Dr. David A. Edmonson is the medical director of the Lymphedema Program for Women & Infants Hospital’s Program in Women’s Oncology. He is an attending physician at the Breast Health Center at Women & Infants Hospital, as well as a clinical associate professor of surgery and obstetrics and gynecology at Brown University’s Warren Alpert Medical School.
He spoke about Care New England Health System’s initiative to make Magtrace, a nonradioactive liquid tracer used to map the potential spread of cancer, available for appropriate breast health cases. CNE, which operates Women & Infants, is the first health care provider in Rhode Island to do so.
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PBN: How does Magtrace work?
EDMONSON: Magtrace is a liquefied form of iron with an associated dye that is taken up by the lymphatic system and designed to settle within the lymph nodes. It is compatible with and is used with the same equipment that we use in the operating room to find breast lesions that are not palpable. It is used as a part of a procedure referred to as a sentinel lymph node biopsy. This procedure is used to determine whether or not a cancer is demonstrating evidence of trying to spread outside of the breast. This information is being utilized to determine the best overall treatment for a specific breast cancer.
PBN: How is it different from previous detection methods?
EDMONSON: The standard method is to use what is referred to as a “dual tracer.“ This refers to the combination of a blue dye, injected into the breast on the day of surgery, as well as a radioactive tracer that can be injected up to 24 hours prior to the surgery. Magtrace replaces the use of both of these materials and with no use of radioactive tracer and no need to go to the nuclear medicine department prior to surgery. Additionally, there is no need for an injection to be done while the patient is awake. We can do the injection after they go to sleep for the surgery. Additionally, different from the dual tracer method, this material will stay within the lymph nodes for three weeks following injection, which can be very useful in very specific cases.
PBN: How did CNE become the first in Rhode Island to make Magtrace available to patients in the Ocean State?
EDMONSON: Care New England became the first hospital system in the region to utilize the magnetic detection device for finding nonpalpable lesions within the breast. The company that developed this device is the same company that developed Magtrace. This company was primarily based in Europe and has been extensively researched and utilized in Europe for a number of years. It just recently got FDA [Food and Drug Administration] approval in the United States.
PBN: Are there some cases in which Magtrace should not be used? Other limitations?
EDMONSON: There are not really any specific limitations for its use per se. There is a specific advantage for its use in women with noninvasive types of breast cancers who need and/or desire a mastectomy. In these women, there is a statistical possibility of finding invasive cancer on the final pathology from their surgery that would require information from the lymph nodes. However, we do not have the ability to go back and do a sentinel lymph node biopsy after a mastectomy has been completed.
Therefore, up to this point, the sentinel node biopsy has been done at the time of the mastectomy just in case we find invasive disease on the final pathology several days later. Therefore, this puts these women at a higher risk for lymphedema, a swelling of the arm.
Because Magtrace can stay in the nodes for three weeks after injection, we can wait for the final pathology to come back and only do a sentinel lymph node biopsy if this information is necessary, in terms of determining what they need for their treatment. These women can therefore be spared the risk of lymphedema in these specific instances.
PBN: Are there uses for Magtrace beyond cases of breast cancer?
EDMONSON: I am not aware, at this point, of other types of cancers in which this material can be used. There are, however, other cancers that utilize the technique of sentinel node biopsy. Therefore, it is entirely possible that this technology could be expanded and utilized in other cancers.
