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Champion NT, Mooney B, Kim Y, Whiting J, Sun W, Kiluk J, Czerniecki B, Hoover S, Lee MC. Surgeon and Radiologist Evaluation of Electromagnetic Chip Localization for Benign and Malignant Breast Lesions. Ann Surg Oncol 2023; 30:7081-7090. [PMID: 37552349 DOI: 10.1245/s10434-023-13976-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND SmartClipTM is a food and drug administration-approved, electromagnetic chip (EMC) localization system that provides three-dimensional navigation for the excision of soft tissue lesions. The purpose of this study was to analyze the accuracy and feasibility of EMC radiologic and surgical localization for benign and malignant breast lesions. PATIENTS AND METHODS An institutional review board-approved, single institution, prospective study from October 2020 to September 2022 of 38 women undergoing breast conserving surgery with EMC localization of a single lesion > 5 mm on mammogram (MMG) or ultrasound (US) imaging. Surveys from performing breast radiologists and breast surgeons were collected after image-guided localization and surgical excision. RESULTS Seventy-six survey responses from nine radiologists and four surgeons were received. The deployment needle and EMC were highly visible in 86.8% and 76.3% of procedures, respectively. There was no difficulty in deployment for 92.1% of procedures. The EMC was in the correct location on postdeployment MMG in 97.4% of cases. Three instances of EMC migration occurred, one 1 cm from target lesion. The targeted mass and EMC were within the surgical specimen in 97.4% of cases. On specimen radiograph, 39.5% of the EMCs were 0-1 mm from the center of the target lesion, 18.4% were within 2-4 mm, and 23.7% were within 5-10 mm. Mean operating room time for all cases was 65 min. One case required US to localize the target due to console malfunction. CONCLUSION There was successful EMC deployment by radiologists with accurate visualization and successful surgical excision in most cases. The EnVisioTM SmartClipTM system is a reproducible and accurate localization method for benign and malignant breast lesions.
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Affiliation(s)
| | - Blaise Mooney
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Youngchul Kim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Junmin Whiting
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Weihong Sun
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - John Kiluk
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brian Czerniecki
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Susan Hoover
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Ferrucci M, Milardi F, Marchet A. ASO Author Reflections: Is the Era of Blind Breast Surgery Coming to an End? IOUS (Intra-Operative Ultrasound-guided Surgery). Ann Surg Oncol 2023; 30:6217-6218. [PMID: 37530993 DOI: 10.1245/s10434-023-14007-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Massimo Ferrucci
- Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy.
| | - Francesco Milardi
- General Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Alberto Marchet
- Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
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Khoo FJ, Wong J, Stephenson J, Bennett I. Technique of intraoperative ultrasound-guided excision of impalpable breast lesions. Australas J Ultrasound Med 2023; 26:63-66. [PMID: 36960138 PMCID: PMC10030088 DOI: 10.1002/ajum.12315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The introduction of breast screening programs has led to the increased detection of occult breast lesions requiring diagnostic surgical biopsy or breast-conserving surgery for early-stage breast cancer. Excision of impalpable breast lesions can be challenging. Whilst a variety of techniques have now been described including the use of adjuncts such as hook wires, radioactive seeds, magnetic seeds or radiofrequency devices, many of these modalities are expensive and can be logistically problematic. The technique of surgeon-performed ultrasound-guided excision is a straightforward technique which is safe, cost-efficient and avoids a painful preoperative procedure for patients such as hook wire localisation. Whilst the use of intraoperative ultrasound-guided excision of breast lesions has been widely reported, the actual technique itself has been less well described.
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Affiliation(s)
- Fuquan Jeremy Khoo
- Department of SurgeryUniversity of Queensland, Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
- Translational Research Institute, Princess Alexandra HospitalKent StBrisbaneQueenslandAustralia
| | - Jessica Wong
- Department of SurgeryUniversity of Queensland, Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
| | - James Stephenson
- Department of SurgeryUniversity of Queensland, Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
- Translational Research Institute, Princess Alexandra HospitalKent StBrisbaneQueenslandAustralia
| | - Ian Bennett
- Department of SurgeryUniversity of Queensland, Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
- Translational Research Institute, Princess Alexandra HospitalKent StBrisbaneQueenslandAustralia
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Banys-Paluchowski M, Rubio IT, Karadeniz Cakmak G, Esgueva A, Krawczyk N, Paluchowski P, Gruber I, Marx M, Brucker SY, Bündgen N, Kühn T, Rody A, Hanker L, Hahn M. Intraoperative Ultrasound-Guided Excision of Non-Palpable and Palpable Breast Cancer: Systematic Review and Meta-Analysis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:367-379. [PMID: 35760079 DOI: 10.1055/a-1821-8559] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Wire-guided localization (WGL) is the most frequently used localization technique in non-palpable breast cancer (BC). However, low negative margin rates, patient discomfort, and the possibility of wire dislocation have been discussed as potential disadvantages, and re-operation due to positive margins may increase relapse risk. Intraoperative ultrasound (IOUS)-guided excision allows direct visualization of the lesion and the resection volume and reduces positive margins in palpable and non-palpable tumors. We performed a systematic review on IOUS in breast cancer and 2 meta-analyses of randomized clinical trials (RCTs). In non-palpable BC, 3 RCTs have shown higher negative margin rates in the IOUS arm compared to WGL. Meta-analysis confirmed a significant difference between IOUS and WGL in terms of positive margins favoring IOUS (risk ratio 4.34, p < 0.0001, I2 = 0%). 41 cohort studies including 3291 patients were identified, of which most reported higher negative margin and lower re-operation rates if IOUS was used. In palpable BC, IOUS was compared to palpation-guided excision in 3 RCTs. Meta-analysis showed significantly higher rates of positive margins in the palpation arm (risk ratio 2.84, p = 0.0047, I2 = 0%). In 13 cohort studies including 942 patients with palpable BC, negative margin rates were higher if IOUS was used, and tissue volumes were higher in palpation-guided cohorts in most studies. IOUS is a safe noninvasive technique for the localization of sonographically visible tumors that significantly improves margin rates in palpable and non-palpable BC. Surgeons should be encouraged to acquire ultrasound skills and participate in breast ultrasound training.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
- Medical Faculty, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Isabel T Rubio
- Breast Surgical Unit, Clinica Universidad de Navarra, Madrid, Spain
| | - Güldeniz Karadeniz Cakmak
- General Surgery Department, Breast and Endocrine Unit, Zonguldak BEUN The School of Medicine, Kozlu/Zonguldak, Turkey
| | - Antonio Esgueva
- Breast Surgical Unit, Clinica Universidad de Navarra, Madrid, Spain
| | - Natalia Krawczyk
- Department of Obstetrics and Gynecology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Peter Paluchowski
- Department of Gynecology and Obstetrics, Regio Klinikum Pinneberg, Pinneberg, Germany
| | - Ines Gruber
- Department for Women's Health, University of Tübingen, Tübingen, Germany
| | - Mario Marx
- Department of Plastic, Reconstructive and Breast Surgery, Elblandklinikum Radebeul, Radebeul, Germany
| | - Sara Y Brucker
- Department for Women's Health, University of Tübingen, Tübingen, Germany
| | - Nana Bündgen
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Achim Rody
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Lars Hanker
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Markus Hahn
- Department for Women's Health, University of Tübingen, Tübingen, Germany
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Muraoka A, Kobayashi M. Accurate resection of nonpalpable, ultrasonography undetectable breast cancer tumor by preoperative indocyanine green injection using stereotactic mammography: A case report. Ann Med Surg (Lond) 2022; 79:103965. [PMID: 35860109 PMCID: PMC9289324 DOI: 10.1016/j.amsu.2022.103965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 10/25/2022] Open
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Intraoperative Margin Trials in Breast Cancer. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Purpose of Review
Obtaining negative margins in breast conservation surgery continues to be a challenge. Re-excisions are difficult for patients and expensive for the health systems. This paper reviews the literature on current strategies and intraoperative clinical trials to reduce positive margin rates.
Recent Findings
The best available data demonstrate that intraoperative imaging with ultrasound, intraoperative pathologic assessment such as frozen section, and cavity margins have been the most successful intraoperative strategies to reduce positive margins. Emerging technologies such as optical coherence tomography and fluorescent imaging need further study but may be important adjuncts.
Summary
There are several proven strategies to reduce positive margin rates to < 10%. Surgeons should utilize best available resources within their institutions to produce the best outcomes for their patients.
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Davey MG, O'Donnell JPM, Boland MR, Ryan ÉJ, Walsh SR, Kerin MJ, Lowery AJ. Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials. Breast 2022; 62:103-113. [PMID: 35151049 PMCID: PMC8844725 DOI: 10.1016/j.breast.2022.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Mammographic screening programmes have increased detection rates of non-palpable breast cancers. In these cases, wire-guided localization (WGL) is the most common approach used to guide breast conserving surgery (BCS). Several RCTs have compared WGL to a range of novel localization techniques. We aimed to perform a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing methods of non-palpable breast cancer localization. Methods A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. Results 24 RCTs assessing 9 tumour localization methods in 4236 breasts were included. Margin positivity and reoperation rates were 16.9% (714/4236) and 14.3% (409/2870) respectively. Cryo-assisted localization had the highest margin positivity (28.2%, 58/206) and reoperation (18.9%, 39/206) rates. Compared to WGL (n = 2045 from 24 RCTs) only ultrasound guided localization (USGL) (n = 316 from 3 RCTs) significantly lowered margin positivity (odds ratio (OR): 0.192, 95% confidence interval (CI): 0.079–0.450) and reoperation rates (OR: 0.182, 95%CI: 0.069–0.434). Anchor-guided localization (n = 52, 1 RCT) significantly lowered margin positivity (OR: 0.229, 95%CI: 0.050–0.938) and magnetic-marker localization improved patient satisfaction (OR: 0.021, 95%CI: 0.001–0.548). There was no difference in operation duration, overall complications, haematoma, seroma, surgical site infection rates, or specimen size/vol/wt between methods. Conclusion USGL and AGL are non-inferior to WGL for the localization of non-palpable breast cancers. The reported data suggests that these techniques confer reduced margin positivity rates and requirement for re-operation. However, caution when interpreting results relating to RCTs with small sample sizes and further validation is required in larger prospective, randomized studies. Ultrasound-guided (USGL) and anchor-guided (AGL) localization had optimal outcomes. These methods significantly lowered margin positivity (odds ratio: 0.192 & 0.229). However, small sample sizes in trials evaluating USGL and AGL limit these results. Operation duration, complications, or specimen data were comparable for all methods.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland.
| | - John P M O'Donnell
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Michael R Boland
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Éanna J Ryan
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Stewart R Walsh
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Michael J Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Aoife J Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
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Liu JJ, Wang Z, Nie LM, Zhu YY, Li G, Lin LL, Chen M, Zhang GJ. RGD-functionalised melanin nanoparticles for intraoperative photoacoustic imaging-guided breast cancer surgery. Eur J Nucl Med Mol Imaging 2022; 49:847-860. [PMID: 34505945 PMCID: PMC8803813 DOI: 10.1007/s00259-021-05545-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/24/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Obtaining tumour-free margins is critical for avoiding re-excision and reducing local recurrence following breast-conserving surgery; however, it remains challenging. Imaging-guided surgery provides precise detection of residual lesions and assists surgical resection. Herein, we described water-soluble melanin nanoparticles (MNPs) conjugated with cyclic Arg-Gly-Asp (cRGD) peptides for breast cancer photoacoustic imaging (PAI) and surgical navigation. METHODS The cRGD-MNPs were synthesised and characterized for morphology, photoacoustic characteristics and stability. Tumour targeting and toxicity of cRGD-MNPs were determined by using either breast cancer cells, MDA-MB-231 tumour-bearing mice or the FVB/N-Tg (MMTV-PyVT) 634Mul/J mice model. PAI was used to locate the tumour and guide surgical resection in MDA-MB-231 tumour-bearing mice. RESULTS The cRGD-MNPs exhibited excellent in vitro and in vivo tumour targeting with low toxicity. Intravenous administration of cRGD-MNPs to MDA-MB-231 tumour-bearing mice showed an approximately 2.1-fold enhancement in photoacoustic (PA) intensity at 2 h, and the ratio of the PA intensity at the tumour site to that in the surrounding normal tissue was 3.2 ± 0.1, which was higher than that using MNPs (1.7 ± 0.3). Similarly, the PA signal in the spontaneous breast cancer increased ~ 2.5-fold at 2 h post-injection of cRGD-MNPs in MMTV-PyVT transgenic mice. Preoperative PAI assessed tumour volume and offered three-dimensional (3D) reconstruction images for accurate surgical planning. Surgical resection following real-time PAI showed high consistency with histopathological analysis. CONCLUSION These results highlight that cRGD-MNP-mediated PAI provide a powerful tool for breast cancer imaging and precise tumour resection. cRGD-MNPs with fine PA properties have great potential for clinical translation.
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Affiliation(s)
- Jing-Jing Liu
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
| | - Zun Wang
- ChangJiang Scholar's Laboratory, Shantou University Medical College, Shantou, 515041, Guangdong, China
- Department of Breast and Thyroid Surgery, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518133, Guangdong, China
| | - Li-Ming Nie
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnosis & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
- Department of Radiology and Optical Imaging Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Yuan-Yuan Zhu
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
| | - Ge Li
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
| | - Lin-Ling Lin
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
| | - Min Chen
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, 361101, Fujian, China
- Clinical Central Research Core, Xiang'an Hospital of Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
| | - Guo-Jun Zhang
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, 361101, Fujian, China
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Li W, Li X. Development of intraoperative assessment of margins in breast conserving surgery: a narrative review. Gland Surg 2022; 11:258-269. [PMID: 35242687 PMCID: PMC8825505 DOI: 10.21037/gs-21-652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/17/2021] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We intend to provide an informative and up-to-date summary on the topic of intraoperative assessment of margins in breast conserving surgery (BCS). Conventional methods as well as cutting-edge technologies are analyzed for their advantages and limitations in the hope that clinicians can turn to this for reference. This review can also offer guidance for technicians in the future design of intraoperative margin assessment tools. BACKGROUND Achieving negative margins during BCS is one of the vital factors for preventing local recurrence. Conducting intraoperative margin assessment can ensure negative margins to a large extent and possibly relieve patients of the anguish of re-interventions. In recent years, innovative methods for margin assessment during BCS are advancing rapidly. And there is a lack of summary regarding the development of intraoperative margin assessment in BCS. METHODS A PubMed search with keywords "intraoperative margin assessment" and "breast conserving surgery" was conducted. Relevant publications were screened manually for its title, abstract and even full text to determine its true relevance. Publications on neo-adjuvant therapy and intraoperative radiotherapy were excluded. References from the searched articles and other supplementary articles were also looked into. CONCLUSIONS Conventional methods for margin assessment yields stable outcome but its use is limited because of the demand on pathology staff and the trade-off between time and precision. Conventional imaging techniques pass the workload to radiologists at the cost of a significantly low duration of time. Involving artificial intelligence for image-based assessment is a further improvement. However, conventional imaging is inherently flawed in that occult lesions can't show on the image and the showing ones are ambiguous and open to interpretation. Unconventional techniques which base their judgment on cellular composition are more reassuring. Nonetheless, unconventional techniques should be subjected to clinical trials before putting into practice. And studies regarding comparison between conventional methods and unconventional methods are also needed to evaluate their relative efficacy.
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Affiliation(s)
- Wanheng Li
- First Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Xiru Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Zhang L, Cheng M, Chen Y, Zhuang X, Yang C, Ji F, Gao H, Yang M, Zhu T, Li J, Wang K. Visualization positioning-guided biopsy of suspicious breast microcalcifications: a retrospective cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1620. [PMID: 34926664 PMCID: PMC8640910 DOI: 10.21037/atm-21-4496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022]
Abstract
Background At present, most histological evaluations of microcalcifications without a mass are performed using X-ray guided hook wire localization or vacuum-assisted stereotactic biopsy (VASB), but there are still several limitations to these techniques. Therefore, we designed a visualization positioning technique based on three directions of mammography to accurately locate suspected microcalcifications to guide the biopsy. Methods We retrospectively analyzed consecutive patients with suspicious microcalcifications who underwent visualization positioning-guided biopsy (VPB) from June 1, 2016, to June 1, 2021. The visualization positioning technique was performed using an electronic ruler to measure the vertical distance from the microcalcification core to the vertical lines on mammography. Results A total of 133 patients (median age 46 years; range, 22–87 years) who underwent VPB were included in our study. Among the 133 cases of microcalcifications based on pathological results, 104 were benign, 14 were high risk, and 15 were malignant. In 124 (93.2%) patients, microcalcification was confirmed during the first round of VPB specimen analysis. Only 6 (4.5%) and 3 (2.3%) patients underwent second and third extended resections, respectively, as the resected specimens did not contain microcalcifications. Four patients (3.0%) with malignant biopsy results underwent a subsequent operation. Two patients with DCIS underwent mastectomy and sentinel lymph node biopsy because of diffuse calcification. One patient had no residual cancer, and the other was upgraded to invasive ductal carcinoma (IDC). Two patients with IDC underwent breast-conserving surgery and mastectomy with sentinel lymph node biopsy. Conclusions VPB can be used to evaluate breast microcalcifications when a mass is not present, making it an effective diagnostic technique.
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Affiliation(s)
- Liulu Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Minyi Cheng
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanqi Chen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaosheng Zhuang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ciqiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fei Ji
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongfei Gao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mei Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jieqing Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Zhou Y, Liang Y, Zhang J, Feng Y, Li X, Kong X, Ma T, Jiang L, Yang Q. Evaluation of Carbon Nanoparticle Suspension and Methylene Blue Localization for Preoperative Localization of Nonpalpable Breast Lesions: A Comparative Study. Front Surg 2021; 8:757694. [PMID: 34888344 PMCID: PMC8651243 DOI: 10.3389/fsurg.2021.757694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The resection of nonpalpable breast lesions (NPBLs) largely depends on the preoperative localization technology. Although several techniques have been used for the guidance of NPBL resection, more comfortable and effective methods are needed. This aim of this study was to evaluate the use and feasibility of carbon nanoparticle suspension (CNS) and methylene blue (MB)-guided resection of NPBL, to introduce alternative techniques. Methods: A total of 105 patients with 172 NPBLs detected by breast ultrasound were randomized to CNS localization (CNSL) group and MB localization (MBL) group. The injection times of the two groups were divided into 2, 4, 6, 12, 16, and 20 h before surgery. In this study, localization time, stained area, operation time, total resection volume (TRV), calculated resection ratio (CRR), and pathological diagnosis were assessed. Results: All of the 172 lesions were finally confirmed benign. Dye persisted in all cases in the CNSL group (109/109, 100%), while that persisted in only 53 cases in the MBL group (53/63, 84.1%) (P < 0.001). There was a significant correlation between dyeing time and dyeing area in the MBL group (r = −0.767, P < 0.001); however, there was no significant correlation in the CNSL group (r = −0.154, P = 0.110). The operation time was 11.05 ± 3.40 min in the CNSL group and 13.48 ± 6.22 min in the MBL group (P < 0.001). The TRV was 2.51 ± 2.42 cm3 in the CNSL group and 3.69 ± 3.24 cm3 in the MBL group (P = 0.016). For CRR, the CNSL group was lower than the MBL group (7.62 ± 0.49 vs. 21.93 ± 78.00, P = 0.018). There is no dye remained on the skin in the MBL group; however, dye persisted in 12 patients (19.4%) in the CNSL group (P = 0.001). Conclusion: Carbon nanoparticle suspension localization and MBL are technically applicable and clinically acceptable procedures for intraoperatively localizing NPBL. Moreover, given the advantages of CNSL compared to MBL, including the ability to perform this technique 5 days before operation and smaller resection volume, it seems to be a more attractive alternative to be used in intraoperative localization of NPBL.
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Affiliation(s)
- Yeqing Zhou
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianshu Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yang Feng
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyan Li
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoli Kong
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tingting Ma
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liyu Jiang
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Pathology Tissue Bank, Qilu Hospital of Shandong University, Jinan, China.,Research Institute of Breast Cancer, Shandong University, Jinan, China
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12
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Bennett I, Khoo JF, De Viana D, Law M. Australian breast surgeons and ultrasound usage: Have practices changed? Australas J Ultrasound Med 2021; 24:217-224. [PMID: 34888131 PMCID: PMC8591276 DOI: 10.1002/ajum.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND A recent survey of surgeon performed ultrasound usage was conducted amongst registered members of the Breast Surgeons of Australia and New Zealand Society (BreastSurgANZ) and was compared with a previous survey undertaken in 2010 to determine whether patterns of utilization had changed. METHODS From July to September 2019, members of BreastSurgANZ were invited to complete an electronic online survey of personal usage of breast ultrasound focusing on ultrasound equipment access, use of office and intraoperative ultrasound, biopsy interventions and training expectations. RESULTS There were 73 respondents to the survey with 45 (61.6%) members indicating access to ultrasound within their practices. Whilst current regular ultrasound usage (68.1%) was only slightly greater than in 2010 (66%), the proportion of respondents not performing any form of needle intervention had increased (62.5% compared to 53% in 2010) and with the proportion of surgeons currently performing >10 biopsies per month decreasing from 10% to only 5.56%. However the percentage of surgeons utilizing intraoperative ultrasound had notably increased since 2010 with 49.3% currently using ultrasound in the operating room compared with only 17% previously. The majority of respondents believed that breast ultrasound training should be conducted through BreastSurgANZ post fellowship training programs. CONCLUSION The overall utilization of surgeon-performed ultrasound amongst BreastSurgANZ members has remained similar over the past 9 years with the performance of needle interventions declining slightly, but with the application of intraoperative ultrasound having increased. An ultrasound training curriculum as part of the BreastSurgANZ post fellowship training program is a necessary imperative.
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Affiliation(s)
- Ian Bennett
- Department of SurgeryPrincess Alexandra HospitalUniversity of QldWoolloongabba, BrisbaneQueenslandAustralia
- Translational Research Institute (TRI)Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
| | - Jeremy F. Khoo
- Department of SurgeryPrincess Alexandra HospitalUniversity of QldWoolloongabba, BrisbaneQueenslandAustralia
- Translational Research Institute (TRI)Princess Alexandra HospitalWoolloongabba, BrisbaneQueenslandAustralia
| | - Daniel De Viana
- BreastScreen Qld Gold CoastPremion PlaceSouthportQueenslandAustralia
| | - Michael Law
- Breast and Endocrine Surgery UnitEastern HealthBox HillVictoriaAustralia
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13
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Athanasiou C, Mallidis E, Tuffaha H. Comparative effectiveness of different localization techniques for non-palpable breast cancer. A systematic review and network meta-analysis. Eur J Surg Oncol 2021; 48:53-59. [PMID: 34656392 DOI: 10.1016/j.ejso.2021.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/25/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Several localization techniques are in use for localization of non palpable breast cancer but data on comparative effectiveness of these techniques are sparse. Our aim was to provide the first comparative effectiveness data on the topic. METHODS PubMed, Ovid, Scopus and Cochrane library were searched for randomized controlled trials. Pairwise meta-analysis was performed when more than 2 studies reported on the same head-to-head comparison. Network meta-analysis was performed in Stata. RESULTS Eighteen studies with 3112 patients were identified. A star shaped network was formed for every outcome as all studies had as common comparator the wire localization technique (WGL). Ultrasound guided surgery (UGS) had decreased positive margin both in the pairwise [OR = 0.19(0.11, 0.35); P < 0.01] and network meta-analysis OR = 0.19 (0.11,0.60). There was also a statistically significant reduction in re-operation rate [OR = 0.19 (0.11, 0.36); P < 0.01] and operative time [MD = -4.24(-7.85,-0.63); P = 0.02] as compared to WGL in pairwise meta-analysis. Re-operation rate and operative time did not hold there statistical significance in network meta-analysis. On network meta-analysis UGS had a statistically significant reduction in positive margin as compared to radio-guided occult lesion localization (ROLL) OR = 0.19 (0.11,0.6) and radioactive seed localization (RSL) OR = 0.26(0.13, 0.52). UGS had a 54.6% of being the best technique for positive margin. All techniques were equivalent for successful excision, localization complications, operative time and overall complications. CONCLUSIONS UGS has potential benefits in reduction of positive surgical margin, the rest of the techniques seem to have equivalent efficacy. Further randomized trials are required to verify these results.
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Affiliation(s)
| | | | - Hussein Tuffaha
- East Suffolk and North Essex Foundation Trust, Ipswich, United Kingdom.
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14
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An Overview of Experience with Preoperative Skin Marking and Clip Insertion in Non-palpable Breast Cancer Lesions in a Tertiary Care Cancer Center and Its Impact on Breast Conservation Surgery. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Chakedis JM, Tang A, Kuehner GE, Vuong B, Lyon LL, Romero LA, Raber BM, Mortenson MM, Shim VC, Datrice-Hill NM, McEvoy JR, Arasu VA, Wisner DJ, Chang SB. Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective. Ann Surg Oncol 2021; 28:5648-5656. [PMID: 34448055 PMCID: PMC8418593 DOI: 10.1245/s10434-021-10454-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intraoperative ultrasound (IUS) localization for breast cancer is a noninvasive localization technique. In 2015, an IUS program for breast-conserving surgery (BCS) was initiated in a large, integrated health care system. This study evaluated the clinical results of IUS implementation. METHODS The study identified breast cancer patients with BCS from 1 January to 31 October 2015 and from 1 January to 31 October 2019. Clinicopathologic characteristics were collected, and localization types were categorized. Clinical outcomes were analyzed, including localization use, surgeon adoption of IUS, day-of-surgery intervals, and re-excision rates. Multivariate logistic regression analysis was performed to evaluate predictors of re-excision. RESULTS The number of BCS procedures increased 23%, from 1815 procedures in 2015 to 2226 procedures in 2019. The IUS rate increased from 4% of lumpectomies (n = 79) in 2015 to 28% of lumpectomies (n = 632) in 2019 (p < 0.001). Surgeons using IUS increased from 6% (5 of 88 surgeons) in 2015 to 70% (42 of 60 surgeons) in 2019. In 2019, 76% of IUS surgeons performed at least 25% of lumpectomies with IUS. The mean time from admission to incision was shorter with IUS or seed localization than with wire localization (202 min with IUS, 201 with seed localization, 262 with wire localization in 2019; p < 0.001). The IUS re-excision rates were lower than for other localization techniques (13.6%, vs 19.6% for seed localization and 24.7% for wire localization in 2019; p = 0.006), and IUS predicted lower re-excision rates in a multivariable model (odds ratio [OR], 0.59). CONCLUSIONS In a high-volume integrated health system, IUS was adopted for BCS by a majority of surgeons. The use of IUS decreased the time from admission to incision compared with wire localization, and decreased re-excision rates compared with other localization techniques.
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Affiliation(s)
- Jeffery M Chakedis
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Annie Tang
- Department of Surgery, University of California San Francisco, East Bay-Highland Hospital, Oakland, CA, USA
| | - Gillian E Kuehner
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Brooke Vuong
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Liisa L Lyon
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Lucinda A Romero
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Benjamin M Raber
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Melinda M Mortenson
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Veronica C Shim
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Nicole M Datrice-Hill
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Jennifer R McEvoy
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Vignesh A Arasu
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Dorota J Wisner
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA
| | - Sharon B Chang
- Department of General Surgery and Radiology, The Permanente Medical Group (TPMG), Oakland, CA, USA. .,Department of Surgery, Kaiser Permanente Fremont Medical Center, Fremont, CA, USA.
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16
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Dickhoff LR, Vrancken Peeters MJ, Bosman PA, Alderliesten T. Therapeutic applications of radioactive sources: from image-guided brachytherapy to radio-guided surgical resection. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:190-201. [PMID: 34105339 DOI: 10.23736/s1824-4785.21.03370-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is well known nowadays that radioactivity can destroy the living cells it interacts with. It is therefore unsurprising that radioactive sources, such as iodine-125, were historically developed for treatment purposes within radiation oncology with the goal of damaging malignant cells. However, since then, new techniques have been invented that make creative use of the same radioactivity properties of these sources for medical applications. Here, we review two distinct kinds of therapeutic uses of radioactive sources with applications to prostate, cervical, and breast cancer: brachytherapy and radioactive seed localization. In brachytherapy (BT), the radioactive sources are used for internal radiation treatment. Current approaches make use of real-time image guidance, for instance by means of magnetic resonance imaging, ultrasound, computed tomography, and sometimes positron emission tomography, depending on clinical availability and cancer type. Such image-guided BT for prostate and cervical cancer presents a promising alternative and/or addition to external beam radiation treatments or surgical resections. Radioactive sources can also be used for radio-guided tumor localization during surgery, for which the example of iodine-125 seed use in breast cancer is given. Radioactive seed localization (RSL) is increasingly popular as an alternative tumor localization technique during breast cancer surgery. Advantages of applying RSL include added flexibility in the clinical scheduling logistics, an increase in tumor localization accuracy, and higher patient satisfaction; safety measures do however have to be employed. We exemplify the implementation of RSL in a clinic through experiences at the Netherlands Cancer Institute.
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Affiliation(s)
- Leah R Dickhoff
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands -
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Peter A Bosman
- Life Sciences and Health group, Centrum Wiskunde & Informatica, Amsterdam, The Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
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17
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Wignarajah P, Papalouka V, Forouhi P. Outcomes of intraoperative versus preoperative ultrasound-guided wire localization of nonpalpable breast lesions. BREAST CANCER MANAGEMENT 2021. [DOI: 10.2217/bmt-2020-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Nonpalpable breast lesions require localization, the gold standard for which is preoperative ultrasound-guided wire localization (PUGWL). Our unit also employs intraoperative ultrasound-guided wire localization (IUGWL). Here we evaluate PUGWL and IUGWL outcomes between 2014 and 2018. Primary outcomes were reoperation rates, complication rates and average specimen weights. Trainee feedback and cost analysis assessed IUGWL viability. Methods: Prospectively recorded data were collected. 511 patients were included (241 PUGWL and 270 IUGWL). Results: Reoperation rates: PUGWL 17.7% versus IUGWL 13.9% (p = 0.28) . Complication rates: PUGWL 5.8% versus IUGWL 6.6% (p = 0.72) . Average specimen weight: PUGWL 34.2 g versus IUGWL 24.3 g (p < 0.0001) . Trainees needed 15 supervised cases to be IUGWL competent. Performing IUGWL saves £289 per localization. Conclusion: IUGWL outcomes are comparable to those of PUGWL. IUGWL is cost-effective, patient-friendly and easy to learn and replicate. IUGWL merits wider dissemination and further planned research.
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Affiliation(s)
- Primeera Wignarajah
- Department of Breast Surgery, Cambridge Breast Unit, Addenbrookes’ Hospital, Cambridge University Hospitals Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Vasiliki Papalouka
- Department of Radiology, Cambridge Breast Unit, Addenbrookes’ Hospital, Cambridge University Hospitals Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Parto Forouhi
- Department of Breast Surgery, Cambridge Breast Unit, Addenbrookes’ Hospital, Cambridge University Hospitals Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
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18
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Wu ZY, Kim HJ, Lee J, Chung IY, Kim J, Lee S, Son BH, Ahn SH, Kim HH, Seo JB, Jeong JH, Gong G, Kim N, Ko B. Breast-conserving surgery with 3D-printed surgical guide: a single-center, prospective clinical study. Sci Rep 2021; 11:2252. [PMID: 33500555 PMCID: PMC7838396 DOI: 10.1038/s41598-021-81936-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/11/2021] [Indexed: 11/17/2022] Open
Abstract
To facilitate precise tumor resection at the time of breast-conserving surgery (BCS), we developed and implemented a magnetic resonance imaging (MRI)-based three-dimensional-printed (3DP) breast surgical guide (BSG). This prospective cohort study was conducted at a single institution from July 2017 to February 2019 on women with breast cancer who underwent partial breast resection using patient-specific 3DP BSGs. Eighty-eight patients with invasive cancer were enrolled, of whom 1 patient had bilateral breast cancer. The mean size of the tumor long-axis on MRI before surgery was 2.8 ± 0.9 cm, and multiple tumors were observed in 34 patients. In 16 cases (18.0%), the resection margin was tumor-positive according to intraoperative frozen biopsy; all of these tumors were ductal carcinoma in situ and were re-excised intraoperatively. In 93.3% of the cases, the resection margin was tumor-free in the permanent pathology. The mean pathological tumor size was 1.7 ± 1.0 cm, and the mean distance from the tumor to the border was 1.5 ± 1.0 cm. This exploratory study showed that the tumor area on the MRI could be directly displayed on the breast when using a 3DP BSG for BCS, thereby allowing precise surgery and safe tumor removal. Trial Registration Clinical Research Information Service (CRIS) Identifier (No. KCT0002375, KCT0003043).
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Affiliation(s)
- Zhen-Yu Wu
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.,Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.,Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jongwon Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Saebyeol Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology, Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Joon Beom Seo
- Department of Radiology, Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jae Ho Jeong
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Namkug Kim
- Department of Radiology, Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. .,Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - BeomSeok Ko
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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19
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Hu X, Li S, Jiang Y, Wei W, Ji Y, Li Q, Jiang Z. Intraoperative ultrasound-guided lumpectomy versus wire-guided excision for nonpalpable breast cancer. J Int Med Res 2020; 48:300060519896707. [PMID: 31937169 PMCID: PMC7113704 DOI: 10.1177/0300060519896707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective This study was designed to compare the margin clearance and re-excision rates of ultrasound (US)- and wire-guided excision in a large number of patients with nonpalpable breast cancer. Methods In total, 520 women who were histologically diagnosed with nonpalpable breast cancer were recruited in this study. All nonpalpable lesions were visible by US. The patients were randomly divided into two groups: those who underwent wire-guided breast-conserving surgery (BCS) and those who underwent US-guided BCS. Re-excision rates and positive surgical margins were recorded. Results A total of 262 patients underwent US-guided excision and 258 patients underwent wire-guided excision. No differences were found in tumor or patient characteristics. The positive margin rate was 4.6% in the US-guided group and 19.4% in the wire-guided group with a significant difference. Age, menopausal status, excision volume, histological grade, and tumor type significantly influenced the positive surgical margin rate. The intraoperative re-excision rate was significantly lower in the US-guided group than wire-guided group (11.1% vs. 24.0%, respectively). Conclusions US-guided BCS seems to be more effective than wire-guided BCS for treatment of nonpalpable breast cancers in terms of the margin clearance and re-excision rates. Patients can avoid the discomfort caused by preoperative wire placement.
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Affiliation(s)
- Xin Hu
- Department of Pain Management, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Si Li
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yi Jiang
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wei Wei
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yinan Ji
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qiuyun Li
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zongbin Jiang
- Department of Pain Management, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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20
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Kennedy KM, Zilkens R, Allen WM, Foo KY, Fang Q, Chin L, Sanderson RW, Anstie J, Wijesinghe P, Curatolo A, Tan HEI, Morin N, Kunjuraman B, Yeomans C, Chin SL, DeJong H, Giles K, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Diagnostic Accuracy of Quantitative Micro-Elastography for Margin Assessment in Breast-Conserving Surgery. Cancer Res 2020; 80:1773-1783. [PMID: 32295783 DOI: 10.1158/0008-5472.can-19-1240] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/09/2019] [Accepted: 02/14/2020] [Indexed: 01/16/2023]
Abstract
Inadequate margins in breast-conserving surgery (BCS) are associated with an increased likelihood of local recurrence of breast cancer. Currently, approximately 20% of BCS patients require repeat surgery due to inadequate margins at the initial operation. Implementation of an accurate, intraoperative margin assessment tool may reduce this re-excision rate. This study determined, for the first time, the diagnostic accuracy of quantitative micro-elastography (QME), an optical coherence tomography (OCT)-based elastography technique that produces images of tissue microscale elasticity, for detecting tumor within 1 mm of the margins of BCS specimens. Simultaneous OCT and QME were performed on the margins of intact, freshly excised specimens from 83 patients undergoing BCS and on dissected specimens from 7 patients undergoing mastectomy. The resulting three-dimensional images (45 × 45 × 1 mm) were coregistered with postoperative histology to determine tissue types present in each scan. Data from 12 BCS patients and the 7 mastectomy patients served to build a set of images for reader training. One hundred and fifty-four subimages (10 × 10 × 1 mm) from the remaining 71 BCS patients were included in a blinded reader study, which resulted in 69.0% sensitivity and 79.0% specificity using OCT images, versus 92.9% sensitivity and 96.4% specificity using elasticity images. The quantitative nature of QME also facilitated development of an automated reader, which resulted in 100.0% sensitivity and 97.7% specificity. These results demonstrate high accuracy of QME for detecting tumor within 1 mm of the margin and the potential for this technique to improve outcomes in BCS. SIGNIFICANCE: An optical imaging technology probes breast tissue elasticity to provide accurate assessment of tumor margin involvement in breast-conserving surgery.
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Affiliation(s)
- Kelsey M Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,School of Medicine, The University of Western Australia, Perth, Australia
| | - Wes M Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Ken Y Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Rowan W Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - James Anstie
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Philip Wijesinghe
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Andrea Curatolo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Hsern Ern I Tan
- School of Medicine, The University of Western Australia, Perth, Australia
| | | | | | - Chris Yeomans
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
| | - Synn Lynn Chin
- Breast Centre, Fiona Stanley Hospital, Murdoch, Australia
| | - Helen DeJong
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia
| | | | - Benjamin F Dessauvagie
- School of Medicine, The University of Western Australia, Perth, Australia.,PathWest, Fiona Stanley Hospital, Murdoch, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
| | - Christobel M Saunders
- School of Medicine, The University of Western Australia, Perth, Australia.,Breast Centre, Fiona Stanley Hospital, Murdoch, Australia.,Breast Clinic, Royal Perth Hospital, Perth, Australia
| | - Brendan F Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia. .,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
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21
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Optimizing breast cancer surgery during the COVID-19 pandemic. Breast Cancer 2020; 27:1045-1047. [PMID: 32948989 PMCID: PMC7500716 DOI: 10.1007/s12282-020-01160-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic poses current and future challenges in the maintenance of surgical operating capacity. In the United Kingdom surgery has continued—in a reduced capacity—through the establishment of regional ‘cancer hubs’ using independent sector facilities to treat public healthcare patients. It is essential that these scarce operating facilities available are optimally utilized and that logistical challenges that result from remote operating away from the surgeon’s primary hospital site are considered. These issues are best addressed through the application of currently available medical technology and enhanced training in advanced oncoplastic techniques, which extend the limits of breast conservation.
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22
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Layeequr Rahman R, Puckett Y, Habrawi Z, Crawford S. A decade of intraoperative ultrasound guided breast conservation for margin negative resection - Radioactive, and magnetic, and Infrared Oh My…. Am J Surg 2020; 220:1410-1416. [PMID: 32958157 DOI: 10.1016/j.amjsurg.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/11/2020] [Accepted: 09/03/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The oncologic goal of margin-negative breast conservation requires adequate localization of tumor. Intraoperative ultrasound remains most feasible but under-utilized method to localize the tumor and assess margins. METHODS A prospectively maintained breast cancer database over a decade was queried for margin status in breast cancer patients undergoing breast conservation. Techniques of tumor localization, margin re-excision and closest margins were analyzed. Rate of conversion to mastectomy was determined. RESULTS Of the 945 breast cancer patients treated at a university-based Breast Center of Excellence between January 1, 2009 and December 31, 2018, 149(15.8%) had ductal carcinoma in situ; 712(75.3%) had invasive ductal carcinoma, and 63(6.7%) had invasive lobular carcinoma. Clinical stage distribution was: T1 = 372(39.4%); T2 = 257(27.2%); T3 = 87(9.2%). Five hundred and eighty three (61.7%) patients underwent breast conservation. The median (25th -75th centile) closest margin was 6(2.5, 10.0) mm. Thirty five (6.0%) patients underwent margin re-excision, of which 9(25%) were converted to mastectomy. Tumor localization was achieved with ultrasound in 521(89.4%) patients and with wire localization in 62(10.6%) patients. The median (25th-75th centile) closest margin with wire localization was 5.0(2.0, 8.5) mm versus 5.0 (2.0, 8.0) mm with ultrasound guidance [p = 0.6635]. The re-excision rate with wire localization was 14.5% versus 4.9% with ultrasound guidance [p = 0.0073]. The unadjusted Odds Ratio (95% CI) for margin revision in wire localized group compared with ultrasound was 3.2 (7.14, 1.42) [p = 0.0045]; multivariate adjusted OR (95%) was 4(9.09, 1.7) [p = 0.0013]. CONCLUSIONS Ultrasound guidance for localization of breast cancer remains the most effective option for margin negative breast conservation.
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Affiliation(s)
- Rakhshanda Layeequr Rahman
- Texas Tech University Health Sciences Center, Department of Surgery, MS 8312, 3601 Fourth Street Lubbock, Texas, 79430, USA.
| | - Yana Puckett
- Texas Tech University Health Sciences Center, Department of Surgery, MS 8312, 3601 Fourth Street Lubbock, Texas, 79430, USA.
| | - Zaina Habrawi
- Texas Tech University Health Sciences Center, Department of Surgery, MS 8312, 3601 Fourth Street Lubbock, Texas, 79430, USA.
| | - Sybil Crawford
- University of Massachusetts, Medical School Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Shaw Building Room 228, Worcester, Massachusetts, 01655, USA.
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23
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Sanderink WBG, Strobbe LJA, Bult P, Schlooz-Vries MS, Lardenoije S, Venderink DJ, Sechopoulos I, Karssemeijer N, Vreuls W, Mann RM. Minimally invasive breast cancer excision using the breast lesion excision system under ultrasound guidance. Breast Cancer Res Treat 2020; 184:37-43. [PMID: 32737712 PMCID: PMC7568696 DOI: 10.1007/s10549-020-05814-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/15/2020] [Indexed: 11/08/2022]
Abstract
Purpose To assess the feasibility of completely excising small breast cancers using the automated, image-guided, single-pass radiofrequency-based breast lesion excision system (BLES) under ultrasound (US) guidance. Methods From February 2018 to July 2019, 22 patients diagnosed with invasive carcinomas ≤ 15 mm at US and mammography were enrolled in this prospective, multi-center, ethics board-approved study. Patients underwent breast MRI to verify lesion size. BLES-based excision and surgery were performed during the same procedure. Histopathology findings from the BLES procedure and surgery were compared, and total excision findings were assessed. Results Of the 22 patients, ten were excluded due to the lesion being > 15 mm and/or being multifocal at MRI, and one due to scheduling issues. The remaining 11 patients underwent BLES excision. Mean diameter of excised lesions at MRI was 11.8 mm (range 8.0–13.9 mm). BLES revealed ten (90.9%) invasive carcinomas of no special type, and one (9.1%) invasive lobular carcinoma. Histopathological results were identical for the needle biopsy, BLES, and surgical specimens for all lesions. None of the BLES excisions were adequate. Margins were usually compromised on both sides of the specimen, indicating that the excised volume was too small. Margin assessment was good for all BLES specimens. One technical complication occurred (retrieval of an empty BLES basket, specimen retrieved during subsequent surgery). Conclusions BLES allows accurate diagnosis of small invasive breast carcinomas. However, BLES cannot be considered as a therapeutic device for small invasive breast carcinomas due to not achieving adequate excision.
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Affiliation(s)
- W B G Sanderink
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - P Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M S Schlooz-Vries
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Lardenoije
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - D J Venderink
- Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - I Sechopoulos
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - N Karssemeijer
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - W Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - R M Mann
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
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Khare S, Singh T, Santosh I, Laroiya I, Singh G. Wire- and Ultrasound-Guided Localization: A Novel Technique for Excision of Nonpalpable Breast Tumors. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2020; 14:1178223420938068. [PMID: 32669849 PMCID: PMC7336821 DOI: 10.1177/1178223420938068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/03/2022]
Abstract
Background: Excision of nonpalpable breast lesions requires intraoperative guidance.
Wire-guided localization and intraoperative ultrasounds have been used
successfully but suffer from some disadvantages. We describe a new
modification of the standard technique using a combination of preoperative
ultrasound in conjunction with standard wire-guided localization. Methods: Wire and ultrasound-guided localization (WUGL) technique was used for the
excision of nonpalpable breast lesions. Results: Sixty-nine patients with nonpalpable breast lesions were subjected to
excision using WUGL, out of whom 63 patients had a preoperative diagnosis of
invasive/noninvasive breast cancer. Six patients had a preoperative
diagnosis of benign lesions, out of which 3 patients were converted to
invasive breast cancer on final pathology. Only 1 patient had positive
margin. Conclusions: WUGL is a technique that uses a combination of well-accepted and easily
available techniques. It has given good results and has the potential for
widespread acceptance in resource-constrained situations.
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Affiliation(s)
- Siddhant Khare
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Tulika Singh
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India.,Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Irrinki Santosh
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Ishita Laroiya
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Gurpreet Singh
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
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25
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Chiu JC, Ajmal S, Zhu X, Griffith E, Encarnacion T, Barr L. Radioactive Seed Localization of Nonpalpable Breast Lesions in an Academic Comprehensive Cancer Program Community Hospital Setting. Am Surg 2020. [DOI: 10.1177/000313481408000722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Wire localized excision (WLE) has been a long-standing method for localization of nonpalpable breast lesions. Disadvantages of this method include difficulty locating the wire tip in relation to borders of the lesion, imprecise placement of the wire, and the need to place the wire shortly before scheduled surgery. These shortcomings may lead to a high positive margin rate requiring re-excision to obtain clear margins for breast cancer. Radioactive seed localized excision (RSLE) of nonpalpable breast lesions has been advocated as a safe and effective alternative to WLE. The primary endpoints of the study were to compare re-excision rates between WLE and RSLE of nonpalpable breast lesions and to determine if there were any differences in volume of tissue removed. One hundred three patients were included in a retrospective review of localized breast excisions done by a single surgeon. Forty-four patients underwent WLE between April 2007 and February 2009. Fifty-nine patients underwent RSLE between September 2009 and January 2012. Margins were considered to be clear if at least 1 mm of normal tissue was obtained from the circumferential periphery of the lesion in question. RSLE resulted in a re-excision rate of 17 versus 55 per cent re-excision rate for wire localization ( P < 0.001). Excision volume was greater for patients having wire localization ( P = 0.074). RSLE is an effective technique for excision of non-palpable breast lesions in the community setting. This technique allows for accurate localization and appears to allow for smaller volume of tissue to be excised.
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Affiliation(s)
- Jeffrey C. Chiu
- From the Florida Hospital Cancer Institute, Orlando, Florida
| | - Saira Ajmal
- From the Florida Hospital Cancer Institute, Orlando, Florida
| | - Xiang Zhu
- From the Florida Hospital Cancer Institute, Orlando, Florida
| | | | | | - Louis Barr
- From the Florida Hospital Cancer Institute, Orlando, Florida
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26
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Behrendorff N, Febery A, Khoo JF, Bennett I. Comparison of intraoperative ultrasound-guided excision and hookwire-guided excision of impalpable breast lesions: An economic evaluation. Breast J 2020; 26:1879-1881. [PMID: 32449189 DOI: 10.1111/tbj.13883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Natasha Behrendorff
- Department of Surgery, University of Qld, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Alice Febery
- Department of Surgery, University of Qld, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Jeremy F Khoo
- Department of Surgery, University of Qld, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Ian Bennett
- Department of Surgery, University of Qld, Princess Alexandra Hospital, Brisbane, Qld, Australia
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27
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Gerrard AD, Shrotri A. Surgeon-led Intraoperative Ultrasound Localization for Nonpalpable Breast Cancers: Results of 5 Years of Practice. Clin Breast Cancer 2019; 19:e748-e752. [PMID: 31208875 DOI: 10.1016/j.clbc.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The uptake of breast screening has led to a rise in the number of nonpalpable breast cancer diagnoses. Breast conserving therapy (BCT) is the treatment of choice for early breast cancer, and this requires localization of the lesion. Commonly detection is achieved by wire-guided localization in the radiology department. This technique has complications and requires utilization of a radiologist. Intraoperative ultrasound (IOUS) has been shown to be a safe alternative, but there is little data on its use. The aim of this study is to report the use of surgeon-led IOUS over the past 5 years, assessing the ability to detect lesions and the re-excision rate for involved margins. PATIENTS AND METHODS A retrospective observational study was performed on consecutive patients undergoing IOUS-marked BCT between 2014 and 2018. The technique is described, and patients' records were reviewed to assess the histologic specimen reports and need for subsequent re-excision. RESULTS Ninety-five IOUS BCT operations were performed. Every cancer was identified by IOUS and removed. Fourteen margins were positive and required re-excision. Of these, only 2 contained residual tumor. CONCLUSION This is the first data from the United Kingdom for IOUS skin marking without wire localization. IOUS is a safe method of localization in BCT. It offers advantages both to the patient and the unit as it reduces pressure on the radiology department.
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Affiliation(s)
- Adam D Gerrard
- Breast Department, Aintree University Hospital NHS Foundation Trust, Liverpool, England
| | - Anu Shrotri
- Breast Department, Aintree University Hospital NHS Foundation Trust, Liverpool, England.
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28
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Esgueva A, Rodríguez-Revuelto R, Espinosa-Bravo M, Salazar JP, Rubio IT. Learning curves in intraoperative ultrasound guided surgery in breast cancer based on complete breast cancer excision and no need for second surgeries. Eur J Surg Oncol 2019; 45:578-583. [DOI: 10.1016/j.ejso.2019.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/11/2018] [Accepted: 01/11/2019] [Indexed: 01/05/2023] Open
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29
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Laws A, Brar MS, Bouchard-Fortier A, Leong B, Quan ML. Does intra-operative margin assessment improve margin status and re-excision rates? A population-based analysis of outcomes in breast-conserving surgery for ductal carcinoma in situ. J Surg Oncol 2018; 118:1205-1211. [PMID: 30293241 DOI: 10.1002/jso.25248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/03/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Using a 2 mm margin criteria, we evaluated the effect of intra-operative margin assessment on margin status and re-excisions following breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). METHODS We identified patients undergoing BCS for DCIS from a prospective, population-based database. Multivariable logistic regression was used to determine the effect of specimen mammography, ultrasound and macroscopic assessment by a pathologist on margins and re-excision rates. RESULTS In 588 patients, 52% (95% confidence interval [CI], 48%-56%) had positive margins (<2 mm), 39% (95% CI, 35%-43%) had a re-excision and 15% (95% CI, 12%-18%) had completion mastectomy. There were few re-excisions for margins ≥2 mm (2%). Adjusting for confounders, any margin assessment versus wire localization alone did not reduce positive margins (odds ratio [OR], 0.75; P = 0.202) or re-excisions (OR, 1.14; P = 0.564), however both outcomes varied by type of technique ( P < 0.001). Individually, only macroscopic assessment by pathologist reduced positive margins (OR, 0.54; P = 0.002) and re-excisions (OR, 0.61; P = 0.036). CONCLUSIONS Despite adherence to a 2 mm margin criteria, re-excision rates remain high following BCS for DCIS, with 39% converted to mastectomy when re-excision is required. Intra-operative margin assessment does not appear to reduce re-excisions; in particular, surgeons should be aware of the limitations of specimen mammography for margin assessment in DCIS.
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Affiliation(s)
- Alison Laws
- Department of Surgery, Foothills Medical Centre, University of Calgary, Canada
| | - Mantaj S Brar
- Department of Surgery, Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, University of Toronto, Canada
| | | | - Brad Leong
- Cancer Surgery Alberta, Alberta Health Services, Canada
| | - May Lynn Quan
- Department of Surgery, Foothills Medical Centre, University of Calgary, Canada
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30
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Merrill AY, Ochoa D, Klimberg VS, Hill EL, Preston M, Neisler K, Henry-Tillman RS. Cutting Healthcare Costs with Hematoma-Directed Ultrasound-Guided Breast Lumpectomy. Ann Surg Oncol 2018; 25:3076-3081. [DOI: 10.1245/s10434-018-6596-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Indexed: 12/28/2022]
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31
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Vieni S, Graceffa G, Priola R, Fricano M, Latteri S, Latteri MA, Cipolla C. Ultrasound-Guided Breast-Conservative Surgery Decreases the Rate of Reoperations for Palpable Breast Cancer. Am Surg 2018. [DOI: 10.1177/000313481808400663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to verify whether the performance of ultrasound-guided quadrantectomy (USGQ) versus palpation-guided quadrantectomy (PGQ) can reduce the incidence of positive margins and if it can change the attitude of the surgeon. A retrospective study was conducted on 842 patients underwent quadrantectomy for breast cancer, 332 of them underwent USGQ, whereas 550 underwent PGQ. The histological type of the tumors and the margin status obtained with the histological examination were compared. The histological examination of the surgical specimen showed involvement of the margins in 24/842 patients (2.85%), 22 (2.61%) of them belonged to the PGQ group, and two to the USGQ group (P = 0.0011). The highest rate of microscopically positive margins was, statistically significant, for carcinoma in situ, when compared with patients with invasive carcinoma (0.0001). USGQ technique showed several advantages compared with PGQ. In fact, the former notes a lower positive margin rate and, consequently, a lower rate of reintervention. In addition, it may change the surgeon's attitude by causing him to remove another slice of margin to ensure more histological negativity. It should be the gold standard technique for breast-conservative surgery of palpable tumors.
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Affiliation(s)
- Salvatore Vieni
- From the Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Giuseppa Graceffa
- From the Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Roberta Priola
- From the Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Martina Fricano
- From the Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Stefania Latteri
- From the Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Mario A. Latteri
- From the Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Calogero Cipolla
- From the Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
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Philpott A, Wong J, Elder K, Gorelik A, Mann GB, Skandarajah A. Factors influencing reoperation following breast-conserving surgery. ANZ J Surg 2018; 88:922-927. [PMID: 29763991 DOI: 10.1111/ans.14467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Reoperation rates after breast-conserving surgery are highly variable and the best techniques for optimizing margin clearance are being evaluated. The aim was to identify the reoperation rate at our centre and identify influential factors, including a change in guidelines on margin recommendations and the introduction of in-theatre specimen X-ray. METHODS A retrospective review of medical records was undertaken to identify 562 patients who underwent breast conservation at The Royal Melbourne Hospital and Royal Women's Hospital between 2013 and 2015. All cases that underwent subsequent re-excision or total mastectomy were captured and factors influencing margin excision recorded. RESULTS Reoperation was undertaken in 19.5% of patients (110; 86 re-excisions and 24 total mastectomies). There was a reduction in reoperation rate from 25% to 17% (P = 0.01) with adoption of the margin guidelines in 2014, but no significant reduction with the introduction of in-theatre specimen X-ray in 2015 (21% versus 16%, P = 0.14). On multivariate analysis, factors that significantly influenced reoperation rates were the presence of multifocality on mammogram (odds ratio (OR): 5.3, 95% confidence interval (CI): 1.6-16.7, P < 0.01); lesion size on mammogram (OR: 2.2 per 10 mm, 95% CI: 1.4-3.6, P < 0.01); smaller excision specimen weight (OR: 0.5 per 25 g of resection, 95% CI: 0.3-0.8, P < 0.01); and pure ductal carcinoma in situ on final pathology (OR: 5.9, 95% CI: 1.9-16.7, P < 0.01). CONCLUSION Optimizing reoperation rates following breast-conserving surgery remains a surgical challenge, particularly in patients with in situ or multifocal disease. Adoption of international margin guidelines reduced reoperation rates at our centre; however, introduction of intraoperative specimen X-ray had no influence.
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Affiliation(s)
- Andrew Philpott
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Joshua Wong
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Kenneth Elder
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Alexandra Gorelik
- Melbourne EpiCentre, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - G Bruce Mann
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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33
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Sakamoto N, Fukuma E, Tsunoda Y, Teraoka K, Koshida Y. Evaluation of the dislocation and long-term sonographic detectability of a hydrogel-based breast biopsy site marker. Breast Cancer 2018; 25:575-582. [PMID: 29572658 DOI: 10.1007/s12282-018-0854-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the usefulness of the HydroMARK, a hydrogel-based breast biopsy site marker for ultrasound localization of breast lesions, we investigated the tendency for dislocation and sonographic detectability of the marker placed in patients. MATERIALS AND METHODS The marker was placed in lesions that were expected to become obscured after biopsy for a suspicious breast lesion or after neoadjuvant chemotherapy for breast cancer. The patients consented to return for a repeat ultrasound ± mammography examination, and the degree of displacement of the marker was measured as the marker-to-residual lesion distance. RESULTS The marker was placed after stereotactic biopsy, ultrasound-guided biopsy, and before/during neoadjuvant chemotherapy, in 11, 22, and 7 lesions, respectively. Surgical resection was performed for 22 of the 40 lesions, while remaining 18 benign lesions were followed. The marker was sonographically detectable in 89.7% (35/39), 100% (35/35), and 100% (18/18) of the cases, respectively, at a median of 8 days, 13 weeks, and 11 months after the deployment. The degree of displacement was lower in the ultrasound-guided placement group than in the stereotactic placement group (median displacement: 0 vs. 4.3 mm; p = 0.001), it was also lower in the core-needle biopsy and neoadjuvent therapy cases than in the vacuum-assisted biopsy cases (p = 0.003). At a median interval of 2.5 months after deployment, the marker remained unchanged in location in all cases (n = 18, p = NS). CONCLUSIONS The HydroMARK appears to be a safe and effective marker with the advantageous characteristics of a low tendency for dislocation with time and long-term sonographic detectability.
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Affiliation(s)
- Naomi Sakamoto
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.
| | - Eisuke Fukuma
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Yuko Tsunoda
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Ko Teraoka
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Yoshitomo Koshida
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
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Volders JH, Negenborn VL, Haloua MH, Krekel NMA, Jóźwiak K, Meijer S, van den Tol PM. Breast-specific factors determine cosmetic outcome and patient satisfaction after breast-conserving therapy: Results from the randomized COBALT study. J Surg Oncol 2018; 117:1001-1008. [PMID: 29473960 DOI: 10.1002/jso.25012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/15/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES To identify breast-specific factors and the role of tumor, treatment, and patient-related items in influencing patient opinion on cosmesis and satisfaction after breast-conserving therapy (BCT). METHODS Data from the randomized COBALT study was used. At 3, 12, and 36 months, 128 patients with T1-T2 breast cancer completed a questionnaire on breast-specific factors and overall cosmetic outcome and patient satisfaction, using a 4-point Likert scale. RESULTS There was a strong positive correlation between breast-specific factors, overall cosmetic outcome,and satisfaction at all time-points. Excellent/good cosmetic outcomes and satisfaction decreased during follow-up. A shift was noted in the degree of influence of the various breast-specific factors. At 3 years, symmetry factors such as size, shape, and nipple position largely determined a patient's opinion on the final cosmesis, followed by firmness. The risk of an unacceptable outcome was associated with young age and large excision volumes. CONCLUSION A questionnaire including breast-specific questions provides important information on final cosmetic results and satisfaction after BCT. These outcomes can also be of great value as quality indicators and pre-operative counseling. The major influence of breast-specific factors on asymmetry underlines the importance of achieving an optimal excision volume at the initial procedure.
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Affiliation(s)
- José H Volders
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Vera L Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Max H Haloua
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole M A Krekel
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, NKI-AVL, Amsterdam, The Netherlands
| | - Sybren Meijer
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Lan L, Xia Y, Li R, Liu K, Mai J, Medley JA, Obeng-Gyasi S, Han LK, Wang P, Cheng JX. A fiber optoacoustic guide with augmented reality for precision breast-conserving surgery. LIGHT, SCIENCE & APPLICATIONS 2018; 7:2. [PMID: 30839601 PMCID: PMC6107008 DOI: 10.1038/s41377-018-0006-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 05/19/2023]
Abstract
Lumpectomy, also called breast-conserving surgery, has become the standard surgical treatment for early-stage breast cancer. However, accurately locating the tumor during a lumpectomy, especially when the lesion is small and nonpalpable, is a challenge. Such difficulty can lead to either incomplete tumor removal or prolonged surgical time, which result in high re-operation rates (~25%) and increased surgical costs. Here, we report a fiber optoacoustic guide (FOG) with augmented reality (AR) for sub-millimeter tumor localization and intuitive surgical guidance with minimal interference. The FOG is preoperatively implanted in the tumor. Under external pulsed light excitation, the FOG omnidirectionally broadcasts acoustic waves through the optoacoustic effect by a specially designed nano-composite layer at its tip. By capturing the acoustic wave, three ultrasound sensors on the breast skin triangulate the FOG tip's position with 0.25-mm accuracy. An AR system with a tablet measures the coordinates of the ultrasound sensors and transforms the FOG tip's position into visual feedback with <1-mm accuracy, thus aiding surgeons in directly visualizing the tumor location and performing fast and accurate tumor removal. We further show the use of a head-mounted display to visualize the same information in the surgeons' first-person view and achieve hands-free guidance. Towards clinical application, a surgeon successfully deployed the FOG to excise a "pseudo tumor" in a female human cadaver. With the high-accuracy tumor localization by FOG and the intuitive surgical guidance by AR, the surgeon performed accurate and fast tumor removal, which will significantly reduce re-operation rates and shorten the surgery time.
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Affiliation(s)
- Lu Lan
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Yan Xia
- Vibronix, Inc., 1281 Win Hentschel Boulevard, West Lafayette, IN 47906 USA
| | - Rui Li
- Department of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 USA
| | - Kaiming Liu
- Department of Precision Instrument, Tsinghua University, Beijing, 10084 China
| | - Jieying Mai
- Department of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907 USA
| | - Jennifer Anne Medley
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd, Indianapolis, IN 46202 USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Indianapolis, IN 46202 USA
| | - Linda K. Han
- Parkview Cancer Institute, 11109 Parkview Plaza Drive, Fort Wayne, IN 46845 USA
| | - Pu Wang
- Vibronix, Inc., 1281 Win Hentschel Boulevard, West Lafayette, IN 47906 USA
| | - Ji-Xin Cheng
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
- Department of Electrical & Computer Engineering, Boston University, 8 Saint Mary’s Street, Boston, MA 02215 USA
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36
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Reyna C, DeSnyder SM. Intraoperative Margin Assessment in Breast Cancer Management. Surg Oncol Clin N Am 2018; 27:155-165. [DOI: 10.1016/j.soc.2017.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Comparative Evaluation of Iodine-125 Radioactive Seed Localization and Wire Localization for Resection of Breast Lesions. Can Assoc Radiol J 2017; 68:447-455. [DOI: 10.1016/j.carj.2017.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/14/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose Radioactive seed localization (RSL) uses a titanium seed labeled with iodine-125 energy for surgery of nonpalpable breast lesions. RSL facilitates radiology–surgery scheduling and allows for improved oncoplasty compared with wire localization (WL). The purpose of this work was to compare the 2 techniques. Methods We performed a retrospective study of all breast lesions operated with RSL between February 2013 and March 2015 at our university institution, and compared with an equivalent number of surgeries performed with a single WL. Imaging and pathology reports were reviewed for information on guidance mode, accuracy of targeting, nature of excised lesion, size and volume of surgical specimen, status of margins, and reinterventions. Results A total of 254 lesions (247 women) were excised with RSL and compared with 257 lesions (244 women) whose surgery was guided by WL. Both groups were comparable in lesion pathology, guidance mode for RSL or WL positioning, and accuracy of targeting (98% correct). Mean delay between biopsy and surgery was 84 days for RSL versus 103 after WL ( P = .04). No differences were noted after RSL or WL for surgical specimen mean weight, largest diameter, and volume excised. For malignancies, the rate of positive margins was comparable (2.8%-3%), with 5 of 10 women in the RSL group who underwent a second surgery displaying residual malignancy compared with 3 of 9 women in the WL group. Conclusions RSL is safe and accurate, and has comparable surgical endpoints to WL. Because RSL offers flexible scheduling and facilitated oncoplasty, RSL may replace WL for resection of nonpalpable single breast lesions.
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Gunn J, McLaughlin S. Current Trends in Localization Techniques for Non-palpable Breast Lesions: Making the Invisible Visible. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0244-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Carmon M, Olsha O, Gekhtman D, Nikitin I, Cohen Y, Messing M, Lioubashevsky N, Abu Dalo R, Hadar T, Golomb E. Detectability of Hygroscopic Clips Used in Breast Cancer Surgery. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:401-408. [PMID: 28039936 DOI: 10.7863/ultra.16.02053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/25/2016] [Indexed: 06/06/2023]
Abstract
Sonographically detectable clips were introduced over the last decade. We retrospectively studied the rate and duration of sonographically detectable clip detectability in patients with breast cancer who had sonographically detectable clips inserted over a 2-year period. Nine of 26 patients had neoadjuvant chemotherapy, with all clips remaining detectable 140 to 187 days after insertion. Six of the 9 had intraoperative sonographic localization, with 1 reoperation (17%). Eleven additional patients with nonpalpable tumors and sonographically detectable clips had intraoperative sonographic localization with 1 reoperation (9%). In 1 patient, a sonographically detectable clip enabled intraoperative identification of a suspicious lymph node. There were no complications or clip migration. Sonographically detectable clips are helpful in breast cancer surgery with and without neoadjuvant chemotherapy, remaining detectable for many months and often averting preoperative localization and scheduling difficulties.
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Affiliation(s)
- Moshe Carmon
- Breast Health Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Oded Olsha
- Breast Health Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - David Gekhtman
- Breast Imaging Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Irena Nikitin
- Breast Imaging Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Yamin Cohen
- Hala: the Rachel Nash Jerusalem Comprehensive Breast Clinic, Jerusalem, Israel
| | - Michael Messing
- Hala: the Rachel Nash Jerusalem Comprehensive Breast Clinic, Jerusalem, Israel
| | | | - Ribhi Abu Dalo
- Breast Health Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Tal Hadar
- Breast Health Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Eliahu Golomb
- Department of Pathology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
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Volders JH, Haloua MH, Krekel NMA, Negenborn VL, Kolk RHE, Lopes Cardozo AMF, Bosch AM, de Widt-Levert LM, van der Veen H, Rijna H, Taets van Amerongen AHM, Jóźwiak K, Meijer S, van den Tol MP. Intraoperative ultrasound guidance in breast-conserving surgery shows superiority in oncological outcome, long-term cosmetic and patient-reported outcomes: Final outcomes of a randomized controlled trial (COBALT). Eur J Surg Oncol 2016; 43:649-657. [PMID: 27916314 DOI: 10.1016/j.ejso.2016.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/18/2016] [Accepted: 11/03/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The multicenter randomized controlled COBALT trial demonstrated that ultrasound-guided breast-conserving surgery (USS) results in a significant reduction of margin involvement (3.1% vs. 13%) and excision volumes compared to palpation-guided surgery (PGS). The aim of the present study was to determine long term oncological and patient-reported outcomes including quality of life (QoL), together with their progress over time. METHODS 134 patients with T1-T2 breast cancer were randomized to USS (N = 65) or PGS (N = 69). Cosmetic outcomes were assessed with the Breast Cancer Conservative Treatment cosmetic results (BCCT.core) software, panel-evaluation and patient self-evaluation on a 4-point Likert-scale. QoL was measured using the EORTC QLQ-C30/-BR23 questionnaire. RESULTS No locoregional recurrences were reported after mean follow-up of 41 months. Seven patients (5%) developed distant metastatic disease (USS 6.3%, PGS 4.4%, p = 0.466), of whom six died of disease (95.5% overall survival). USS achieved better cosmetic outcomes compared to PGS, with poor outcomes of 11% and 21% respectively, a result mainly attributable to mastectomies due to involved margins following PGS. There was no difference after 1 and 3 years in cosmetic outcome. Dissatisfied patients included those with larger excision volumes, additional local therapies and worse QoL. Patients with poor/fair cosmetic outcomes scored significantly lower on aspects of QoL, including breast-symptoms, body image and sexual enjoyment. CONCLUSION By significantly reducing positive margin status and lowering resection volumes, USS improves the rate of good cosmetic outcomes and increases patient-satisfaction. Considering the large impact of cosmetic outcome on QoL, USS has great potential to improve QoL following breast-conserving therapy.
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Affiliation(s)
- J H Volders
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
| | - M H Haloua
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - N M A Krekel
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - V L Negenborn
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - R H E Kolk
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - A M F Lopes Cardozo
- Department of Surgery, Northwest Clinics, Wilhelminalaan 12, 1815JD Alkmaar, The Netherlands.
| | - A M Bosch
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
| | - L M de Widt-Levert
- Department of Surgery, Waterland Hospital, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands.
| | - H van der Veen
- Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands.
| | - H Rijna
- Department of Surgery, Kennemergasthuis, Boerhaavelaan 22, 2035 RC Haarlem, The Netherlands.
| | - A H M Taets van Amerongen
- Department of Radiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - K Jóźwiak
- Department of Epidemiology and Biostatistics, NKI-AVL, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | - S Meijer
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - M P van den Tol
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Evaluation of the sonographic visibility and sonographic appearance of the breast biopsy marker (UltraClip®) placed in phantoms and patients. Breast Cancer 2016; 24:585-592. [DOI: 10.1007/s12282-016-0741-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Cox CE, Russell S, Prowler V, Carter E, Beard A, Mehindru A, Blumencranz P, Allen K, Portillo M, Whitworth P, Funk K, Barone J, Norton D, Schroeder J, Police A, Lin E, Combs F, Schnabel F, Toth H, Lee J, Anglin B, Nguyen M, Canavan L, Laidley A, Warden MJ, Prati R, King J, Shivers SC. A Prospective, Single Arm, Multi-site, Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Location of Nonpalpable Breast Lesions during Excision. Ann Surg Oncol 2016; 23:3168-74. [DOI: 10.1245/s10434-016-5405-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/18/2022]
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Ultrasound-guided breast-conserving surgery for early-stage palpable and nonpalpable invasive breast cancer: decreased excision volume at unchanged tumor-free resection margin. Breast Cancer Res Treat 2016; 158:535-41. [PMID: 27444926 DOI: 10.1007/s10549-016-3914-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/14/2016] [Indexed: 01/08/2023]
Abstract
Ultrasound guidance (USG) during breast-conserving surgery improves tumor-free surgical resection margins. The objective of this study was to evaluate whether USG reduces resection volumes without compromising margin status. 134 patients with palpable or nonpalpable T1-2N0-1 invasive breast cancer were treated with USG and compared with a historical reference control group (CON) consisting of palpation-guided (PAG) or wire-guided localization (WIG) breast-conserving surgery. Primary outcomes were excess resection volume and clear margin status, and secondary outcome was re-excision rate. 66 patients underwent USG. In the CON group (n = 68), PAG was performed in 24 (35 %) and WIG in 44 (64 %) patients. Median excision volume [39 (IQR 20-66) vs 56 (38-94) cm(3); p = 0.001] and median calculated resection ratio [1.7 (1.0-2.9) vs 2.8 (1.4-4.6) (p = 0.005)] were significantly smaller in the USG than in the CON group. Median minimal distance to the resection margin [4 mm (IQR 2-5 mm) vs 2 mm (1-4 mm), p = 0.004] was significantly larger. Clear resection margins were achieved in 58 of the USG patients (88 %) and in 58 of the CON patients (86 %) (p = 0.91); this was true in patients with palpable as well as nonpalpable lesions. Reexcision was needed in 6.1 and 7.2 % respectively. Relative risk for re-excision in the USG group was 0.82 (95 % CI 0.23-2.93). In patients with palpable and nonpalpable breast cancers, USG allows for lower excision volume and reduced resection of healthy breast tissue, without increased re-excision rate.
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Neoadjuvant chemotherapy in breast-conserving surgery – Consequences on margin status and excision volumes. Eur J Surg Oncol 2016; 42:986-93. [DOI: 10.1016/j.ejso.2016.02.252] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/21/2016] [Accepted: 02/24/2016] [Indexed: 11/20/2022] Open
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Gentile LF, Himmler A, Shaw CM, Bouton A, Vorhis E, Marshall J, Spiguel LRP. Ultrasound-Guided Segmental Mastectomy and Excisional Biopsy Using Hydrogel-Encapsulated Clip Localization as an Alternative to Wire Localization. Ann Surg Oncol 2016; 23:3284-9. [DOI: 10.1245/s10434-016-5325-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 01/22/2023]
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Espinosa-Bravo M, Rubio IT. Intraoperative ultrasound guided breast surgery: paving the way for personalized surgery. Gland Surg 2016; 5:366-8. [PMID: 27294242 DOI: 10.21037/gs.2016.03.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Martin Espinosa-Bravo
- Breast Surgical Oncology, Breast Cancer Center, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Isabel T Rubio
- Breast Surgical Oncology, Breast Cancer Center, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Lee J, Park HY, Jung JH, Kim WW, Hwang SO, Kwon TJ, Chung JH, Bae Y. Non-stereotactic method involving combination of ultrasound-guided wire localization and vacuum-assisted breast biopsy for microcalcification. Gland Surg 2016; 5:300-5. [PMID: 27294037 DOI: 10.21037/gs.2015.12.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stereotactic breast biopsy is a standard intervention for evaluation of "microcalcification-only" lesions. However, an expensive stereotactic device and radiologic expertise are necessary for this procedure. We herein report a non-stereotactic technique involving the combination of wire localization and vacuum-assisted breast biopsy (VABB) under ultrasound (US) guidance. METHODS Twenty-two consecutive patients with category 3 or 4a microcalcification only as shown by mammography underwent the above-mentioned non-stereotactic combination method involving US-guided wire localization and VABB. The location of the microcalcification was measured by manual stereotaxis, and the microcalcification was confirmed by specimen mammography after the procedure. RESULTS The mean number ± standard deviation of removed cores and calcified cores was 28.4±13.4 and 2.2±0.9, respectively. In one case, the procedure was repeated 3 times. The histologic diagnoses were fibrocystic change (n=14), fibroadenoma (n=4), sclerosing adenosis (n=1), usual ductal hyperplasia (n=2), and atypical ductal hyperplasia (n=1). CONCLUSIONS "Microcalcification-only" breast lesions can be easily evaluated with the combination of non-stereotactic US-guided wire localization and VABB. This would be an effective diagnostic technique for breast lesion which reveals only microcalcification.
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Affiliation(s)
- Jeeyeon Lee
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ho Yong Park
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin Hyang Jung
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Wan Wook Kim
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seung Ook Hwang
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Taek Ju Kwon
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin Ho Chung
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Youngtae Bae
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Rubio I, Ahmed M, Kovacs T, Marco V. Margins in breast conserving surgery: A practice-changing process. Eur J Surg Oncol 2016; 42:631-40. [DOI: 10.1016/j.ejso.2016.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/18/2016] [Indexed: 11/17/2022] Open
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Cox CE, Garcia-Henriquez N, Glancy MJ, Whitworth P, Cox JM, Themar-Geck M, Prati R, Jung M, Russell S, Appleton K, King J, Shivers SC. Pilot Study of a New Nonradioactive Surgical Guidance Technology for Locating Nonpalpable Breast Lesions. Ann Surg Oncol 2016; 23:1824-30. [DOI: 10.1245/s10434-015-5079-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Indexed: 01/05/2023]
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50
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Rubio IT, Esgueva-Colmenarejo A, Espinosa-Bravo M, Salazar JP, Miranda I, Peg V. Intraoperative Ultrasound-Guided Lumpectomy Versus Mammographic Wire Localization for Breast Cancer Patients After Neoadjuvant Treatment. Ann Surg Oncol 2016; 23:38-43. [DOI: 10.1245/s10434-015-4935-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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