Bringing value to patients


What is breast cancer?

Breast cancer is the most common cancer among women and the second most common cancer in the world [1].

As an example, around 16.000 women are diagnosed with invasive or in situ breast carcinoma each year in the Netherlands alone [2]. In this country of 17 million inhabitants, breast cancer is responsible for approximately 3.100 deaths and 26.000 life-years lost every year [3].

Beyond the huge burden imposed on sufferers and their loved ones, breast cancer has a significant economic impact. Again using the Netherlands as an example, the yearly cost is estimated at around €1.27 billion [3].

How is breast tumor treated?

Care for breast cancer involves a multidisciplinary team. Surgery is usually the first line of management. In the majority of cases (over 60 percent), breast-conserving surgery is possible.

In locally advanced cases, neoadjudant chemotherapy can downstage tumors to allow breast-conserving surgery, or allow a surgical option in initially inoperable cases.


What is breast conserving surgery?

Breast conserving surgery is a complete removal of the breast issue with a concentric margin of surrounding healthy issue performed in a cosmetically acceptable manner (also known as lumpectomy, quadrantectomy or Wide Local Excision) usually followed by radiation therapy.

Several technologies are available to support radiologist and surgeon to detect and effectively remove the lump. Wire-guided localization is the current standard of care to localize non-palpable breast cancer tumors yet, because of its several limitations, newer technologies have been developed.

Diagnosis and treatment

Approximately 35% of breast cancers are non-palpable at diagnosis and require a localization procedure to guide intraoperative identification and surgical resection.

These tumors have lower metastatic potential and a better prognosis than palpable cancers [4].

For non-palpable tumors, as well as other low- grade breast cancers, breast conserving surgery (BCS) with radiation therapy is the standard of care, with survival rates similar to those for mastectomy [5].


Limitation with other techniques

Wire guided localization

  • Surgeons have limited guidance towards the lesion.
  • The wire may displace, fracture or become dissected prior to or during surgery.
  • Hospitals are faced with logistical issues placement of the wire and surgery on the same day which leads to delays.
  • Patients need to undergo two procedures which leads to a lot of stress and having a wire extruding leads to pain.

Radioactive seed localization

  • Regulations regarding the safe procurement, use and disposal of these seeds are very strict (in the USA the RSL procedure should be done within 7 days).
  • There needs to be strict control over the entire chain of custody in place.
  • Radioactive isotopes are scarce and the European Commission stimulates to look for alternatives.

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[1].Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;n/a(n/a). doi:
[2].Janssen, N. N. Y., et al. “Radioactive seed localization in breast cancer treatment. British Journal of Surgery 103.1 (2016): 70-80.
[3].Vondeling, G. T., et al. “Burden of early, advanced and metastatic breast cancer in The Netherlands.” BMC cancer 18.1 (2018): 1-11.
[4].Skinner, Kristin A., et al. “Palpable breast cancers are inherently different from nonpalpable breast cancers.” Annals of surgical oncology 8.9 (2001): 705-710.
[5].E. Cheang, R. Ha, C. M. Thornton, V. L. Mango, BJR , 20170740 (2018).