New MRI-Guided Wireless Tumor Localization Revolutionizing Breast Conservation Surgery at Tulane |
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Ralph Corsetti, MD, Edward G. Schleider Chair in Surgical Oncology, offers patients on both the North and South Shores state-of-the-art MRI-guided wireless tumor localization techniques for breast conservation surgery. |
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Many women diagnosed with early-stage breast cancer opt for breast-conserving surgery or lumpectomy. For those whose tumors are nonpalpable – not able to be felt – pre-operative localization of the tumor is necessary so the surgeon can find and remove the cancerous tissue.
Image-guided wire localization (WGL) – involving the placement of an external wire into the tumor – was once the preferred technique. However, this option presents several challenges. "Patient stress and discomfort are chief among them," said Ralph Corsetti, MD, the Edward G. Schleider Chair in Surgical Oncology. "The patient would have to undergo a separate pre-operative procedure on the day of surgery during which a wire would be inserted into the breast and guided to the tumor by the radiology team." The surgeon would later follow this wire during surgery and remove the tumor and any affected adjoining tissue.
Having to undergo multiple procedures on the same day, limitations in movement from the time the wire is place until the surgical procedure begins, and the visual of an external wire are all challenges for patients who undergo this localization technique. Wires can also migrate, making it difficult to remove all of the cancerous tissue and possibly setting up the need for a second surgery.
Additionally, same-day wire localization requires coordination of schedules for both the radiology and surgical teams, often resulting in delays in procedure start times. And it limits the ability of the surgeon to pre-plan his surgical approach.
Over the last decade, alternatives to WGL have emerged. "There are several wireless technologies; all of them have pros and cons," said Corsetti. "The one we have been using for the past five years – the Savi Scout® – has the most pros and the fewest cons."
The Savi Scout® is a radar detection system for the pre-surgical, wire-free localization of breast tumors. It uses a reflector that is about the size of a grain of rice that can be implanted into a breast tumor via a hollow needle-like sheath at any time prior to surgery. The radiologist uses image guidance to help appropriately position the pellet within the tumor. The reflector is not radioactive, it's not visible, it doesn't migrate, it can stay in indefinitely and patient movement is not restricted after placement. It can even be deployed in the lymph nodes.
On the day of surgery, the device is activated and begins to emit radar waves from the site of the tumor. "I use a handheld pencil-like probe device that detects and interprets the signals while I'm operating, letting me know the exact location of the tumor and how close I am to it," said Corsetti. "It's like radar on an airplane. This technology optimizes my ability to completely excise the tumor and it reduces the amount of normal tissue I have to remove so my patients have better cosmetic results."
In addition to eliminating the discomfort and anxiety of wire localization, the Savi Scout® allows patients to have their surgeries earlier in the day because there is no need to coordinate schedules between the radiology and surgical teams. And it allows surgeons to better plan their incisions with specificity during surgery, limiting tissue removal and leading to less painful, more rapid recoveries.
Tulane has recently taken this revolutionary technology a step further, becoming one of the first programs in the region offering MRI-guided wireless localizations.
"There are some masses only seen on MRI," said Corsetti. "Where a standard mammogram or ultrasound might only show a 1 cm area of abnormality, an MRI could detect 3 cm of enhancement around it that you don't see on mammogram or ultrasound. The problem is any time you do anything by MRI guidance, all of the equipment you use has to be non-magnetic or non-iron based. Otherwise it will get sucked up by the magnet. To address this issue, the manufacturer developed and we've recently started using a non-metallic sheath for deploying the Savi Scout® reflector with MRI guidance to optimize our surgeries not only for lumpectomies but in patients who have had mastectomies as well."
In fact, MRI deployment has helped to alleviate the need for post-surgical radiation in some patients who choose to undergo mastectomy. "In the past, when we found a mass was close to the skin, the patient would have to undergo post-surgical radiation," said Corsetti. "Now, using MRI-guided Scout® placement, I can put a reflector where an abnormality shows up close to the skin on MRI and take a small amount of the skin out. The patient gets excellent margins, good cosmetic results – often they can't even tell that a small amount of skin has been removed – and we obviate the need for post-surgical radiation. I've had patients where if we didn't use this technique, we would have had to radiate."
Another innovation that Corsetti and his team use to optimize results for patients is intraoperative 3D specimen imaging, which allows him to examine – while in the OR –the margins of the tissue he removes with much more precision and accuracy. "Patients end up with a more accurate and effective surgery," said Corsetti. This technology optimizes his chances of getting clear margins, and eliminates or reduces the chance of the patient needing a second excision surgery.
"It's really invaluable to our practice to make sure our patients are getting the best care," said Corsetti. "At Tulane, we are committed to adopting new technologies and revolutionizing surgical techniques to optimize your breast cancer surgery so that we can preserve more healthy tissue and provide better cosmetic results while achieving clear margins."
To see Dr. Corsetti at his Tulane Lakeside Hospital Clinic in Metairie, call 504-988-8100. Patients can also visit him at his Surgical Oncology North Shore Clinic. For appointments there, call 985-900-7071.
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Tulane Doctor Says Colonoscopy Still Best Tool for Prevention / Early Detection of Colon Cancer |
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Jacquelyn Turner, MD, Chief of the Section of Colon & Rectal Surgery, advocates for colonoscopy as the most effective tool for the comprehensive detection of colon cancer. |
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In the fight against colon and rectal cancer, early detection is the key to saving lives.
Jacquelyn Turner, MD, Chief of the Section of Colon and Rectal Surgery, emphasizes the urgent need for increased screening, especially within the African American community, where the prevalence of these cancers is higher.
"The prevalence is higher and the morbidity rates are higher for African Americans," said Turner. "And there are multiple reasons for this. Social determinants of health, living in food deserts and not getting proper nutrition could be part of the explanation for increased prevalence. There are also ongoing studies looking into genetic reasons for higher incidence rates of colorectal cancer among African Americans."
When it comes to morbidity, Dr. Turner says access to care is the predominant issue. "About 60% of the patients I treat are on Medicare or Medicaid or are uninsured, and I see them in the ER. That's how they get diagnosed, typically with later-stage cancer and fewer options. That's not when patients should get their colon cancer diagnosis."
Screening could help to detect colon cancers and pre-cancerous polyps earlier, providing more treatment options and more positive prognoses. "But many of my patients are hesitant to take time off of work to be screened," said Dr. Turner. "I've had patients with known cancer say they can't miss work for treatment because they can't afford to lose a day's pay or they're afraid of retaliation in the workplace."
In an effort to help remedy these and other obstacles facing cancer patients, Dr. Turner serves on the medical advisory board of the Cancer Advocacy Group of Louisiana (CAGLA). Among its other initiatives, CAGLA helped to lobby the Louisiana State Legislature during the 2023 legislative session to pass Senate Bill 200, which protects employees who miss work to undergo medically necessary cancer screenings, providing essential employment security during a challenging time. "A lot of my patients can't miss work, so I'm glad that bill got passed. That's one less reason for them to not get their colonoscopies."
And despite the availability of other screening methods – stool studies or flexible sigmoidoscopy – Dr. Turner unequivocally advocates for colonoscopy as the gold standard because of its ability to identify not only colon cancers but also potentially dangerous pre-cancerous colon polyps.
"The at-home tests, such as FIT and Cologuard®, detect the DNA that cancer cells shed in your stool," said Turner. "They detect cancer, that's true. But they don't detect polyps. When you find polyps during colonoscopy, you can remove them before they turn into cancer. Why wait until you get cancer and then look for it as opposed to preventing it before it has a chance to develop?"
Dr. Turner says it takes about 10 years on average for a small polyp to develop into a full-blown cancer. So that's why the current guidelines recommend screenings begin at the age of 45 and are scheduled every 10 years for those at average risk and with no family history of the disease.
Those at higher risk – with a history of inflammatory bowel disease, previously detected polyps, or first-degree relatives who have had colon cancer or polyps – should be screened at shorter intervals.
The American Cancer Society says the rate of people being diagnosed with colon or rectal cancer each year has dropped overall since the mid-1980s, mainly because more people are getting screened and changing their lifestyle-related risk factors. From 2011 to 2019, incidence rates dropped by about 1% each year. But this downward trend is mostly in older adults. In people younger than 50, rates have been increasing by 1% to 2% a year since the mid-1990s.
"Some cancers can't be prevented, but colon cancer is preventable with lifestyle changes and regular screening," said Turner.
If you are interested in scheduling a colonoscopy, please contact Dr. Turner's Clinic at 504-988-5110 to make your appointment. No referral is needed.
And click here to view Dr. Turner's recent Tulane Doctor's Health Check segment on Fox 8 Live.
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AACR Cancer Progress Report 2023 Outlines Pivotal Advances / Persisting Challenges in Cancer Research & Care |
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The American Association for Cancer Research (AACR) recently released the 13th edition of its annual Cancer Progress Report, which chronicles how basic, translational, and clinical cancer research and cancer-related population sciences—primarily supported by federal investments in the National Institutes of Health (NIH) and the National Cancer Institute (NCI)—remain vitally important to improving health and saving lives.
Highlights from the report are outlined below.
PROMISING TRENDS AND ADVANCES IN CANCER CARE
- From August 1, 2022, to July 31, 2023, the U.S. Food and Drug Administration (FDA) approved 14 new anticancer therapeutics, including:
- A new gene therapy-based immunotherapeutic for certain patients with bladder cancer
- A first-in-class antibody drug conjugate for patients with ovarian cancer
- Four new T-cell engaging bispecific antibodies for a range of hematologic malignancies
- During this same time frame, the FDA approved two new imaging agents and expanded the use of 12 previously approved anticancer therapeutics to treat additional cancer types, including:
- The first approval of an immune checkpoint inhibitor for pediatric and adult patients with a rare form of sarcoma
- Due in large part to advances in prevention, early detection, and treatment, the age-adjusted overall cancer death rate in the U.S. fell by 33% between 1991 and 2020—an estimated 3.8 million cancer deaths averted.
- This reduction is driven by declines in mortality from various cancer types, including breast, colorectal, lung, and prostate cancer, as well as melanoma. For example:
- Breast cancer mortality declined by 43% between 1989 and 2020, leading to an estimated 460,000 fewer breast cancer deaths.
- The decrease in lung cancer mortality has accelerated from 0.9% a year between 1995 and 2005 to nearly 5% a year between 2014 and 2020. This rapid decline is the result of a steep reduction in the U.S. smoking rate as well as the development of numerous highly effective molecularly targeted therapeutics and immunotherapeutics.
- More and better treatment options have led to notable progress against many pediatric cancers as well. Among children (14 and younger) and adolescents (15-19), overall cancer death rates declined by 70% and 64%, respectively, between 1970 and 2020.
THE IMMUNOTHERAPY REVOLUTION
Immunotherapy has revolutionized cancer care. Breakthroughs in this field have contributed to much of the progress noted above, such as declines in the death rates for previously intractable cancers like advanced lung cancer and melanoma.
The AACR Cancer Progress Report 2023 contains a spotlight on the history of cancer immunotherapy, the current state of this treatment modality, and the immense promise of the next generation of immunotherapeutics. Highlights include:
- Since 2011, the FDA has approved 11 immune checkpoint inhibitors, which release “brakes” on the surface of certain immune cells—called T cells—so that the T cells are able to destroy cancer cells. Many of these drugs are approved for more than one type of cancer, making immune checkpoint inhibitors a treatment option for 20 cancer types and any tumor with certain specific molecular characteristics.
- Since 2017, the FDA has approved six CAR T-cell therapies to treat a range of hematologic malignancies. CAR T-cell therapy is a type of adoptive cell therapy, which is designed to dramatically increase the number of cancer-killing immune cells a patient has.
- The field is expanding in exciting ways, with researchers combining the power of other cells in the immune system with recent advances in gene editing to develop more personalized and effective versions of adoptive cell therapy for treatment of solid tumors; developing mRNA-based vaccines and therapeutics to treat cancer; and targeting the gut microbiome to increase the efficacy of cancer immunotherapy, among many other innovative approaches.
DESPITE PROGRESS, CHALLENGES PERSIST
Despite the extraordinary scientific progress against cancer in recent years, this complex disease remains a significant threat to human health around the world. In the U.S., it is estimated that nearly 2 million new cases of cancer will be diagnosed and more than 609,000 people will die from the disease in 2023.
- Cancer disparities are a pervasive public health problem, with racial and ethnic minorities and other medically underserved U.S. populations shouldering a disproportionally higher burden of cancer. While advances have been made in identifying, understanding, and addressing some of these disparities, more research and policy solutions are urgently needed to ensure equitable progress against cancer.
- There has been uneven progress against different cancer types. Few treatment options exist for patients diagnosed with pancreatic cancer or glioblastoma, for example, and 5-year relative survival rates for these cancers are extremely low.
- Incidence rates for some cancers are increasing, including for early-onset colorectal cancer, pancreatic cancer, and uterine cancer, in part due to the rising rate of obesity.
- Financial toxicity is widespread, exacerbated by the rising cost of cancer care. In 2019, U.S. cancer patients paid an estimated $16.2 billion in out-of-pocket cancer care costs and lost an additional $5 billion in “time costs.”
FEDERAL FUNDING ESSENTIAL FOR CONTINUED PROGRESS
To confront these and other challenges, the AACR Cancer Progress Report 2023 calls on Congress to support robust, sustained, and predictable annual funding growth for NIH and NCI by providing increases of at least $3.465 billion and $2.6 billion, respectively, in their fiscal year 2024 base budgets. This funding is crucial to continued progress for patients. From 2010 to 2019, NIH funding contributed to the development of 354 out of 356 new drugs, including many cancer drugs, approved by the FDA.
“We are proud to release the 13th annual AACR Cancer Progress Report,” said AACR CEO Margaret Foti, PhD, MD (hc). “It is our hope that this comprehensive resource will help to increase knowledge about the myriad diseases we call cancer as well as the innovative research that is improving and extending lives. The findings in this report, along with the personal stories of the featured patients, underscore the enormous impact that robust, sustained, and predictable funding for cancer research has had on Americans’ health, and why that support must continue.”
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Ladies Leukemia League Kicks Off the
Holiday Season With Annual Fête de Noël Luncheon
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This event is always a special way to welcome the Holiday season and party for a cause. In addition to a festive and fabulous runway fashion show sponsored by Dillard's, guests will enjoy a delightful lunch, auction, parade of prizes, raffles, door prizes, and other special entertainment.
LLL is a non-profit organization comprised of a group of dedicated volunteers who work year-round to raise money to fund research grants to support scientists working in leukemia / lymphoma research or related fields in the Gulf South region of Louisiana, Mississippi and Texas. The organization has raised over $4 million since its founding in 1969, and the Fête is their major annual fundraiser. Tulane researchers William C. Wimley, PhD, (pictured above, bottom row far left) and Zhen Lin, MD, PhD, (bottom row far right) are current recipients of LLL funding.
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Krewe de Pink Prom
a Meaningful & Pinktastic Night!
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Generations Hall was awash in all shades of pink for Krewe de Pink's recent Pink Prom fundraiser.
Attendees danced the night away to the eclectic sounds of Crescent City Soul, while also enjoying raffles, a silent auction, prom photos, and the annual crowning of the Prom king and queen. Especially symbolic and touching was the celebration of breast cancer survivors in attendance, who were honored with an emotional and triumphant "I Will Survive" serenade and dance.
To learn more about Krewe de Pink initiatives and events or to become involved, visit www.krewedepink.org.
(Photos by Amber Wolf Photography)
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or visit
To make a tax-deductible donation to Tulane Cancer Center
(Federal Tax ID# 72-0423889) please click here.
Thank you for your generosity and support!
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