Targeted Axillary Dissection (TAD) is a new surgical technique that allows surgeons to assess cancer in specific lymph nodes while minimizing the patient’s risk of developing lymphedema linked to their treatment
A novel procedure could now spare breast cancer patients an invasive surgical procedure on their lymphatic system. At MD Anderson Cancer Center, doctors have pioneered the Targeted Axillary Dissection (TAD) technique, where a tiny magnetic seed is placed into patient lymph nodes known to contain cancer. Following a course of neoadjuvant chemotherapy aimed to shrink or even eradicate their cancer, prior to surgery, this novel technique allows surgeons to monitor the response of targeted lymph nodes to the chemotherapy without the need for upfront invasive surgery, such as a complete axillary dissection.
The magnetic seed, known as a Magseed allows surgeons to accurately remove the node marked prior to chemotherapy and remove it with minimal damage to healthy lymph node tissue.
Lymph nodes are a vital part of the system which helps the body to fight infection but are also the first structures breast cancer can spread to. In 40 to 75% of women, a course of chemotherapy before surgery can clear the nodes of cancer.1,2,3 However, until now, there has been no way to confirm the chemotherapy has been effective without removing a large number of lymph nodes from the underarm.
“The standard surgical approach for patients with breast cancer that has spread to the lymph nodes has been axillary lymphadenectomy (ALND), which involves removing most of the lymph nodes in the axilla,” explains Dr Abigail Caudle, MD, who first pioneered the TAD technique at MD Anderson. “Unfortunately, this approach is associated with significant complications which can impact a patient’s quality of life including swelling, pain, and decreased range of motion. Some patients have an excellent response to chemotherapy and may have no disease remaining in the lymph nodes. We suspect that these patients may not benefit from having all of their lymph nodes removed, although the studies looking at this question are not yet available.
The challenge has been how to identify these patients that might benefit from less aggressive surgery. By specifically removing the exact lymph nodes that had confirmed cancer at the time of diagnosis, as well as the lymph nodes most likely to contain disease, we can now accurately assess whether there is cancer remaining in the lymph nodes and consider no further surgery if there is no evidence of cancer.”
It is widely reported that up to 70% of women who have multiple nodes removed in an ALND procedure will develop complications linked to their treatment, such as the life-altering condition of lymphedema.4,5,6 Lymphedema is a condition where damage to the lymphatic system results in a build-up of lymphatic fluid in the body as a result of lymphadenectomy, causing lifelong symptoms of severe swelling, altered sensation, pain and limitations in range of motion.3. There are currently more than 10m people in the United States living with lymphedema,7 and for many patients, lymphedema is incurable.8
“There is a sea-change afoot in the treatment of breast cancer as patients become increasingly educated about the options available to prevent side effects of treatment. Foremost on this list are procedures and technologies that can prevent lymphedema—an incurable, debilitating, progressive and disfiguring swelling that can occur when the lymphatic system is damaged during surgery, radiation or chemotherapy. Women who win their battle against breast cancer routinely state that lymphedema can be worse than their cancer. Their cancer was cured. Their lymphedema is forever. In this modern world, every woman deserves the full benefits of our knowledge to mitigate onset of the life-long disease of lymphedema,” explains William Repicci, LE&RN President & CEO
The Magseed marker, used by surgeons at MD Anderson, is the world’s most studied non-radioactive seed, with the technology available in over 40 countries around the world. Results from a series of past and ongoing multi-national studies 9,10 have demonstrated the ease and accuracy of marking positive lymph nodes with a Magseed marker with 100% success in surgical retrieval, negating the need for unnecessary node removal.
“This pioneering surgery exemplifies the importance of new technologies such as Magseed in moving breast cancer treatment forward.” said Eric Mayes, CEO of Endomag. “These technologies have already helped over 200,000 patients globally access a better standard of cancer care. We’re committed to continually learning from physicians around the world and providing access to cutting-edge clinical applications that will make a difference to these patients for years to come.
About Endomag
Endomag is a global medical technology company that believes everyone deserves a better standard of cancer care. Many of the world’s leading physicians and hospitals use the company’s technologies to help women with breast cancer avoid surgery when it isn’t needed, and experience better outcomes when it is.
At the heart of the company’s product platform is the Sentimag localization system. The Sentimag system features a probe which works like a metal detector, and when placed near the skin’s surface is used to detect Endomag’s magnetic seed (Magseed) or liquid tracer (Magtrace), for tissue localization and sentinel node biopsy procedures.
To date, Sentimag has been used in over 250,000 tissue localisations in over 45 countries and on all six continents that perform breast cancer surgery. The technology has allowed these patients, regardless of hospital setting, to access more precise and less invasive breast cancer treatment. The company’s technologies are also widely supported by extensive clinical data, with over 5,000 patients featured Magseed marker studies, making it the world’s most studied non-radioactive seed technology.
Endomag is headquartered in Cambridge, UK, with an office in Austin, Texas.
References
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2 Hennessy BT, et al. Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin Oncol. 2005 Dec 20;23(36):9304-11.
3 Dominici LS, et al. Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2-positive breast cancer. Cancer. 2010 Jun 15;116(12):2884-9.
4 Kakuda JT, et al. Objective assessment of axillary morbidity in breast cancer treatment. Am Surg. 1999 Oct;65(10):995-8.
5 Lucci, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007 Aug 20;25(24):3657-63.
6 Blanchard, et al. Relapse and Morbidity in Patients Undergoing Sentinel Lymph Node Biopsy Alone or With Axillary Dissection for Breast Cancer. Arch Surg. 2003 138(5):482–488.
7 Cancer Research UK. Living with Lymphoedema After Treatment. Available at : https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/lymphoedema-after-treatment Last Accessed, August 2020.
8 Anbari. A, et al. Breast cancer-related lymphedema and quality of life: A qualitative analysis over years of survivorship. Chronic Illness. 2019:0(0):1-12.
9 Simons JM, et al. Prospective Trial of Magnetic Seed Localization of Clipped Nodes after Neoadjuvant Chemotherapy in Node Positive Breast Cancer. ASBrS 2021, Poster 581650.
10 Greenwood H, et al. Feasibility of Magnetic Seeds for Preoperative Localization of Axillary Lymph Nodes in Breast Cancer Treatment. American Journal of Roentgenology. 2019;213: 953-957.
