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Varghese J, Patani N, Wazir U, Novintan S, Michell MJ, Malhotra A, Mokbel K, Mokbel K. Wire-Free Targeted Axillary Dissection: A Pooled Analysis of 1300+ Cases Post-Neoadjuvant Systemic Therapy in Node-Positive Early Breast Cancer. Cancers (Basel) 2024; 16:2172. [PMID: 38927878 PMCID: PMC11201777 DOI: 10.3390/cancers16122172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Recent advances in neoadjuvant systemic therapy (NST) have significantly improved pathologic complete response rates in early breast cancer, challenging the role of axillary lymph node dissection in nose-positive patients. Targeted axillary dissection (TAD) integrates marked lymph node biopsy (MLNB) and tracer-guided sentinel lymph node biopsy (SLNB). The introduction of new wire-free localisation markers (LMs) has streamlined TAD and increased its adoption. The primary endpoints include the successful localisation and retrieval rates of LMs. The secondary endpoints include the pathological complete response (pCR), SLNB, and MLNB concordance, as well as false-negative rates. Seventeen studies encompassing 1358 TAD procedures in 1355 met the inclusion criteria. The localisation and retrieval rate of LMs were 97% and 99%. A concordance rate of 67% (95% CI: 64-70) between SLNB and MLNB was demonstrated. Notably, 49 days (range: 0-272) was the average LM deployment time to surgery. pCR was observed in 46% (95% CI: 43-49) of cases, with no significant procedure-related complications. Omitting MLNB or SLNB would have under-staged the axilla in 15.2% or 5.4% (p = 0.0001) of cases, respectively. MLNB inclusion in axillary staging post-NST for initially node-positive patients is crucial. The radiation-free Savi Scout, with its minimal MRI artefacts, is the preferred technology for TAD.
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Affiliation(s)
- Jajini Varghese
- The London Breast Institute, The Women’s Health Centre, HCA Healthcare UK, London W1U 9QP, UK
- Royal Free London NHS Trust, Pond Street, London NW3 2QG, UK
- Division of Surgery and Interventional Sciences, University College London, London WC1E 6BT, UK
| | - Neill Patani
- The London Breast Institute, The Women’s Health Centre, HCA Healthcare UK, London W1U 9QP, UK
- Division of Surgery and Interventional Sciences, University College London, London WC1E 6BT, UK
| | - Umar Wazir
- The London Breast Institute, The Women’s Health Centre, HCA Healthcare UK, London W1U 9QP, UK
| | - Shonnelly Novintan
- The London Breast Institute, The Women’s Health Centre, HCA Healthcare UK, London W1U 9QP, UK
- East Suffolk North Essex NHS Foundation Trust, Turner Road, Colchester CO4 5JL, UK
| | - Michael J. Michell
- The London Breast Institute, The Women’s Health Centre, HCA Healthcare UK, London W1U 9QP, UK
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Anmol Malhotra
- The London Breast Institute, The Women’s Health Centre, HCA Healthcare UK, London W1U 9QP, UK
- Royal Free London NHS Trust, Pond Street, London NW3 2QG, UK
- Division of Surgery and Interventional Sciences, University College London, London WC1E 6BT, UK
| | - Kinan Mokbel
- The London Breast Institute, The Women’s Health Centre, HCA Healthcare UK, London W1U 9QP, UK
- Health and Care Profession Department, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter EX1 2HZ, UK
| | - Kefah Mokbel
- The London Breast Institute, The Women’s Health Centre, HCA Healthcare UK, London W1U 9QP, UK
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Alamoodi M, Wazir U, Sakr RA, Venkataraman J, Mokbel K, Mokbel K. Evaluating Magnetic Seed Localization in Targeted Axillary Dissection for Node-Positive Early Breast Cancer Patients Receiving Neoadjuvant Systemic Therapy: A Comprehensive Review and Pooled Analysis. J Clin Med 2024; 13:2908. [PMID: 38792449 PMCID: PMC11122577 DOI: 10.3390/jcm13102908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: De-escalation of axillary surgery is made possible by advancements in both neoadjuvant systemic therapy (NST) and in localisation technology for breast lesions. Magseed®, developed in 2013 by Dr. Michael Douk of Cambridge, United Kingdom, is a wire-free localisation technology that facilitates the localisation and retrieval of lymph nodes for staging. Targeted axillary dissection (TAD), which entails marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB), has emerged as the preferred method to assess residual disease in post-NST node-positive patients. This systematic review and pooled analysis evaluate the performance of Magseed® in TAD. Methods: The search was carried out in PubMed and Google Scholar. An assessment of localisation, retrieval rates, concordance between MLNB and SLNB, and pathological complete response (pCR) in clinically node-positive patients post NST was undertaken. Results: Nine studies spanning 494 patients and 497 procedures were identified, with a 100% successful deployment rate, a 94.2% (468/497) [95% confidence interval (CI), 93.7-94.7] localisation rate, a 98.8% (491/497) retrieval rate, and a 68.8% (247/359) [95% CI 65.6-72.0] concordance rate. pCR was observed in 47.9% (220/459) ) [95% CI 43.3-52.6] of cases. Subgroup analysis of studies reporting the pathological status of MLNB and SLNB separately revealed an FNR of 4.2% for MLNB and 17.6% for SLNB (p = 0.0013). Mean duration of implantation was 37 days (range: 0-188). Conclusions: These findings highlight magnetic seed localisation's efficacy in TAD for NST-treated node-positive patients, aiding in accurate axillary pCR identification and safe de-escalation of axillary surgery in excellent responders.
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Affiliation(s)
- Munaser Alamoodi
- London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (U.W.); (J.V.); (K.M.)
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Umar Wazir
- London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (U.W.); (J.V.); (K.M.)
| | - Rita A. Sakr
- College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Department of Oncoplastic Surgery, King’s College Hospital London, Dubai P.O. Box 340901, United Arab Emirates
| | - Janhavi Venkataraman
- London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (U.W.); (J.V.); (K.M.)
| | - Kinan Mokbel
- London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (U.W.); (J.V.); (K.M.)
- Health and Care Profession Department, College of Medicine and Health, University of Exeter Medical School, Exeter B3183, UK
| | - Kefah Mokbel
- London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (U.W.); (J.V.); (K.M.)
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Harvey J, Morgan J, Lowes S, Milligan R, Barrett E, Carmichael A, Elgammal S, Masudi T, Holcombe C, Masannat Y, Potter S, Dave RV. Wire- and radiofrequency identification tag-guided localization of impalpable breast lesions: iBRA-NET localization study. Br J Surg 2024; 111:znae007. [PMID: 38326941 DOI: 10.1093/bjs/znae007] [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: 07/18/2023] [Revised: 11/12/2023] [Accepted: 01/01/2024] [Indexed: 02/09/2024]
Abstract
A national cohort ideal stage 2a/2b study comparing the safety and effectiveness of Wire- and RFID -guided localisation for impalpable breast lesions.
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Affiliation(s)
- James Harvey
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Doncaster, UK
| | - Simon Lowes
- Breast Unit, Gateshead Health NHS Foundation Trust, Gateshead, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Milligan
- Breast Unit, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Emma Barrett
- Department of Medical Statistics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Amtul Carmichael
- University Hospital of Derby and Burton NHS Foundation Trust, Queens Hospital, Burton upon Trent, UK
| | - Suzanne Elgammal
- Breast Unit, University Hospital Crosshouse, NHS Ayrshire and Arran, Crosshouse, Kilmarnock, UK
| | - Tahir Masudi
- Breast Unit, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Chris Holcombe
- Breast Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | - Rajiv V Dave
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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4
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Streeter SS, Zuurbier RA, diFlorio-Alexander RM, Hansberry MT, Maloney BW, Pogue BW, Wells WA, Paulsen KD, Barth RJ. Breast-Conserving Surgery Margin Guidance Using Micro-Computed Tomography: Challenges When Imaging Radiodense Resection Specimens. Ann Surg Oncol 2023; 30:4097-4108. [PMID: 37041429 PMCID: PMC10600965 DOI: 10.1245/s10434-023-13364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Breast-conserving surgery (BCS) is an integral component of early-stage breast cancer treatment, but costly reexcision procedures are common due to the high prevalence of cancer-positive margins on primary resections. A need exists to develop and evaluate improved methods of margin assessment to detect positive margins intraoperatively. METHODS A prospective trial was conducted through which micro-computed tomography (micro-CT) with radiological interpretation by three independent readers was evaluated for BCS margin assessment. Results were compared to standard-of-care intraoperative margin assessment (i.e., specimen palpation and radiography [abbreviated SIA]) for detecting cancer-positive margins. RESULTS Six hundred margins from 100 patients were analyzed. Twenty-one margins in 14 patients were pathologically positive. On analysis at the specimen-level, SIA yielded a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 42.9%, 76.7%, 23.1%, and 89.2%, respectively. SIA correctly identified six of 14 margin-positive cases with a 23.5% false positive rate (FPR). Micro-CT readers achieved sensitivity, specificity, PPV, and NPV ranges of 35.7-50.0%, 55.8-68.6%, 15.6-15.8%, and 86.8-87.3%, respectively. Micro-CT readers correctly identified five to seven of 14 margin-positive cases with an FPR range of 31.4-44.2%. If micro-CT scanning had been combined with SIA, up to three additional margin-positive specimens would have been identified. DISCUSSION Micro-CT identified a similar proportion of margin-positive cases as standard specimen palpation and radiography, but due to difficulty distinguishing between radiodense fibroglandular tissue and cancer, resulted in a higher proportion of false positive margin assessments.
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Affiliation(s)
- Samuel S Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, USA.
| | - Rebecca A Zuurbier
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
| | - Roberta M diFlorio-Alexander
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
| | - Mark T Hansberry
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Wendy A Wells
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
| | - Richard J Barth
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA.
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
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5
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Christenhusz A, den Dekker BM, van Dalen T, Jongen L, van der Schaaf MC, Alic L, Ten Haken B, Pijnappel RM, Dassen AE. Radiofrequency localization of nonpalpable breast cancer in a multicentre prospective cohort study: feasibility, clinical acceptability, and safety. Breast Cancer Res Treat 2023:10.1007/s10549-023-07006-x. [PMID: 37322358 DOI: 10.1007/s10549-023-07006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE In breast conserving surgery, accurate lesion localization is essential for obtaining adequate surgical margins. Preoperative wire localization (WL) and radioactive seed localization (RSL) are widely accepted methods to guide surgical excision of nonpalpable breast lesions but are limited by logistical challenges, migration issues, and legislative complexities. Radiofrequency identification (RFID) technology may offer a viable alternative. The purpose of this study was to evaluate the feasibility, clinical acceptability, and safety of RFID surgical guidance for localization of nonpalpable breast cancer. METHODS In a prospective multicentre cohort study, the first 100 RFID localization procedures were included. The primary outcome was the percentage of clear resection margins and re-excision rate. Secondary outcomes included procedure details, user experience, learningcurve, and adverse events. RESULTS Between April 2019 and May 2021, 100 women underwent RFID guided breast conserving surgery. Clear resection margins were obtained in 89 out of 96 included patients (92.7%), re-excision was indicated in three patients (3.1%). Radiologists reported difficulties with the placement of the RFID tag, partially related to the relatively large needle-applicator (12-gauge). This led to the premature termination of the study in the hospital using RSL as regular care. The radiologist experience was improved after a manufacturer modification of the needle-applicator. Surgical localization involved a low learning curve. Adverse events (n = 33) included dislocation of the marker during insertion (8%) and hematomas (9%). The majority of adverse events (85%) occurred using the first-generation needle-applicator. CONCLUSION RFID technology is a potential alternative for non-radioactive and non-wire localization of nonpalpable breast lesions.
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Affiliation(s)
- Anke Christenhusz
- Department of Surgery, Medisch Spectrum Twente Enschede, Enschede, The Netherlands.
- University of Twente, Magnetic Detection and Imaging Group, Enschede, The Netherlands.
| | - Bianca M den Dekker
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Lisa Jongen
- Department of Radiology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | | | - Lejla Alic
- University of Twente, Magnetic Detection and Imaging Group, Enschede, The Netherlands
| | - Bennie Ten Haken
- University of Twente, Magnetic Detection and Imaging Group, Enschede, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Anneriet E Dassen
- Department of Surgery, Medisch Spectrum Twente Enschede, Enschede, The Netherlands
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6
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Image-Guided Radar Reflector Localization for Small Soft-Tissue Lesions in the Musculoskeletal System. AJR Am J Roentgenol 2023; 220:399-406. [PMID: 36259594 DOI: 10.2214/ajr.22.28399] [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: 01/19/2023]
Abstract
Preoperative localization of nonpalpable breast lesions using a radar reflector surgical guidance system has become commonplace, but the clinical utility of this emerging technology in the musculoskeletal system has not yet been well established. The system components include a console, a handpiece, an implanted radiofrequency reflector that works as a lesion marker, and an infrared light-emitting probe to guide the surgeon. The reflector can be deployed to localize small nonpalpable nodules within the subcutaneous fat as well as lesions within the deeper soft tissues. It can also be used for lymph nodes and foreign bodies. Localization can be performed both before and after treatment. The objective of this article is to describe the potential applications and our technique and initial experience for radar reflector localization within the musculoskeletal system.
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7
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Banys-Paluchowski M, Kühn T, Masannat Y, Rubio I, de Boniface J, Ditsch N, Karadeniz Cakmak G, Karakatsanis A, Dave R, Hahn M, Potter S, Kothari A, Gentilini OD, Gulluoglu BM, Lux MP, Smidt M, Weber WP, Aktas Sezen B, Krawczyk N, Hartmann S, Di Micco R, Nietz S, Malherbe F, Cabioglu N, Canturk NZ, Gasparri ML, Murawa D, Harvey J. Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411). Cancers (Basel) 2023; 15:cancers15041173. [PMID: 36831516 PMCID: PMC9954476 DOI: 10.3390/cancers15041173] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Surgical excision of a non-palpable breast lesion requires a localization step. Among available techniques, wire-guided localization (WGL) is most commonly used. Other techniques (radioactive, magnetic, radar or radiofrequency-based, and intraoperative ultrasound) have been developed in the last two decades with the aim of improving outcomes and logistics. METHODS We performed a systematic review on localization techniques for non-palpable breast cancer. RESULTS For most techniques, oncological outcomes such as lesion identification and clear margin rate seem either comparable with or better than for WGL, but evidence is limited to small cohort studies for some of the devices. Intraoperative ultrasound is associated with significantly higher negative margin rates in meta-analyses of randomized clinical trials (RCTs). Radioactive techniques were studied in several RCTs and are non-inferior to WGL. Smaller studies show higher patient preference towards wire-free localization, but little is known about surgeons' and radiologists' attitudes towards these techniques. CONCLUSIONS Large studies with an additional focus on patient, surgeon, and radiologist preference are necessary. This review aims to present the rationale for the MELODY (NCT05559411) study and to enable standardization of outcome measures for future studies.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
- Correspondence:
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Die Filderklinik, 70794 Filderstadt, Germany
| | - Yazan Masannat
- Aberdeen Breast Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Isabel Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, 28027 Madrid, Spain
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Surgery, Capio St. Göran’s Hospital, 11219 Stockholm, Sweden
| | - Nina Ditsch
- Breast Cancer Center, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Güldeniz Karadeniz Cakmak
- Breast and Endocrine Unit, General Surgery Department, Zonguldak BEUN The School of Medicine, Kozlu/Zonguldak 67600, Turkey
| | - Andreas Karakatsanis
- Department for Surgical Sciences, Faculty of Pharmacy and Medicine, Uppsala University, 75236 Uppsala, Sweden
- Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, 75236 Uppsala, Sweden
| | - Rajiv Dave
- Nightingale & Genesis Breast Cancer Prevention Centre, Manchester University NHS Foundation Trust, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Markus Hahn
- Department for Women’s Health, University of Tübingen, 72076 Tübingen, Germany
| | - Shelley Potter
- Bristol Medical School (THS), Bristol Population Health Science Institute, Bristol BS8 1QU, UK
| | - Ashutosh Kothari
- Guy’s & St Thomas NHS Foundation Trust, Kings College, London SE1 9RT, UK
| | - Oreste Davide Gentilini
- Department of Breast Surgery, San Raffaele University and Research Hospital, 20132 Milan, Italy
| | - Bahadir M. Gulluoglu
- Department of Surgery, Breast Surgery Unit, Marmara University School of Medicine and SENATURK Turkish Academy of Senology, Istanbul 34854, Turkey
| | - Michael Patrick Lux
- Department of Gynecology and Obstetrics, St. Louise Frauen-und Kinderklinik, 33098 Paderborn, Germany
| | - Marjolein Smidt
- Department of Surgical Oncology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Walter Paul Weber
- Division of Breast Surgery, Department of Surgery, Basel University Hospital, 4031 Basel, Switzerland
| | - Bilge Aktas Sezen
- European Breast Cancer Research Association of Surgical Trialists (EUBREAST), 73730 Esslingen, Germany
| | - Natalia Krawczyk
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Steffi Hartmann
- Department of Gynecology and Obstetrics, University Hospital Rostock, 18059 Rostock, Germany
| | - Rosa Di Micco
- Department of Breast Surgery, San Raffaele University and Research Hospital, 20132 Milan, Italy
| | - Sarah Nietz
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Francois Malherbe
- Breast and Endocrine Surgery Unit, Groote Schuur Hospital, University of Cape Town, Cape Town 7935, South Africa
| | - Neslihan Cabioglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul 34093, Turkey
| | - Nuh Zafer Canturk
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli 41001, Turkey
| | - Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, 6900 Lugano, Switzerland
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale, Via Pietro Capelli 1, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Via Giuseppe Buffi 13, 6900 Lugano, Switzerland
| | - Dawid Murawa
- General Surgery and Surgical Oncology Department, Collegium Medicum, University in Zielona Gora, 65-417 Zielona Góra, Poland
| | - James Harvey
- Nightingale & Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester M13 9PL, UK
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D’Angelo A, Trombadori CML, Caprini F, Lo Cicero S, Longo V, Ferrara F, Palma S, Conti M, Franco A, Scardina L, D’Archi S, Belli P, Manfredi R. Efficacy and Accuracy of Using Magnetic Seed for Preoperative Non-Palpable Breast Lesions Localization: Our Experience with Magseed. Curr Oncol 2022; 29:8468-8474. [PMID: 36354727 PMCID: PMC9689792 DOI: 10.3390/curroncol29110667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
In this retrospective study we share our single-center experience using a magnetic seed for the preoperative localization of non-palpable breast lesions. Patients who underwent a preoperative localization with Magseed® (Endomagnetics, Cambridge, UK) placement between 2020 and 2022 were enrolled. Indications to Magseed placement have been established during multidisciplinary meetings prior to surgery and all patients underwent breast-conserving surgery (BCS). 45 patients were included. Magnetic seeds have been introduced under ultrasound guidance in 40 patients (88.9%) and under stereotactic guidance in 5 patients (11.1%). We registered a highly successful placement rate (97.8%), with only one case of migration (2.2%). After BCS, all the magnetic seeds were recovered (100% retrieval rate). The re-excision rate for positive margins was 0%. Our experience, with a highly successful placement and retrieval rate and a re-excision rate equal to 0%, is consistent with the encouraging literature published on Magseed so far, suggesting this technique to be extremely effective. Moreover, our single case of seed migration supports the existing data stating that Magseed migration is rare. In conclusion, despite acknowledging Magseed limitations, we highly value the advantages linked to this technique, and we, therefore, uphold its use.
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Affiliation(s)
- Anna D’Angelo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Charlotte Marguerite Lucille Trombadori
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Flavia Caprini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Stefano Lo Cicero
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Valentina Longo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Francesca Ferrara
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Simone Palma
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Marco Conti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Sabatino D’Archi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Paolo Belli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
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Radiofrequency Identification—RFID using LOCalizer-Tag in Non-palpable Breast Lump. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
For many years, wire-guided localization represented the gold standard method for the detection of non-palpable breast lesions, despite the acknowledged limitations. LOCalizer™ is the most recent and promising radiofrequency identification system, characterized by the capability of measuring the distance from the tagged lesion in millimeters and the association of each marker with a unique code. A 45-year-old woman with two lesions suspected of cancer in the same breast was referred to our department. She underwent double localization with LOCalizer™ (Hologic, Santa Carla, CA, USA) of the lumps into opposite quadrants. We performed a mini-invasive and oncologically safe surgical excision through a tunneling approach after a peri-areolar incision. The surgical technique realized with Localizer™ could be an effective method for locating multiple non-palpable breast lesions and is able to offer excellent oncological and cosmetic results, as also confirmed by several reports in the literature.
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10
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Comparison of Wireless Localization Alternatives with Wire Localization for Nonpalpable Breast Lesions. J Am Coll Surg 2022; 234:1091-1099. [PMID: 35703803 DOI: 10.1097/xcs.0000000000000170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Radiofrequency identification tag localization (TL) and magnetic seed localization (MSL) are alternatives to wire localization (WL) for excision of nonpalpable breast lesions. We sought to compare localization methods with respect to operative time, specimen volume, and re-excision rate. STUDY DESIGN A retrospective cohort analysis was performed on TL, MSL, and WL lumpectomies and excisional biopsies at a single institution. Association between localization method and operative time, specimen volume, and re-excision rate was assessed by multiple logistic regression using odds ratios (ORs) and 95% CIs. RESULTS A total of 506 procedures were included: 147 TL (29.0%), 140 MSL (27.7%), and 219 WL (43.3%). On logistic regression analysis, MSL was associated with longer operative times than WL for excisional biopsies only (OR 4.24, 95% CI 1.92 to 9.34, p < 0.001). Mean excisional biopsy time was 39.1 minutes for MSL and 33.0 minutes for WL. Specimen volume did not vary significantly across surgery types between localization methods. In an analysis of all lumpectomies with an indication of carcinoma, marker choice was not associated with rate of re-excision (TL vs WL OR 0.64, 95% CI 0.26 to 1.60, p = 0.342; MSL vs WL OR 1.22, 95% CI 0.60 to 2.49, p = 0.587; TL vs MSL OR 0.65, 95% CI 0.26 to 1.64, p = 0.359). CONCLUSION TL, MSL, and WL are comparable in performance for excision of nonpalpable breast lesions. Although increased operative time associated with MSL vs WL excisional biopsies is statistically significant, clinical significance warrants additional study. With similar outcomes, physicians may choose the marker most appropriate for the patient and setting.
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11
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den Dekker BM, Christenhusz A, van Dalen T, Jongen LM, van der Schaaf MC, Dassen AE, Pijnappel RM. A multicenter prospective cohort study to evaluate feasibility of radio-frequency identification surgical guidance for nonpalpable breast lesions: design and rationale of the RFID Localizer 1 Trial. BMC Cancer 2022; 22:305. [PMID: 35317766 PMCID: PMC8939217 DOI: 10.1186/s12885-022-09394-7] [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: 01/08/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer screening and improving imaging techniques have led to an increase in the detection rate of early, nonpalpable breast cancers. For early breast cancer, breast conserving surgery is an effective and safe treatment. Accurate intraoperative lesion localization during breast conserving surgery is essential for adequate surgical margins while sparing surrounding healthy tissue to achieve optimal cosmesis. Preoperative wire localization and radioactive seed localization are accepted standard methods to guide surgical excision of nonpalpable breast lesions. However, these techniques present significant limitations. Radiofrequency identification (RFID) technology offers a new, nonradioactive method for localizing nonpalpable breast lesions in patients undergoing breast conserving surgery. This study aims to evaluate the feasibility of RFID surgical guidance for nonpalpable breast lesions. METHODS This multicenter prospective cohort study was approved by the Institutional Review Board of the University Medical Center Utrecht. Written informed consent is obtained from all participants. Women with nonpalpable, histologically proven in situ or invasive breast cancer, who can undergo breast conserving surgery with RFID localization are considered eligible for participation. An RFID tag is placed under ultrasound guidance, up to 30 days preoperatively. The surgeon localizes the RFID tag with a radiofrequency reader that provides audible and visual real-time surgical guidance. The primary study outcome is the percentage of irradical excisions and reexcision rate, which will be compared to standards of the National Breast Cancer Organisation Netherlands (NABON)(≤ 15% irradical excisions of invasive carcinomas). Secondary outcomes include user acceptability/experiences, learning curve, duration and ease of the placement- and surgical procedure and adverse events. DISCUSSION This study evaluates the feasibility of RFID surgical guidance for nonpalpable breast lesions. Results may have implications for the future localization techniques in women with nonpalpable breast cancer undergoing breast conserving surgery. TRIAL REGISTRATION Netherlands National Trial Register, NL8019 , registered on September 12th 2019.
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Affiliation(s)
- Bianca M den Dekker
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Anke Christenhusz
- Department of Surgery, Medisch Spectrum Twente Enschede, University of Twente, Enschede, the Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Lisa M Jongen
- Department of Radiology, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | | | - Anneriet E Dassen
- Department of Surgery, Medisch Spectrum Twente Enschede, University of Twente, Enschede, the Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Dutch Expert Centre for Screening, Nijmegen, the Netherlands
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12
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Singh C, Juette A. Radio-Frequency Identifier Devices (RFIDs): Our Experience With Wireless Localisation in Non-palpable Breast Masses at a UK Tertiary Breast Imaging Unit. Cureus 2022; 14:e22402. [PMID: 35345700 PMCID: PMC8939460 DOI: 10.7759/cureus.22402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/05/2022] Open
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13
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Anderson TL, Johnson MP, Viers LD, Khanani S. Practice Patterns of Preoperative Breast and Axillary Localizations. Curr Probl Diagn Radiol 2022; 51:707-711. [DOI: 10.1067/j.cpradiol.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
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14
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Kasales C. Wireless localization of breast lesions: An update. Semin Roentgenol 2021; 57:139-144. [DOI: 10.1053/j.ro.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 11/11/2022]
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15
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The Challenging Image-Guided Preoperative Breast Localization: A Modality-Based Approach. AJR Am J Roentgenol 2021; 218:423-434. [PMID: 34612680 DOI: 10.2214/ajr.21.26664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Breast conservation surgery (BCS) is the standard of care for treating patients with early-stage breast cancer and those with locally advanced breast cancer who achieve an excellent response to neoadjuvant chemotherapy. The radiologist is responsible for accurately localizing nonpalpable lesions to facilitate successful BCS. In this article, we present a practical modality-based guide on approaching challenging preoperative localizations, incorporating illustrative examples of challenging localizations performed under sonographic, mammographic, and MRI guidance, as well as under multiple modalities. Aspects of preprocedure planning, modality selection, patient communication, as well as procedural and positional techniques are highlighted. Clip and device migration is also considered. Further, an overview is provided of the most widely used wire localization (WL) and non-wire localization (NWL) devices in the United States. Accurate preoperative localization of breast lesions is essential to achieve successful surgical outcomes. Certain modality-based techniques can be adopted to successfully complete challenging cases.
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16
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The Evolving Role of Radiofrequency Guided Localisation in Breast Surgery: A Systematic Review. Cancers (Basel) 2021; 13:cancers13194996. [PMID: 34638480 PMCID: PMC8508195 DOI: 10.3390/cancers13194996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/17/2021] [Accepted: 10/02/2021] [Indexed: 12/24/2022] Open
Abstract
Wire-guided localisation (WGL) has been the gold-standard for localising non-palpable breast lesions before excision. Due to its drawbacks, various wireless alternatives have been developed, including LOCalizer™, which is based on radio-frequency identification (RFID) technology. In this systematic review, we consulted EMBASE, Medline and PubMed databases using appropriate search terms regarding the use of RFID technology in the localisation of occult breast lesions. Retrospective and prospective studies were included if they quoted the number of patients, rate of successful placement, retrieval rate, margin positivity rate and the re-excision rate. In addition, studies comparing RFID to WGL were also included and analysed separately. Seven studies were included in this systematic review spanning 1151 patients and 1344 tags. The pooled deployment rate was 99.1% and retrieval rate was 100%. Re-excision rate was 13.9%. One complication was identified. Two studies compared RFID with WGL (128 vs. 282 patients respectively). For both techniques the re-excision rate was 15.6% (20/128 vs. 44/282 respectively, p value is 0.995). Based on our review, LOCalizer™ is safe and non-inferior to WGL in terms of successful localisation and re-excision rates. However, further research is required to assess the cost effectiveness of this approach and its impact on the aesthetic outcome compared with WGL and other wire free technologies to better inform decision making in service planning and provision.
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17
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Davis KM, Raybon CP, Monga N, Waheed U, Michaels A, Henry C, Spalluto LB. Image-guided Localization Techniques for Nonpalpable Breast Lesions: An Opportunity for Multidisciplinary Patient-centered Care. JOURNAL OF BREAST IMAGING 2021; 3:542-555. [PMID: 38424951 PMCID: PMC11256989 DOI: 10.1093/jbi/wbab061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Indexed: 03/02/2024]
Abstract
Selection of a localization method for nonpalpable breast lesions offers an opportunity for institutions to seek multidisciplinary input to promote value-based, patient-centered care. The diverse range of nonpalpable breast and axillary pathologies identified through increased utilization of screening mammography often necessitates image-guided preoperative localization for accurate lesion identification and excision. Preoperative localization techniques for breast and axillary lesions have evolved to include both wire and nonwire methods, the latter of which include radioactive seeds, radar reflectors, magnetic seeds, and radiofrequency identification tag localizers. There are no statistically significant differences in surgical outcomes when comparing wire and nonwire localization devices. Factors to consider during selection and adoption of image-guided localization systems include physician preference and ease of use, workflow efficiency, and patient satisfaction.
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Affiliation(s)
- Katie M. Davis
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN, USA
| | - Courtney P. Raybon
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN, USA
| | - Natasha Monga
- Case Western Reserve University, The MetroHealth System, Department of Radiology, Cleveland, OH, USA
| | - Uzma Waheed
- University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Aya Michaels
- Newton Wellesley Hospital, Department of Radiology, Newton, MA, USA
| | - Cameron Henry
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN, USA
| | - Lucy B. Spalluto
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN, USA
- Vanderbilt Ingram Cancer Center, Nashville, TN, USA
- Veterans Health Administration—Tennessee Valley Healthcare System Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA
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18
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Parisi S, Ruggiero R, Gualtieri G, Volpe ML, Rinaldi S, Nesta G, Bogdanovich L, Lucido FS, Tolone S, Parmeggiani D, Gambardella C, Docimo L. Combined LOCalizer™ and Intraoperative Ultrasound Localization: First Experience in Localization of Non-palpable Breast Cancer. In Vivo 2021; 35:1669-1676. [PMID: 33910851 DOI: 10.21873/invivo.12426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Wire-guided localization is the gold-standard for the detection of non-palpable breast lesions, although with acknowledged limitations. The aim of this study was to evaluate the combined use of LOCalizerr™ (Hologic, Santa Carla, CA, USA), and intraoperative ultrasound (IOUS) for localization and surgery of non-palpable breast cancer. PATIENTS AND METHODS Patients with non-palpable breast lesions underwent localization procedure with LOCalizer™ and IOUS. After the placement of the marker, eight measures were made to guide the excision. LOCalizerr™ Pencil and IOUS were performed to obtain the distance between the dissection plane and the margins of lesions. RESULTS The procedure was feasible in the five enrolled patients and associated with clear oncological margins in all cases. Moreover, a high satisfaction according to Likert scale for surgeons, radiologists and patients, performing limited and tailored resections, was reported. CONCLUSION Combining LOCalizerr™ and IOUS is an effective method for locating non-palpable breast cancer, guarantying excellent oncological and cosmetic results.
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Affiliation(s)
- Simona Parisi
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Roberto Ruggiero
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Giorgia Gualtieri
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Mariachiara Lanza Volpe
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Serena Rinaldi
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Giusiana Nesta
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Lidija Bogdanovich
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Francesco Saverio Lucido
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Salvatore Tolone
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Domenico Parmeggiani
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Claudio Gambardella
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Ludovico Docimo
- Department of Advanced Science and Surgery, General, Mini-invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
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Reflector-Guided Localisation of Non-Palpable Breast Lesions: A Prospective Evaluation of the SAVI SCOUT ® System. Cancers (Basel) 2021; 13:cancers13102409. [PMID: 34067552 PMCID: PMC8156313 DOI: 10.3390/cancers13102409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Marking impalpable areas of breast cancer prior to surgery is an important part of the modern treatment of breast cancer. Traditionally, the target lesion would be marked by a wire just before surgery under image guidance and would help the surgeon locate the tumour during surgery. However, this method has some drawbacks, such as patient discomfort, the risk of migration and dislodgement, and the need to couple surgical and radiological schedules. Therefore, there has been a growing interest in this system, thus supporting its potential. In this study, we have evaluated one such system, SAVI SCOUT®, in 63 consecutive patients. Our experience with this system supported its potential role in modern breast surgery. Abstract Wire-guided localisation (WGL) has been the mainstay for localising non-palpable breast lesions before excision. Due to its limitations, various wireless alternatives have been developed. In this prospective study, we evaluate the role of radiation-free wireless localisation using the SAVI SCOUT® system at the London Breast Institute. A total of 72 reflectors were deployed in 67 consecutive patients undergoing breast conserving surgery for non-palpable breast lesions. The mean interval between deployment and surgery for the therapeutic cases was 18.8 days (range: 0–210). The median deployment duration was 5 min (range: 1–15 min). The mean distance from the lesion was 1.1 mm (median distance: 0; range: 0–20 mm). The rate of surgical localisation and retrieval of the reflector was 98.6% and 100%, respectively. The median operating time was 28 min (range: 15–55 min) for the therapeutic excision of malignancy and 17 min (range: 15–24) for diagnostic excision. The incidence of reflector migration was 0%. Radial margin positivity in malignant cases was 7%. The median weight for malignant lesions was 19.6 g (range: 3.5–70 g). Radiologists and surgeons rated the system higher than WGL (93.7% and 98.6%, respectively; 60/64 and 70/71). The patient mean satisfaction score was 9.7/10 (n = 47, median = 10; range: 7–10). One instance of signal failure was reported. In patients who had breast MRI after the deployment of the reflector, the MRI void signal was <5 mm (n = 6). There was no specific technique-related surgical complication. Our study demonstrates that wire-free localisation using SAVI SCOUT® is an effective and time-efficient alternative to WGL with excellent physician and patient acceptance.
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20
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The Evolving Role of Marked Lymph Node Biopsy (MLNB) and Targeted Axillary Dissection (TAD) after Neoadjuvant Chemotherapy (NACT) for Node-Positive Breast Cancer: Systematic Review and Pooled Analysis. Cancers (Basel) 2021; 13:cancers13071539. [PMID: 33810544 PMCID: PMC8037051 DOI: 10.3390/cancers13071539] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary The 5-year survival rate for patients with breast cancer, in whom disease has spread to local lymph nodes, is 85%. However, many live with the complications of surgery to remove the lymph nodes in the armpit thus impacting their quality of life. In recent years, new approaches have been developed to minimise surgery and reduce complications. The aim of this systematic review was to assess the feasibility and accuracy of two minimally invasive surgical procedures, Marked Lymph Node Biopsy and Targeted Axillary Dissection as an alternative to complete removal of the axillary lymph nodes after upfront chemotherapy in patients in whom cancer spread to the regional lymph nodes. Our findings confirm that these procedures can safely replace more radical surgery in women who have responded well to upfront drug treatment. Therefore, although further research to determine long-term outcomes is required, this review concludes that it is reasonable to offer such patients the option of less invasive surgery thus avoiding over treatment and enhancing quality of life. Abstract Targeted axillary dissection (TAD) is a new axillary staging technique that consists of the surgical removal of biopsy-proven positive axillary nodes, which are marked (marked lymph node biopsy (MLNB)) prior to neoadjuvant chemotherapy (NACT) in addition to the sentinel lymph node biopsy (SLNB). In a meta-analysis of more than 3000 patients, we previously reported a false-negative rate (FNR) of 13% using the SLNB alone in this setting. The aim of this systematic review and pooled analysis is to determine the FNR of MLNB alone and TAD (MLNB plus SLNB) compared with the gold standard of complete axillary lymph node dissection (cALND). The PubMed, Cochrane and Google Scholar databases were searched using MeSH-relevant terms and free words. A total of 9 studies of 366 patients that met the inclusion criteria evaluating the FNR of MLNB alone were included in the pooled analysis, yielding a pooled FNR of 6.28% (95% CI: 3.98–9.43). In 13 studies spanning 521 patients, the addition of SLNB to MLNB (TAD) was associated with a FNR of 5.18% (95% CI: 3.41–7.54), which was not significantly different from that of MLNB alone (p = 0.48). Data regarding the oncological safety of this approach were lacking. In a separate analysis of all published studies reporting successful identification and surgical retrieval of the MLN, we calculated a pooled success rate of 90.0% (95% CI: 85.1–95.1). The present pooled analysis demonstrates that the FNR associated with MLNB alone or combined with SLNB is acceptably low and both approaches are highly accurate in staging the axilla in patients with node-positive breast cancer after NACT. The SLNB adds minimal new information and therefore can be safely omitted from TAD. Further research to confirm the oncological safety of this de-escalation approach of axillary surgery is required. MLNB alone and TAD are associated with acceptably low FNRs and represent valid alternatives to cALND in patients with node-positive breast cancer after excellent response to NACT.
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21
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Malter W, Eichler C, Hanstein B, Mallmann P, Holtschmidt J. First Reported Use of Radiofrequency Identification (RFID) Technique for Targeted Excision of Suspicious Axillary Lymph Nodes in Early Stage Breast Cancer - Evaluation of Feasibility and Review of Current Recommendations. In Vivo 2021; 34:1207-1213. [PMID: 32354911 DOI: 10.21873/invivo.11894] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM The purpose of this study was to evaluate, whether radio frequency identification (RFID) labeling of axillary lymph nodes (LNs) for the use of targeted resection is feasible in primary breast cancer patients with suspicious LNs. PATIENTS AND METHODS We analyzed 10 consecutive patients where RFID technique was used for intraoperative detection of suspicious LNs without preceding neoadjuvant chemotherapy (NACT). We compared the specifics of these procedures to 10 consecutive sentinel lymph node biopsies (SLNB) in the cN0 situation. RESULTS Intraoperative detection rate (DR) for the RFID-labeled target lymph node (TLN) was 100%. Perioperative complications were infrequent and comparable to SLNB. Average time for location of the RFID labeled TLN was quicker than for the SLN. In 71.4% the chip bearing TLN equaled a SLN. CONCLUSION The use of the RFID technique for intraoperative localization of axillary LNs for targeted excision seems feasible. RFID technique for targeted axillary dissection (TAD) following NACT should be investigated in a prospective manner.
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Affiliation(s)
- Wolfram Malter
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Christian Eichler
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bettina Hanstein
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Johannes Holtschmidt
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
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22
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Norman C, Lafaurie G, Uhercik M, Kasem A, Sinha P. Novel wire-free techniques for localization of impalpable breast lesions-A review of current options. Breast J 2020; 27:141-148. [PMID: 33368757 DOI: 10.1111/tbj.14146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022]
Abstract
Localization methods for breast lesions including cancers have changed and advanced since their inception. Currently, the most widely used technique in the United Kingdom is the image-guided hook wire localizer developed in the 1970s. It remains as the gold standard for localization of impalpable breast tumors. Besides its advantages, there are some disadvantages associated with this technique. In recent years, novel wire-free techniques (eg, Magseed® , SCOUT® , and LOCalizer™) have been developed to not only localize impalpable breast lesions but also negate the disadvantages of wire localization. This article reviews the variety of techniques from their origins to the most recent advancements that are used to localize breast lesions. The future is heading toward non-wire technology and wire localization may then be reserved for special cases.
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Affiliation(s)
- Carol Norman
- Kings College Hospital NHS Foundation Trust, Princess Royal University Hospital, Bromley, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Guillaume Lafaurie
- Kings College Hospital NHS Foundation Trust, Princess Royal University Hospital, Bromley, UK.,Lewisham & Greenwich NHS Trust, Queen Elizabeth Hospital, Woolwich, UK
| | - Michal Uhercik
- Kings College Hospital NHS Foundation Trust, Princess Royal University Hospital, Bromley, UK
| | - Abdul Kasem
- Kings College Hospital NHS Foundation Trust, Princess Royal University Hospital, Bromley, UK
| | - Prakash Sinha
- Kings College Hospital NHS Foundation Trust, Princess Royal University Hospital, Bromley, UK
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Retrospective Review of Preoperative Radiofrequency Tag Localization of Breast Lesions in 848 Patients. AJR Am J Roentgenol 2020; 217:605-612. [PMID: 33084384 DOI: 10.2214/ajr.20.24374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND. Advantages of radiofrequency tags for preoperative breast lesion localization include decoupling of tag placement from surgical schedules and improved patient comfort. OBJECTIVE. The purpose of this study was to evaluate the feasibility of a preoperative localization radiofrequency tag system for breast lesions requiring surgical excision. METHODS. The cohort for this retrospective study included consecutive patients who underwent image-guided needle localization with radiofrequency tags before surgical excision from July 12, 2018, to July 31, 2019. Images and medical records were reviewed to evaluate the pathologic diagnoses serving as indications for tag placement, imaging guidance for tag placement, number of tags placed, and target lesion type. Tag placement technical accuracy rate (defined as deployment of the tag within 1 cm of the edge of the target), success (defined as technical accuracy without complication), and surgical margin and reexcision status were evaluated. RESULTS. A total of 1013 tags were placed under imaging guidance in 848 patients (mean age, 60 years; range, 23-96 years) and 847 subsequently underwent surgical excision. Tags were most commonly placed for invasive carcinoma (537/1013, 53.0%), ductal carcinoma in situ (138/1013, 13.6%), and high-risk lesions (289/1013, 28.5%). A total of 673 (66.4%) tags were deployed under mammographic guidance, whereas 340 (33.6%) were placed under sonographic guidance. Two or more tags were placed in 149 of 848 patients (17.6%). Targeted lesion types primarily included masses (448/1013, 44.2%), biopsy clip markers (331/1013, 32.7%), and calcifications (155/1013, 15.3%). Technical accuracy of placement was achieved in 1004 (99.1%) tags. Of the nine inaccurate tag placements, seven (77.8%) required an additional tag or wire placement. Seven (0.7%) biopsy clip markers were displaced within the breast or removed by the tag device during placement. No complications were reported intraoperatively. Therefore, success was achieved in 997 (98.4%) tags. Tags were successfully retrieved in all 847 patients who underwent surgery. Of the 568 patients with a preoperative diagnosis of carcinoma, 86 (15.1%) had positive or close surgical margins requiring surgical reexcision. CONCLUSION. Preoperative image-guided localization with radiofrequency tags is a safe and feasible technique for breast lesions requiring surgery. CLINICAL IMPACT. Radiofrequency tag localization is an acceptable alternative to needle or wire localization, offering the potential for improved patient workflow and experience.
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Development and characterization of a handheld radiation detector for radio-guided surgery. RADIAT MEAS 2020. [DOI: 10.1016/j.radmeas.2020.106362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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