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Magseed

Magseed is designed to replace the guidewire system that we use currently. It enables the surgeon to locate and remove cancers that are too small to feel. Approximately 1/3rd of breast cancers are diagnosed (eg by routine screening mammograms) when they are still too small to feel. Currently on the morning of surgery, the patients are sent from the ward down to the breast care unit and have a guidewire inserted into the cancer under ultrasound or Xray guidance. The wire is then coiled up under a dressing and the patient goes back to the ward and waits for their operation. The guidewire has to be placed on the day of surgery because it can become dislodged if it is left too long. It is not pleasant for the patients to have a wire sticking out of their breast, even if only for a short time pre-operatively. If Magseed is placed before the day of surgery, the patient may be scheduled first on the operating list and so be more likely to be discharged home on the same day.

Magseed

The Magseed is about the size of a grain of rice and made of surgical grade steel and sterilised. It can be injected into the breast by the radiologists under either ultrasound or Xray guidance up to 30 days before the patient’s breast cancer operation. In the operation the surgeon uses a handheld probe called Sentimag to find the location of the Magseed in the breast. Sentimag works like a metal detector but the technology inside is actually more like a handheld MRI machine. From the skin surface, the surgeon can detect the location of the Magseed in the cancer and then plan the incision and operation accurately. This is an improvement on the wire because although it is obvious where the guidewire enters the breast, the entry point can be quite a way from the cancer itself. With Magseed we can remove the cancer just as effectively as we do with a guidewire but with less dissection to access the right area, we are causing a smaller “injury” and so we hope the patients recover better as a result. 

Sentimag

Just as importantly there are some knock-on benefits to other patients – currently we see most of our new referrals (eg patients referred by their GP with a lump) in the morning "one-stop" breast clinic. We have limited equipment, radiology manpower and space so the wires are placed first and only after that can the radiologists start seeing the new patients and doing their mammograms, ultrasound scans and biopsies. If Magseeds are placed a few days before surgery, the radiologists will be able to start seeing the new patients earlier and reduce the time each new patient spends in the department waiting to have their tests.


This is a pilot study and we have been given approval by the UHL NIPAG committee for a pilot of 10 Magseeds, which have been donated by the suppliers, Sysmex UK and EndoMag. The pilot is being led by two Consultant Oncoplastic Breast Surgeons, Mr Simon Pilgrim & Miss Monika Kaushik alongside two of our specialist breast Consultant Radiologists, Dr Moin Hoosein and Dr Miaad Al-Attar, but has involved considerable help from colleagues of all disciplines in Breast Care and Glenfield operating theatres. I am especially grateful to those patients who have helped to draft our patient information as well as the patients who have volunteered to take part in the pilot. As of 15/2/18, we have used 6 Magseeds successfully. More than half of the breast surgeons have been to theatre to see the system in action and we have even had interest from our thoracic surgical colleagues with ideas for potential applications in lung cancer treatment. Although the cost of each Magseed is more expensive than a guidewire, we think the improved patient experience and the improvements to efficiency in clinic and theatre will offset this to a large extent. Once the pilot is complete we hope to submit a business case to use Magseed routinely instead of the wires. Wires will still need to be used in some patients, for example those with pacemakers as the magnetic field of the Sentimag probe could interfere with the functioning of the pacemaker unit.


As a unit we are constantly working to try to improve our outcomes but it is just as important to improve the experience of our patients while they are being treated. We don’t think Magseed will improve breast cancer outcomes or survival. We believe Magseed will improve the patient experience for those patients who would otherwise be having a wire as well as the patients who attend the one-stop clinic which will run better as a consequence. The breast ward at Glenfield already scores the highest of any ward in the hospital for patient satisfaction (100% scores for 15 consecutive months) but we still want to do better.


There are likely to be some interesting developments in breast cancer treatment in the next one or two years, particularly in reducing the number of lymph nodes we need to remove from the axilla (armpit) as part of breast cancer surgery after chemotherapy. Subject to licensing approvals, we already have some ideas as to how Magseed could be used in this setting as well.