Precise tumour targeting

At the University Hospital of the West Indies (UHWI), someone is diagnosed with breast cancer nearly every day. There are almost daily surgeries as well – excluding Sundays unless emergencies arise – to remove cancerous lesions from women of all ages, including teenagers.

Surgeons at the UHWI carry out either partial or full mastectomies based on the extent of the cancer. While the frequency of diagnosis itself doesn’t surprise oncologists, what is alarming is the stage at which many women are diagnosed – often late – highlighting the urgent need for better breast-health awareness and earlier detection.

Consultant Surgical Oncologist Dr Patrick Roberts still remembers one case that transformed his career: a 14-year-old girl diagnosed with stage four breast cancer who later died. Her case prompted him to engage in further studies and to seek out better diagnostic and surgical tools to treat breast cancer more accurately and effectively.

Roberts initially studied at The University of the West Indies (UWI) and later at the University of Toronto, where the magnetic occult lesion localisation instrument (MOLLI) technology was invented, before returning to Jamaica to pioneer its use locally.

“All along, the method of localisation used in Jamaica was called hookwire localisation,” Roberts said, explaining that this referred to the technique of pinpointing the specific locations of abnormalities in the breast.

“I was not a big fan of this [hookwire] method because it was very time-consuming, and the patients hated it. I was aware that there were numerous other wireless methods to localise the lesion in the breast, and I started researching them. I came across this method called MOLLI that was developed by the Canadians at University of Toronto. I also studied there. So I purchased the machine and brought the technology to Jamaica,” he told The Gleaner.

MOLLI offers a modern, wireless, non-radioactive alternative to the traditional hookwire system, enabling surgeons to locate and remove even the smallest, non-palpable tumours with precision.

“The technology uses a tiny 3.2mm magnetic marker that is inserted into the breast, near the tumour, before surgery. A specialised wand is used by the surgeon to locate the MOLLI marker during surgery, which shows the exact location of the lesion. This removes all guesswork and allows for more accurate tumour removal compared to traditional methods such as the hookwire,” said Roberts.

“MOLLI allows for more precise tumour removal; it is minimally invasive, leading to smaller incisions, less pain, and better cosmetic outcomes for patients,” Roberts explained.

Hospitalisation time is also reduced.

Unlike the hookwire, which must be inserted on the day of surgery due to the risk of dislodgement, the MOLLI marker can be placed days – or even weeks – in advance. This flexibility makes scheduling easier, reduces surgery delays, and lowers patient anxiety.

Although Roberts did not invent MOLLI, he was instrumental in acquiring the machine and introducing it at the UHWI. The full cost of treatment using MOLLI can exceed $2 million, with the Government’s Compassionate Fund covering up to a third for eligible patients.

Before MOLLI, the UHWI relied exclusively on the hookwire system. Consultant Radiologist Dr Derria Cornwall explained that the method, while widely used for decades, has significant drawbacks.

“We all have a state-of-the-art 3D mammogram here. So when we find a lump in the patient that is not palpable, the doctor would need to know where to find it to take the lump out. Because of the equipment we have, we know if the entire breast needs to be taken or only the lump,” Cornwall said.

With hookwire, once a lesion is detected via ultrasound, a wire is inserted in the breast at the site on surgery day as there are fears it could be dislodged, leaving the surgeon to feel their way to the site of the mass. In very rare cases, the night before, she explained.

“So when we take the patient to the operating room, we take out all the breast tissue around the wire because if the wire is in the area, and we take the tissue around the wire, then we should have the lesion that we’re going for. Because if this is a cancer, you don’t want a doctor to go in and try and feel for this and can’t find it. So this is to help to localise where the cancer is,” she told The Gleaner. “This technique is called hookwire. And this has been around for about 50, 60 years.”

Known to offer a prayer over the slides after each biopsy, Cornwall acknowledged that everyone is under the coverage of a superior being, but she also trusts the science, competence, and experience of Roberts and other surgical teams.

Cornwall said the UHWI and two other government hospitals now have 3D mammogram technology to detect non-palpable lesions. Still, surgical accuracy depends on the localisation method used. She supports MOLLI’s adoption.

“What Dr Roberts has done is brought into Jamaica a revolutionised method of putting a marker in the area that can be put in up to a month before. This is a little magnet, so instead of putting this wire, we drop in a little seed that has a magnetic property to it and which provides an accurate location of any mass in the breast,” Cornwall said.

Both Drs Roberts and Cornwall emphasised that early detection is crucial. When cancer is caught early – while lesions are still tiny – the chances of a cure are much higher. It also opens the door to breast-conserving treatments rather than full mastectomies.

“This is the size and stage we want to catch lesions with breast cancer, when it is so small, that we can’t feel it. Because the chance of a cure is higher. And the cost associated with treating it is much cheaper. And the options that you have, for example, if it’s a cancer, we don’t need to remove the breast purely because it’s a small lesion. So we have more treatment options. It is cheaper, and the cure rate is better,” explained Roberts.

While hookwire is no longer used in many parts of the world, it is still used at the UHWI and is the benchmark by which all other standards are judged.

erica.virtue@gleanerjm.com