Ex Vivo Model of Biopsy Clip Migration in Breast Cancer; Evaluating the Influence of Treatment Options on Patient Experience and Women’s Autonomy in Breast Cancer Care

The technical project investigates the migration of biopsy clips used to localize lesions in breast tissue. The typical clinical protocol for diagnosis and treatment of breast cancer involves a mammogram, a biopsy during which a clip is inserted, a secondary localization procedure to insert a wire or seed, and a lumpectomy to excise the lesion. However, this secondary localization procedure can be painful and stress inducing. The ultimate goal of the technical project is to develop an effective one-step lesion localization method that does not migrate since current one-step devices like the HydroMARK demonstrate high rates of migration. The first step towards this was modeling the migration of biopsy clips in breast tissue. To model the compression and decompression of breast tissue during a mammogram, we designed and built a device using CAD to allow for tissue compression of a predefined distance. We created coil and pin shaped titanium biopsy clips and inserted them into compressed mammary and fat tissue from a heifer under X-ray. We took X-ray images of clip location within compressed and decompressed tissue states and analyzed them using ImageJ. Based on this, we determined that titanium clip migration was insignificant since clips migrated less than the 5 mm threshold for clinically harmful migration. Furthermore, the difference in migration between clip shapes and tissue types was insignificant. Our analysis successfully established a negative control of titanium clips not migrating significantly. Next steps would be to conduct testing using HydroMARK clips that are expected to migrate and analyze the mechanism of migration in order to design and develop a prototype of an improved clip that migrates less.

The STS project examines the psychological impacts of various breast cancer treatment options on the patient experience and the role that clinicians should play in guiding patients while protecting their autonomy. The breast cancer diagnosis and treatment protocol consists of breast cancer detection, localization, removal, and subsequent therapies. All of these stages have a multitude of options available to patients which can be overwhelming. To investigate impacts of decisions on patient experience and autonomy, I conducted a literature review of journal articles and online sources, and I applied the frameworks of care ethics by Annemarie Mol and Kelly Pender. The frameworks I used emphasized that care is an adaptive process that should involve collaboration between clinicians, patients, and their respective networks in order to carefully develop treatments that align with patients’ lives. I found that during diagnosis, women of color experience greater false-positive rates which can be stressful, so it is important to develop methods that minimize discomfort, anxiety, and inequity. In regards to treatment, women in the United States have been electing for a mastectomy followed by reconstruction with increasing frequency which demonstrates changes in preferences over time, but overtreatment is a potential concern. Subsequent therapies also demonstrate varying psychological impacts, so it is important that physicians address patients’ anxieties and misconceptions with empathetic, continuous guidance. The heterogeneity of breast cancer requires consideration and support for special cases like ductal carcinoma in situ, mutations in BRCA genes, and triple-negative breast cancer. Due to the heterogeneity of breast cancer and the heterogeneity of lives of patients, it is essential for physicians to specifically personalize and tailor treatment towards individual patients to foster a healthcare system focused on collaboration, trust, and personalized care.

The technical project and STS project are deeply intertwined. The technical project sets the foundation for development of a novel one-step lesion localization procedure that improves the patient experience by eliminating the often stressful and painful secondary localization procedure as well as the complications of clip migration. By potentially introducing a new treatment option, this ties into the STS project’s focus on how the range of treatment options available impacts patient experiences, decision-making, and autonomy. An improved clip will have the potential to reduce psychological distress, minimize clinical inefficiencies, and streamline the breast cancer treatment protocol. Although this innovation solves clinical problems, it also contributes to the already overwhelming and expanding list of medical technologies and choices that patients must navigate during their breast cancer treatment. However, it is important to continue to empathetically develop improved devices that center the patient and consider the ultimate psychological implications. Through the lens of care ethics, clinicians must offer effective, innovative treatments as improvements arise, and it is important that they guide patients through the use of these new technologies in a compassionate and collaborative way tailored to individual needs and values. It is important for clinicians to explore new technologies and select consciously to ensure the best outcome for patients based on their specific lives and situations. Together, these projects demonstrate how technical innovation should be informed by an understanding of patient-centered care. Ultimately, this work advocates for a healthcare system that balances technological progress with empathy and respect for autonomy.

School of Engineering and Applied Science

Bachelor of Science in Biomedical Engineering

Technical Advisor: William Guilford, Lynn Dengel, Timothy Allen

STS Advisor: Joshua Earle

Technical Team Members: Lucy Brown, Carly Nerger