Five Questions With: Dr. David Edmonson

"Up to this point, the pathologist would have to look at the tissue under the microscope in order to decipher whether or not the cancer cells came up to the edge of the tissue that was removed."

Dr. David Edmonson is medical director of the Lymphedema Program for Women & Infants’ Program in Women’s Oncology and is also chairman and physician liaison for Women & Infants Hospital Cancer Committee. Women & Infants recently became the first hospital in the state to offer breast cancer patients access to the MarginProbe System, a tool that said to be three times more effective in identifying cancer on the margin of a breast mass during a lumpectomy than traditional methods.

PBN: To what extent is the new technology being brought to bear with this device something that couldn’t have been imagined a decade ago?
EDMONSON:
Up to this point, the pathologist would have to look at the tissue under the microscope in order to decipher whether or not the cancer cells came up to the edge of the tissue that was removed. Multiple methods have been looked at as far as trying to get that assessment done in real time while the patient is in the operating room. However, these methods are notoriously unreliable, and take quite a while (20 to 30 minutes). This device is quick (5 minutes), easy (it gives a yes or no answer) and reportedly reliable without the need to look at the tissue under the microscope. We are going to look at this last piece very carefully as that is a major component to its utility.
One of the more difficult conversations we have to have with patients after their surgery is that we didn’t quite get enough and we have to go back and take more. Not only is this traumatic for the patient psychologically, it can also have the potential to worsen the cosmetic result.

PBN: How does the device determine the existence of cancerous material?
EDMONSON:
It transmits radiofrequency waves at the tissue and then reads the signals returning to the device. Cancerous cells have one signature and normal cells have a different signature. The device interprets these signals and gives the surgeon a digital indication as to whether that margin is involved or not. If it is, we can take more tissue from that edge right then while the patient is there in the OR.

PBN: Will this device become standard in the field in the next several years?
EDMONSON:
It’s hard to know. We are just beginning to use the device and are beginning to learn about its benefits. We need to figure out how beneficial it is in comparison to our current methodologies of evaluating margins in the OR. Currently, our data at Women and Infants shows that we have to go back 15 to 16 percent – of the time, well below the national average – so how much more benefit our patients get from utilization of this device remains to be seen, but we are planning on looking at that scientifically.

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PBN: Where was the system developed, and does it have applications for all types of cancer surgery or only for breast cancer?
EDMONSON:
The device was developed in Israel and has been cleared through the FDA in the United States. At the moment it has only been cleared for use for evaluating margins for breast cancers. It is possible that it could be found to be useful in several other types of cancer that also necessitate margins around the tumor, with further testing.

PBN: How large of a breakthrough is this compared to other developments you’ve seen in your career?
EDMONSON:
Intraoperative margin evaluation has been the Holy Grail of breast cancer surgery for many decades. Currently, national figures indicate that 30 percent of women having lumpectomies for breast cancer have to go back for additional surgery in order to clear margins. The makers of this device state that it will reduce that by 56 percent – so a significant reduction in the number of women going through the stress of additional surgery, fewer women having treatment delays because of the need to do more surgery, and lower overall cost to the healthcare system. So, it’s a major breakthrough, but not yet that “Holy Grail.”

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