RFID tags revolutionizing how breast surgery is approached

Radiologist Richard Ogles, MD, points to what looks like a large grain of rice visible on a mammogram of a patient with early stage breast cancer.

"This," he says emphatically, "is completely changing the way we approach targeting and treating this type of cancer."

The tiny spot is a radiofrequency identification, or RFID, tag. The tags, commonly used to track products for shipping and inventory, are now being used to help surgeons easily identify small lesions in the breast. It is offered in the Cape Girardeau region only at SoutheastHEALTH, which invested in this technology understanding its ability to revolutionize treatment protocols for breast cancer patients.

"It's important because in our patients, about 60 to 75 percent of breast cancers detected on a mammogram are not palpable, or can't be felt, by the patient or the surgeon removing the tumor," Dr. Ogles said. "This enables surgeons to more easily and accurately find the small lesions."

SoutheastHEALTH physicians are the first in the Cape Girardeau region to use the RFID system for breast cancer treatment. The system is FDA-approved and offers precision targeting of small lesions.mage courtesy of Faxitron

To target a small cancer, the gold standard for the past 20 years has been the use of a thin wire, called a hook wire. Radiologists locate the mass on an ultrasound and mammogram and then insert a small needle through the skin. A tiny wire then is threaded through the needle and placed inside the lesion so that a surgeon can later track down the wire and remove the abnormal breast tissue. The top of the wire is left protruding outside of the breast prior to surgery. In some cases, radiologists will have to insert two wires.

"The hook wire is usually placed the day of surgery, so a patient would be undergoing two procedures in a single day, making it stressful for them," said Joseph McCadams, MD, a surgeon with Cape Girardeau Surgical Clinic. "The other concern is that the radiologist can only place that wire in a certain way due to the limitations of his instrumentation, which then also limits how we approach surgery."

With the RFID tag, however, there are several benefits. It can be placed up to one month prior to surgery. Because there is no wire to make a path to the tumor, the surgeon also can determine the best way to surgically approach removing it, enhancing both surgical and cosmetic outcomes.

"We've used the RFID tags on several patients and it's a definite improvement over the previous procedure," McCadams said. "I don't want to go back to the way we've done it before."

Hook wires are still used in some cases when multiple lesions have been identified. The RFID tags, however, are slowly replacing another option for tagging breast lesions -- the use of radioactive seeds, which exposes patients to radiation.

"Once you explain the benefits of using RFID tags over a wire, everyone seems to prefer the tag," Ogles said. "It's faster, taking about 10 minutes or less to implant, and it's definitely more comfortable than having a wire taped to the outside of the breast."

RFID tags being used to target small breast cancers are as small as a coffee bean or large grain of rice.mage courtesy of Faxitron

RFID tags were initially developed for military use. A hybrid of both radar and radio broadcast technologies, it was used by the U.S. and then Britain to track missiles and enemy aircraft. Beginning in the 1960s, however, RFID tags began proliferating in factories and businesses for product and vehicle tracking. Along the way, tags became smaller and more sophisticated. The RFID tags used by Drs. Ogles and McCadams are about the size of a coffee bean or a grain of rice. In just the past year, though, researchers have developed microscopic RFID tags that can fit inside some large cells within the body, including melanoma and breast cancer cells.

RFID tags are "smarter" barcodes. Whereas barcodes need to be scanned with an optical scanner and, thus, be in the line of sight, RFID tags transmit radio signals, which means they can be tracked without having to actually see the tag. Radio signals can be transmitted and tracked through various materials; in medicine, for example, they can be tracked through the skin.

Within the past two years, RFID tags have been FDA-approved for breast cancer localization. Once the tag is precisely positioned in a lesion, its signal can be picked up with a handheld antennae and receiver. Each tag has a unique identification code customized to each patient. When the surgeon removes the lesion and a small margin of healthy tissue around it, the tag also is removed.

"I knew when I first heard about this technology three years ago, that it was going to revolutionize breast cancer treatment," says Dr. Ogles. "It's covered by insurance, it's a painless procedure for patients, it reduces stress and anxiety and it allows for more precise targeting for the surgeon."

Dr. McCadams agrees. "There has been a shift in breast cancer treatment from full mastectomy to breast conservation surgery," he said. "Because we now have the ability to change how we approach making an incision to remove the cancer, this RFID technology helps us do a better cosmetic procedure when patients elect breast conservation procedures. And we can do that without compromising our main goal, which, of course, is to remove the cancer."

Dr. Ogles and Dr. McCadamsSubmitted by SEHealth