Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 4 experts were familiar with or had used this technology before.

Level of innovation

All expert commentators considered the technology innovative compared with standard care. The experts agreed that one of the main advantages of Magseed compared with the wire procedure was Magseed could be inserted before surgery, while wires had to be placed on the morning of surgery. The other advantage of Magseed compared with wire localisation was the optimal incision placement by improving the accuracy of the localisation with less extensive excision. The experts described alternative localisation procedures available to the NHS such as radioactive iodine seeds, Scout Radar (surgical guidance system) and radio nucleotide occult lesion local excision (ROLL) localisation. They noted that these technologies all have pros and cons; for instance, the ease of use, the length of time that the markers can be kept in situ, and the cost.

Potential patient impact

The most important benefit identified by the experts was the flexibility of inserting the Magseed any time before the operation, allowing people to maintain their daily lives leading up to their surgery. Two experts thought that the Magseed procedure could improve patient experience, because patients were unlikely to experience pain and potentially reduce the feeling of anxiety before surgery. The experts suggested that people with impalpable breast cancer were most likely to benefit from the technology.

Potential system impact

The experts agreed that the cost of Magseed localisation is likely to be more expensive compared with the wire procedure. But, the potential benefits for the healthcare system were better use of radiology services, theatre time and reduced need for further surgery. Magseed could potentially free up breast radiological staff time and re-excision rates may decrease over time.

General comments

The experts thought Magseed could replace majority wire procedures. Two experts noted that Magseed may not be suitable for people with lesions deeper than 3 cm or people with multiple lesions. None of the experts were aware of any safety issues. One expert noted that when removing Magseed, the excision could be too close to the lesion, and there might be interference locating the seeds if metallic objects were near to the breast. The expert was aware that a few cases of displacements were reported. The main barrier to adoption identified by 2 experts was the technology cost. Little change to facilities or infrastructure would be needed, but training is needed to perform the technique and to identify the seeds.