In a groundbreaking leap forward for breast cancer surgery, the MAGTOTAL trial has unveiled a promising alternative to the conventional guidewire method. The trial, with results published in the Journal of the American Medical Association, compared using a paramagnetic marker for lesion localization and sentinel lymph node detection (SLND) with the current standard of care guidewire technique.
Essentially, in the experimental group, a 5-millimeter seed, Magseed, was used for the localization of the breast cancer lesions, and in the control group, a guidewire was used for the localization of the group. This technology is beneficial for both patients and healthcare providers.
The trial demonstrated that the paramagnetic marker proved equivalent to the guidewire in critical parameters such as re-excision rates and excess tissue removal. These are important since it is not ideal to discover that the surgeon was not able to excise all of the tumor in the first surgery, resulting in requiring another surgery. This strengthens the evidence from previous cohort studies with Magseed technology.
The trial truly showed the safety and adaptability of the totally magnetic technique. It addressed concerns about potential complications arising from the combination of a paramagnetic marker for lesion localization and a peritumoral superparamagnetic iron oxide (SPIO) injection. SPIO is a type of staining that helps surgeons distinguish what tissue to resect and which is healthy. Results indicated that regardless of SPIO injection location, the resection ratios remained similar between trial arms.
One of the noteworthy observations was the potential for more precise surgery with the paramagnetic marker, particularly in breast cancer centers with extensive experience. The ability to create a magnetic halo around the lesion using the SPIO's brown staining for intraoperative navigation contributes to lower failed localization rates than the guidewire. Additionally, shorter operative times and simplified preoperative planning were notable benefits attributed to the magnetic technique.
The most revolutionary aspect of the MAGTOTAL trial is the shift towards a totally magnetic technique. This approach is wire- and radioisotope-free; it also simplifies the surgical procedure and presents an attractive alternative in diverse clinical settings. The trial's pragmatic design ensures external validity, emphasizing that the ease and flexibility of implementing the intervention, even without specialized expertise or prior familiarization.
This finding is significant due to the positive results and the fact that it is a large, multi-center trial that proves the efficiency of magnetic techniques in guiding clinical decision-making skills. This technique will most likely be adopted by breast cancer centers worldwide, one by one.
Sources: Journal of the American Medical Association
