Physician Insight for Patients: Dr. Melanie Friedlander – MarginProbe® Greatly Enhances Outcomes with DCIS Breast Cancer Surgery

MarginProbe® Supports Better Outcomes When Dealing with DCIS

melanie friedlander

Dr. Melanie Friedlander


Dr. Melanie Friedlander with the Association of South Bay Surgeons is an expert in laparoscopic (minimally invasive) and breast cancer surgery. Throughout her career she has developed and published a variety of scientific studies and has presented several research projects at national medical conferences. She loves taking care of her patients and has the unique perspective that comes from being a breast cancer survivor herself. Patients tend to appreciate that this experience provides her with an insight into what they’re experiencing and they trust her expertise to guide them through this process.

Dr. Friedlander is on the leading edge of breast cancer surgical treatments, utilizing one of the latest tools to safely and effectively treat this disease. Known as MarginProbe®, this system helps ensure clean margins in breast conserving surgery for both ductal carcinoma in situ (DCIS) and invasive breast cancers. DCIS is the presence of abnormal cells inside a milk duct in the breast. DCIS is considered the earliest form of breast cancer and it is noninvasive, meaning it hasn’t spread out of the milk duct to invade other parts of the breast. Dr. Friedlander’s goal is to keep it that way.

Why MarginProbe is Important

When removing a lump, it’s critical to ensure that all cancerous cells are removed, through a procedure known as a lumpectomy. The key is having what’s known as a clear margin around the tissue removed. The surgeon must know that there’s a rim of normal breast tissue all the way around the border of the cancer so that both doctor and patient know that all of the disease has been effectively removed.

But that’s the challenge. With a more advanced, invasive cancer, a pathologist can open the tumor during the procedure and provide an estimate of the margin. But with DCIS, this cannot be accomplished with the naked eye. In the past, estimating margins on DCIS was a complicated procedure that could not take place during surgery. This meant that when a patient woke up, they did not have a clear answer on whether all of the cancer was removed.

MarginProbe now provides the ability to check the margins of patients with DCIS. This reduces the number of patients that have positive margins (a risk of cancer still present) as a finding on their final pathology report. In fact, data shows that positive margins drop by up to 60% compared to previous standards of care.

Surgical Feedback to MarginProbe

“I use the MarginProbe right in the operating room,” said Dr. Friedlander. “If it tells me I need to remove additional tissue from any of those edges on the tissue, we can do it right at that time. This significantly increases the chances of getting good margins on the first surgery. I’ve definitely been able to save patients from a second surgery using the MarginProbe, no question.”

Beyond avoiding surgery, MarginProbe has made a clear difference in positive outcomes when treating DCIS according to Dr. Friedlander. “I once had a patient that I did a lumpectomy for DCIS, and the MarginProbe said that she had two positive margins, so I re-excised tissue from those two margins,” she explained. “When the final pathology report came back, those two margins were still positive. That was such a significant additional piece of tissue that at that point I counseled the patient to have a mastectomy and she agreed. She wound up having very extensive DCIS that her x-rays had not predicted.”

“The MarginProbe was even more helpful in that scenario because, not only did it find the positive margins, but it allowed me to remove additional tissue that really showed us what was going on at the first surgery,” she continued. “A patient like that normally will go back for a re-excision and then still wind up going back for a mastectomy.”

Using MarginProbe for Invasive Cancer

Dr. Friedlander sees her facility joining others in using MarginProbe as a highly effective tool for treating invasive breast cancer, as it is already approved for that application. In fact, this system has already been widely accepted in invasive breast cancer cases.

 

Dr Melanie H. Friedlander

  • General Surgery Specialist
  • Advanced Laparoscopic Surgery Specialist
  • Breast Surgery Specialist
  • Thyroid and Parathyroid Surgery Specialist
  • Appointed Clinical Instructor of Surgery at the University of Southern California in 1999
  • Member of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the Society of Laparoscopic Surgeons
  • Recently adopted a minimally invasive technique for thyroid surgery to reduce scar size

Association of South Bay Surgeons

  • Formed in 1995 by 8 general surgeons
  • Currently has 4 vascular surgeons, and 11 general surgeons
  • Specialties include endocrine-trained surgeons, bariatric surgeons, laparoscopic surgeons, and a colorectal surgeon
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