“I did a breast fellowship because I was drawn to the fact that you get to build a long-term relationship with the patients,” stated Dr. Barnas. “I like to maintain a steady level of support with patients throughout their care, and with this specialization, that is definitely needed.”
But Dr. Barnas admitted there are some tough parts to the job, especially when a patient has undergone a lumpectomy and the post-surgical pathology determines the need for re-excision. “Patients have an understandable fear of the unknown: What will they look like after the second surgery? And while this re-excision process is generally easier on the patient overall, that person will still need to be absent from their job for another week, as they are going back to stage 1 of their recovery. It’s a hard conversation to have. I tell them that what we’re trying to do is bring that cancer recurrence rate down—that we got the tumor out, but this is necessary for clean-up.”
“I still get a bit anxious when I open a pathology report,” Dr. Barnas admitted. “There are two things I’m looking at when I open the report. First is the lymph node, and second is the margins. With the newer trials, we don’t do frozen sections on lymph nodes as often, so I really don’t know for sure that the lymph node is normal until I open the report. And with the margins, I have to remind myself: ‘I can’t see cancer cells.’ If I take out tissue and it looks normal around the edge, that’s still not a guarantee. While it’s much harder on the patient and their family to get bad news, I still feel that emotional weight as well. Nobody wants to go through cancer surgery a second time.”
MarginProbe Lessens the “Tough Conversations”
Then Dr. Barnas discovered a tool that helps ensure successful removal of all cancer during the first surgery and reduces the chance a specimen will have positive margins. “I first saw MarginProbe when I was a fellow presenting at the American Society of Breast Surgeons,” he said. “I’ve always felt that it was important to get the best overall margins and minimize the need to go back for additional surgeries while still getting the best possible cosmetic outcome. The biggest thing that endeared me to MarginProbe early-on is that it provides a path to accomplish that goal and avoid those painful conversations.”
“When I sit down with patients, I review all of their options, because everyone is a bit different in what their personal goals are, and what they consider most important. We review critical choices together, such as why a patient would choose a lumpectomy over a mastectomy. If I feel that MarginProbe is the right fit for their situation, I will explain what to expect, and the fact that it has helped to push our positive margin rates well below the national average, so they typically understand its value.”
Dr. Barnas went on to explain the impact that MarginProbe has during the surgical event. “I excise the tumor and a small rim of margin,” he stated. “Then I use MarginProbe to tell me if any of the margins have residual cancer – and it’s not just telling me that it’s a superior margin, it’s telling me it’s superior lateral or superior medial, so I don’t need to take a bunch of tissue in the medial area if it’s in the lateral. It’s a more tailored approach.”
Based on guidance from the device manufacturer, the physician does not typically use MarginProbe with certain treatments such as mastectomies or after neoadjuvant chemotherapy. But while Dr. Barnas previously did not use MarginProbe on very dense breast tissues, he now does, as studies have shown it works very well.
MarginProbe Can Reduce positive margin rates by over 50%
The result of this approach is that while the national re-excision rate stands at about 25%, Dr. Barnas experiences only a 10% positive margin rate within his own practice since using MarginProbe, which he indicates has reduced his need to bring patients back for re-excision by more than half.
Dr. Barnas put the impact of these results in very human terms. “I had a patient come to me with a very large tumor and she had been told that she needed to have a mastectomy,” he shared. “She was actually my first patient using MarginProbe. The tumor was so big that we actually had to use two probes to complete the scan. But we were able to excise a couple of extra margins until we got to clear margins and we had a great cosmetic result, while still protecting the health of the patient.”
“I had another patient, visiting from a foreign country, where the MarginProbe results led me to excise an additional umbrella margin. Within that umbrella, we found a small separate cancer that might have gone undetected using other methods, as there was clear tissue in-between. We were able to excise enough of a margin on both cancers to provide a level of comfort, since I was unsure what types of follow-up treatments she would be able to receive in her country of origin.”
“Preventing recurrences of cancer is something that I want to bring to my patients as often as I can,” he concluded. “And MarginProbe is another step in making that happen.”
Dr. Daniel Barnas
- Breast Surgeon at Borgess Surgical Specialties
- Clinical Assistant Professor at Western Michigan University School of Medicine
- Former Breast Surgery Fellow at Lehigh Valley Health Network
- Former General Surgeon and Chief of Surgery at South Haven Health System
- Former General Surgeon and Vice Chief of Surgery at Owosso Memorial Healthcare
Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Dune Medical.