44 Implementation of a Novel Radiopaque Filament Marker at a Single Breast Cancer Surgery Center

Background

Marking of lumpectomy sites for adjuvant radiation therapy (XRT) in breast-conserving surgery historically uses metal clips, with reports of suboptimal tumor bed delineation. A novel radiopaque filament marker (FM) has been adopted at our breast center to map tumor beds. The aim of our project is to understand the clinical characteristics of the population in which the FM is placed and optimize device utilization through collaboration with radiation oncologists.

Methods

Patients undergoing breast surgery receiving the radiopaque FM at our breast cancer center from 2019 to 2021 were retrospectively queried. Patient demographics, tumor characteristics, and surgical and radiation treatment data were recorded. An anonymous REDCap survey was sent to local breast radiation oncologists evaluating their impressions on the use of the FM. Continuous and categorical variables were analyzed by independent t-test and chi-square test, respectively. Survey responses were compiled.

Results

The radiopaque FM was placed in 104 patients, with 50 patients having complete follow-up data. The average age of this all-female cohort was 62 years (standard deviation, ± 11.2). Invasive ductal carcinoma was the most common pathology (39.2%), followed by ductal carcinoma in situ (31.4%). Over half were stage IA on clinical (50%) and pathologic (52.9%) staging. The surgical treatment was lumpectomy (98.1%), with 58.8% having a sentinel lymph node biopsy and all patients undergoing some level of oncoplastic reconstruction. XRT was given in 82.4% of cases. The survey was completed by 5 local breast radiation oncologists, with 100% agreeing that the use of the FM simplified radiation planning and 80% agreeing that its use enhanced target coverage and reduced normal tissue exposure. Free text suggestions included the strategic use of FM in deeper lumpectomy beds to distinguish between surgery tract and cavity as well as the containment of filament tails within the lumpectomy defect.

Conclusion

Our study found that radiopaque FM is mainly used in patients undergoing breast-conserving surgery with anticipated adjuvant XRT and that it can be used with oncoplastic reconstruction. In addition, our survey proposes actionable technical changes and raises salient questions regarding the permanent nature of the device and how it may affect patients’ longitudinal care. Ultimately, multidisciplinary investigations are needed to determine how to best integrate new FM technologies into surgical and radiation oncology practices.

Author Affiliations:

Helene M. Sterbling,¹ Ashish Chawla,² Lolita Ramsey,¹ Stephanie Akbari,³ David Weintritt,⁴ Shawna C. Willey⁵

¹Inova Health Systems, Department of Surgery, Fairfax, VA

²Inova Health Systems, Department of Radiation Oncology, Fairfax, VA
³Virginia Cancer Specialists, Fairfax, VA

⁴National Breast Center, Alexandria, VA 5Inova Schar Cancer Institute, Fairfax, VA

Corresponding author: Helene M. Sterbling, MD, MA; Inova Health Systems, Department of Surgery; Tel: 540-556-0186; Helene.Sterbling@inova.org