Great strides have been made in the past few decades that have seen more women and men survive breast cancer, but the journey leaves behind physical, mental and emotional impacts that can be devastating. It takes years to recover or learn to cope with often disabling new realities.
For Dr. Nandini N. Kulkarni, medical director of surgical oncology at New Jersey-based Inspira Health Network, technologies provide early detection to prevent chronic diseases, increasing severity precision for biopsies and tumors and improved surgical outcomes that improve survival.
Prevent lymphedema with early intervention
Kulkarni has called biological hindrance spectroscopy a game changer and looks forward to sharing the advances made in the continuum of surgical care.
Detecting subclinical lymphedema much earlier than clinical manifestations “allowed me to refer patients to physical therapy much more promptly and aggressively than before,” she said.
Lymphedema can rapidly progress to a chronic, debilitating and potentially fatal stage with increased risk of lymphatic infection and development of sarcoma over time.
Some women have higher risk factors for developing lymphedema, but even those who have had a focal node biopsy and have not had additional lymph node dissection as part of their cancer treatment, The risk of getting the disease is 6-12%.
“Risk cannot be neutralized after 5, 7, 10 years,” says Kulkarni.
And only in the early stages can lymphatic dysfunction be reversed.
Early detection of lymphedema to improve quality of life and reduce downstream diseases is a very attractive patient data collection tool for breast cancer preventive care programs.
“This is going to be a pretty important tool in every surgeon’s archive,” she said.
Before L-Dex
Ideally, at diagnosis, breast cancer patients are scanned as part of their regularly scheduled appointments at their surgeon’s office, Kulkarni said.
Of Inspira Health’s 261 breast cancer patients who received post-treatment scans between January 2021 and October 12 at two cancer centers, nearly 15% reached the threshold and were referred to physiotherapy.
Kulkarni explains: “An alternative to interference spectroscopy is a tape measure. You know, the actual type of limb circumference measurement, as you can imagine, is a rather complicated process because it has to be standardized. chemistry,” Kulkarni explains.
There is a lot of variation in measure depending on the technician. However, Impedimed’s SOZO platform is self-calibrating, ensuring the patient is positioned correctly for the most accurate Lymphedema Index (L-Dex) score.
“That’s incredibly helpful, I don’t have to worry that these measurements aren’t accurate,” she says.
Although the patient must avoid exercise and fluids before the L-Dex scan and remove jewelry, socks, and shoes, results from the 30-second test will be available immediately. The patient simply stands on the device and the low-level electrical signals transmitted through the body provide an accurate picture of the fluid status and tissue composition.
As part of the New Jersey-based nonprofit health system’s “prehab to rehab” program, patients were measured and followed up for up to 5 years after surgery.
Researched and used in Australia since the early 2000s, there are more than 700 SOZO devices in use. Practitioners there advocate extensive L-Dex monitoring of all breast cancer patients for early detection of disease progression.
Although it is too early for Kulkarni to report statistically significant results, it is clear that the surveillance and early intervention program is reducing the incidence of chronic lymphedema in clinical practice at Inspira Health.
“Anecdotally, it definitely made a difference. I’ve seen patients with fluid counts up more than six triggering a physical therapy appointment, and I can see that number has gone down. “, she said.
Kulkarni says patients whose L-Dex counts rise to near the point of clinical lymphedema can begin treatment with manual compression devices and reverse their scores.
“I’ve seen that number go back to green and stay green,” she said.
Wireless connection with localization
Kulkarni also uses SAVI SCOUT – a wireless localization card from Merit Medical that increases patient comfort, reduces the number of steps before breast cancer surgery, and improves the accuracy of tumors and lymph node surgery blood.
About the size of a grain of rice, these tags are also used to locate biopsied lymph nodes for greater accuracy in dissection.
“Localization is so much more than you know, that kind of estimates where that wire went based on mammograms. Now I have a probe that tells me exactly how far from the probe to the segment. How much is the clip. There’s no speculation here. And it allows me to make my incision much more esthetic,” she explained.
The cards can be placed safely before the day of surgery. According to the manufacturer’s website, they may even be placed during the initial biopsy after detection.
Flexible plastic device sharpens radiation field
The bio-absorbable spiral scaffold embedded with dual-purpose radiation clips is also one of her favorite tools, says Kulkarni.
Scaffolding provides a more accurate 3-D view of the tumor location treated with targeted radiation.
“It really honed the area where they had to strengthen during radioactivity,” she said.
The second advantage that Hologic Biozorb offers is that it fills in the volume loss created by a lumpectomy, allowing Kulkarni to connect adjacent breast tissues and improve the overall cosmetic outcome of the surgery.
The biosorber will dissolve over a two-year period, leaving only the clamps behind, which are bridged to the cavity so it doesn’t sink in.
Andrea Fox is the senior editor of Healthcare IT News.
Email: [email protected]
Healthcare IT News is a HIMSS publication.
