Transcription:
Making Breast Surgery More Comfortable and Precise

Scott Webb: The breast health program at Upland Hills Health is unusually comprehensive for a rural hospital. And that includes the SAVI scout, which uses radar localization technology to treat women diagnosed with early stage breast cancer. And joining me today to discuss the many advantages of the SAVI scout and the breast health program at UHH is Dr. Jared Linebarger. He's a general surgeon who specializes in breast surgery at UHH.

This is the Inspire Health Podcast from Upland Hills Health. I'm Scott Webb. So doctor, thanks so much for joining me today. Let's talk about the breast health program at UHH. It's unusually comprehensive for a rural hospital, right?

Dr. Jared Linebarger: I do believe that's the case. Thanks for having me on today. I do want to emphasize that I do feel at Upland Hills we have a very robust breast health screening program. It starts with our primary care providers who I think understand the importance of breast health in our community. And then I think it transitions nicely into our radiology department. I think we have state-of-the-art screening equipment, including 3D breast mammography as well as screening MRIs when needed. And we really do have, I think, a complete diagnostic tool kit for breast health in our imaging department.

Scott Webb: Yeah, it does sound that way. And I've heard a lot about 3D mammography and some of that other technology. So great to know that UHH has all of that for patients. And speaking of new technology, let's talk about the SAVI scout, how this pinpoints tissue to be removed. It sounds pretty remarkable.

Dr. Jared Linebarger: Yeah. We're really happy to be able to offer this type of technology for women who do need a surgical excisions.

One thing that we have noticed with the advances in screening and early detection is that many concerning breast masses are caught early even before they can be felt. And so that requires us to have smart ways to remove just the areas that need to be removed, because we typically want to spare as much of the natural breast as possible.

The SAVI scout is a different type of technology than what has previously been used at Upland Hills. We've been using this technology for nearly a year now. Um, at previous hospitals, I've used somewhat similar technology, but was really happy when I was given the opportunity at Upland Hills to choose the type of technology that we use, because I do think the SAVI scout has a lot of advantages over some of the other things that have been done.

Historically, many women who needed an excision of something in the breast that was not able to be felt and needed a more targeted, um, removal of breast tissue would have a wire placed in the breast. Those wires were long and pointy wires that would have to stick out of the breast for some distance. They would have to be placed on the day of the procedure. Um, and oftentimes they coursed through the breast tissue for a long distance before actually getting to the target. It was, I would say, uh, improvement from doing more blind excisions, but, um, not as precise as the technology that we have available now. There were more issues with inconvenience and scheduling and also, um, they were a little bit more uncomfortable to have in place, because you can imagine having a wire coursing through the breast tissue and sticking out the breast. It is a bit uncomfortable up until the time that it's removed.

And what we've transitioned to is a small reflector. It's about the size of a grain of rice and it's implanted in the breast tissue itself. The reflector is not externally visible. It doesn't restrict movements at all. It cannot be felt and it can really be placed any time from the time of a biopsy being performed in the imaging department, um, up until the time that an excision is performed in the operating room.

So it does also give a lot more flexibility in scheduling, which we have found to be a real significant satisfier in terms of patient scheduling and convenience for the procedure. The reflector itself is really a silent reflector. There's no way to know that it's in there until it's actually activated in the operating room for example. The reflector is detectable by a non-radioactive radar wave that I'm able to, uh, send or submit, transmit to the reflector using a small probe, a little bigger than the size of a pencil, which I can point at the breast tissue. And that radar wave that's sent to the reflector is sent back to that probe and is able to tell me the area to be removed within about a one millimeter distance. So it allows me to know exactly the area to be removed. And it also allows me in so doing to remove a much smaller amount of tissue, perform a much more precise excision. And it also allows me to place incisions in more discrete locations sometimes and remove smaller volumes to try to prevent cosmetic changes, contour changes, um, yet still effectively accomplish our goals of performing the excision.

Scott Webb: Wow. There's a lot to unpack there, but it sounds pretty amazing. And, uh, especially for you on the, uh, you know, the healthcare side, but especially for patients when it comes to comfort and scheduling, cosmetics, all of that. How exactly is the SAVI scout placed?

Dr. Jared Linebarger: It's very similar to how a needle biopsy of the breast is performed. Most biopsies initially, for trying to obtain a diagnosis when there is an abnormality that's concerning that's identified on either in the physical exam or breast imaging, um, in general, those should be sampled with what we call a minimally invasive biopsy or a needle biopsy first. And that's always the policy at Upland Hills is to perform the most minimal biopsy necessary to understand what's going on.

We try to reserve surgery for the purpose of treatment when needed. Occasionally, it's needed to clarify an uncertain diagnosis from a needle biopsy. But in general, um, when a needle biopsy is performed, um, it can let us know whether or not a surgical excision is required or not, to either, uh, further the clarification of the diagnosis or actually for the treatment. Needle biopsies are done typically using image guidance, either an ultrasound or a mammogram, occasionally using an MRI, because again, most of these things are being found when they are not palpable or visible. Placing the SAVI scout is done exactly the same way as an image-guided needle biopsy. Again, it can be done using a mammogram or an ultrasound to perform a very precise placement of this reflector exactly into the spot that needs to be removed.

It's done, like I said, in a very similar way to how the needle biopsies are done. The difference being with a biopsy, tissue is actually removed. But with the SAVI scout placement, no tissue is removed at that time. Just the reflector being left behind in the breast and its placement confirmed on imaging.

Scott Webb: So doctor, you have such a great way of explaining things, especially I'm sure to patients. So let's go through this one last time. What are the advantages to the patient in terms of comfort? Recovery time, the discrete placement of the incision, all that good stuff.

Dr. Jared Linebarger: My experience with using the SAVI scout over the previous year is that it does give us significant advantages in being able to schedule patients for procedures. Not only in terms of, um, how long patients have to wait on the day of the procedure, but even in the day that they can choose. Schedules don't have to be coordinated between surgery and radiology. So there is significant advantage in scheduling. I think beyond that when the actual procedure is performed, it gives me a lot more comfort in the operating room, knowing that I'll be able to exactly and precisely locate the area to be removed from a number of approaches.

And in general, I do try to place incisions in areas where I think they will be more discreet and also lead to a better recovery with less scarring and less contour changes. These are all things that I think about, um, that I try to make this as easy on folks as possible. Um, I also think about how can I place incisions so that recovery will be quicker with less soreness and place the incisions in locations where I think, uh, maybe they will have less pain and also removing smaller amounts of tissue only as much as needed.

Generally, um, when I was describing the wires, how, uh, they would course a long distance through the breast tissue, it generally required a long dissection through the breast tissue. Whereas with these reflectors, I can go directly to the area that needs to be removed and don't have to follow a wire through a long course of breast tissue and do a lot of unnecessary dissection.

Sometimes the SAVI scout reflector can actually even be placed at the time of the needle biopsy, which means that for some patients, they will not have to return for a separate procedure to localize the area to be removed. So for some women, when at the time of their needle biopsy, it's known that the area will need to ultimately be removed, the SAVI scout reflector can be placed at the time of biopsy. And this is a very important reason that we chose the SAVI scout reflector, because it is FDA approved to stay within the breast tissue indefinitely. And it is compatible with any type of imaging that we might need to do prior to surgery, including breast MRI, which is often done prior to surgery. But many other technologies that localize breast lesions are not completely compatible with MRI. So that was a big reason in us choosing this technology. And we've been very happy with our first year of use at Upland Hills with this technology.

Scott Webb: Yeah. And it sounds like you guys made the right choice. So many advantages for radiologists, surgeons and most especially patients. Doctor, as we wrap up here today, anything else you want to tell listeners about this amazing comprehensive breast health program at UHH?

Dr. Jared Linebarger: Well, I know we've emphasized today, uh, some of this screening and the, um, the surgical localized excision technology that we have here, but I do want to emphasize that breast health is so much more than those things. I always encourage folks to work with their primary care providers with any breast concern, but I also want to let folks know that a referral's not necessary to see me. I do help women with really any types of breast concerns or breast risk management. Um, and so a referral is not necessary to see me.

Again, I encourage folks to always keep their primary care providers in the loop of what's going on, but, um, I do welcome any self-referrals or primary care provider referrals.

Scott Webb: That's a great way to finish, Dr. Linebarger. Thank you so much for being on today. Your expertise, your time, your compassionate way of explaining all of this and you stay well.

Dr. Jared Linebarger: Thank you.

Scott Webb: To reach Dr. Linebarger, call (608) 930-7115. And to see how this technology works, visit the Upland Hills Health YouTube channel and search for the breast health webinar with Dr. Linebarger. And if you found this podcast helpful, please share it on your social channels. This is the Inspire Health podcast from Upland Hills health.

I'm Scott Webb. Stay well.