12 Oct 2011
By: MELISSA PANG
A PROCEDURE to help surgeons locate breast lumps that cannot be seen and felt through the flesh, or impalpable breast lesions, is now available here.
Such lumps could signal that the patient has breast cancer.
The technique involves the use of radioactive material for more precise and faster removal of the lumps, with minimal scarring.
General surgeon Felicia Tan from Raffles Hospital pioneered the procedure – called Radioisotope Occult Lesion Localisation – here after learning it in Milan, Italy, in January. More than 50 patients have benefited so far. The Singapore General Hospital and National Cancer Centre Singapore are currently recruiting patients for a trial.
The procedure is recommended only for patients with impalpable breast lesions. About 30 per cent to 40 per cent of women with breast abnormalities have such lumps. Due to their size, and sometimes location, they can be hard to remove, even with the current hookwire localisation method.
In this method, a fine wire is inserted into the breast as a marker for the doctor to know where the lumps are. It causes some discomfort, and has a 30 per cent to 40 per cent chance of inaccuracy.
With the new technique, patients first undergo an X-ray or ultrasound scan to locate the abnormalities, which are either tiny lumps or calcium deposits. When found, a nuclear medicine doctor will inject a low dose of radioactive material into the lesion
A surgeon then makes a 1.5cm to 2cm incision at an area that would have the least visible scarring. A gamma-ray probe, which detects radioactive areas, helps him locate and extract the abnormal tissue accurately. Once removed, the probe scans the breast to ensure it is free of radioactive material.
Dr Tan said that with the new technique, lumps can be removed cleanly in just half the time needed for the conventional method. It also eliminates the unnecessary removal of excess healthy tissue, which is common when using the hookwire technique.
She added: "Precise localisation of the abnormal tissue is critical, as it allows the surgeon to better plan the skin incision for a better cosmetic outcome. The new technique allows for minimal removal of healthy breast tissue, while ensuring that the tumour is entirely removed."
The technique costs from $700 to $1,000, compared with $500 to $700 for the hookwire method, at Raffles Hospital. It is also done at the KK Women's and Children's Hospital, where Dr Tan is a visiting consultant.
Breast cancer accounts for about 30 per cent of all cancers among women in Singapore. From 2005 to 2009, an average of 1,500 women were diagnosed with it annually, and about 350 died of it each year.
Email: melpang@sph.com.sg
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