients. The Savi Scout’s reflector chip is also MRI compatible, unlike the hook wire and other current methods and can be placed anytime prior to surgery, whereas the hook wire which must be implanted on the day of surgery.
“The disadvantage of the hook wire is that it is somewhat painful for patients to come in and have a wire placed in the breast. Patients then have a dressing put over the wire, and sometimes have to sit around for hours with the wire in place while waiting for theatre, which can be uncomfortable,” PA Hospital surgeon Professor Ian Bennett says.
“One other disadvantage is that in following the wire down into the breast to excise the cancerous tissue at the end of the wire, sometimes the surgeon can cut into the wire and leave a little bit left behind.”
“Not infrequently the wires can actually migrate, and sometimes they go quite far if the breast is quite fatty.”
“With the Savi Scout we can place the metal reflector into the breast next to the tumour to pinpoint the lesion which can then be detected using the radar guidance probe. The biggest advantage of this technique is that it does not have to be done on the day of the lumpectomy surgery; It can be done a week or two before surgery. The patient simply goes to the radiology department and has the small reflector implanted into or right next to the breast tumour and this can be done as a stand-alone procedure.
“The reflector can remain in the breast for a period of time until the patient comes to theatre, and at which time we use the Savi Scout radar detector probe which directs the surgeon to the right area. After the surgeon makes an incision in the breast, the detector probe directs the surgeon down to the site of the reflector and the breast lesion.
Professor Bennett said staff at the PAH will also be able to use technology in the axilla (armpit) to help excise lymph nodes which contain metastatic breast cancer.
“This secondary use of Savi Scout is in patients who for example have received neoadjuvant chemotherapy and who have been shown to have cancer in their lymph nodes on biopsy. We can use the Savi Scout in these circumstances by placing the reflector into the affected node or next to the affected node. So that when we come to undertake surgery after chemotherapy, we can excise the lymph node(s) that have been marked by the Savi Scout reflector.
“This is where Savi Scout is very useful because we can actually mark a node in the axilla, whereas it's very hard to put a hook wire up into the axilla.”
Equally important and impactful, the console is also being used in the care of patients with metastatic melanoma, and Dr Iain Thomson said it has similar benefits for the patient and the health system in melanoma as it does in breast cancer.
“Previously, your only option a patient was surgery to take all the nodes out and you had all the troubles and recovery associated with that. These days we've got immunotherapy to treat stage 3 or 4 cancer so we can biopsy it to prove its melanoma at the same time we put the little reflector in,” Dr Thomson said.
“The patient has their immunotherapy treatment and then we can just go back and find that one node, take that out and then we send that off to the lab and they can tell us whether the immunotherapy worked and whether they need further surgery. So, it's main benefit is that it is targeted and precise and saves people having more radical surgery.”
“The whole Savi Scout procedure is much more comfortable for the patients just on the day of the surgery. It’s also an economic advantage from the point of view of time saving in paying for nurses looking after patients. It also makes radiology bit more efficient as well as they can schedule times when they're not so hectic to implant the reflector chips,” Prof Bennett said.
