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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Janssen NNY, van la Parra RFD, Loo CE, Groen EJ, van den Berg MJ, Oldenburg HSA, Nijkamp J, Vrancken Peeters MTFD. Breast conserving surgery for extensive DCIS using multiple radioactive seeds. Eur J Surg Oncol 2017; 44:67-73. [PMID: 29239733 DOI: 10.1016/j.ejso.2017.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/26/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Breast conserving surgery (BCS) can be challenging for large regions of ductal carcinoma in situ (DCIS), resulting in high rates of positive resection margins. Radioactive seed localization (RSL) using multiple radioactive iodine (125I) seeds can be used to bracket extensive DCIS (eDCIS). The goal of this study was to retrospectively compare the use of a single or multiple 125I seeds in RSL to enable BCS in patients with eDCIS. METHODS All patients with eDCIS (area of ≥3.0 cm) who underwent either single or multiple-seed RSL between January 2008 and December 2016 were included. Patient, tumor and surgery characteristics were compared between both groups. Primary outcome measures were positive resection margin and re-operation rates. RESULTS Respectively 48 and 58 patients with eDCIS underwent single- and multiple-seed RSL and subsequent BCS. The rate of positive resection margin (focal and more than focal) with single-seed RSL was 47.9%, compared to 29.3% with multiple-seed RSL (p = 0.06). The re-operation rate was 39.6% with single-seed RSL and 20.7% in the multiple-seed RSL group (p = 0.05). CONCLUSION Multiple-seed RSL enables bracketing of large areas of DCIS, with the potential to decrease the high rate of positive resection margins in this patient group.
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Affiliation(s)
- N N Y Janssen
- Department of Radiation Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - R F D van la Parra
- Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C E Loo
- Department of Radiology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - E J Groen
- Department of Pathology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M J van den Berg
- Department of Plastic and Reconstructive Surgery, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - H S A Oldenburg
- Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J Nijkamp
- Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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van der Noordaa ME, Pengel KE, Groen E, van Werkhoven E, Rutgers EJ, Loo CE, Vogel W, Vrancken Peeters MJ. The use of radioactive iodine-125 seed localization in patients with non-palpable breast cancer: a comparison with the radioguided occult lesion localization with 99m technetium. Eur J Surg Oncol 2015; 41:553-8. [PMID: 25707349 DOI: 10.1016/j.ejso.2015.01.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/11/2015] [Accepted: 01/15/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Radioactive Seed Localization with a radioactive iodine-125 seed (RSL) and Radioguided Occult Lesion Localization with 99mTechnetium colloid (ROLL) are both attractive alternatives to wire localization for guiding breast conserving surgery (BCS) of non-palpable breast cancer. The aim of this study was to evaluate and compare the efficacy of RSL and ROLL. METHODS We retrospectively analyzed 387 patients with unifocal non-palpable ductal carcinoma in situ (DCIS) or invasive carcinoma treated with BCS at the Netherlands Cancer Institute. In total 403 non-palpable lesions were localized either by RSL (N = 128) or by ROLL (N = 275). Primary outcome measures were positive margins and re-excision rates; the secondary outcome measure was weight of the specimen. RESULTS Pre-operative mammography or ultrasound showed similar sizes of DCIS and invasive tumours in both RSL and ROLL groups. In the RSL group, more lesions were DCIS (58%) than in the ROLL group, where 32% of the lesions were pure DCIS. The proportions of focally positive margins (11% vs. 10%) and more than focally positive margins (9% vs. 9%) were comparable between the RSL and the ROLL group, resulting in the same re-excision rate in both RSL and ROLL groups (9% vs. 10%). For DCIS lesions, the specimen weight was significantly lower in the RSL group than in the ROLL group after adjusting for tumour size on mammography (12 g; 95% CI 2.6-21). CONCLUSION Margin status and re-excision rates were comparable for RSL and ROLL in patients with non-palpable breast lesions. Because of the significant lower weight of the resected specimen in DCIS, the feasibility of position verification of the I-125 seed and more convenient logistics, we favour RSL over ROLL to guide breast-conserving therapy.
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Pouw B, der Veen LJDWV, Hellingman D, Brouwer OR, Peeters MJTV, Stokkel MP, Olmos RAV. Feasibility of preoperative (125)I seed-guided tumoural tracer injection using freehand SPECT for sentinel lymph node mapping in non-palpable breast cancer. EJNMMI Res 2014; 4:19. [PMID: 24949282 PMCID: PMC4052880 DOI: 10.1186/s13550-014-0019-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/27/2014] [Indexed: 11/25/2022] Open
Abstract
Background This study was designed to explore the feasibility of replacing the conventional peri-/intratumoural ultrasound (US)-guided technetium-99m albumin nanocolloid (99mTc-nanocolloid) administration by an injection of the same tracer guided by a freehand single-photon emission computed tomography (SPECT) device in patients with non-palpable breast cancer with an iodine-125 (125I) seed as tumour marker, who are scheduled for a sentinel lymph node biopsy (SLNB). This approach aimed to decrease the workload of the radiology department, avoiding a second US-guided procedure. Methods In ten patients, the implanted 125I seed was primarily localised using freehand SPECT and subsequently verified by conventional US in order to inject the 99mTc-nanocolloid. The following 34 patients were injected using only freehand SPECT localisation. In these patients, additional SPECT/CT was acquired to measure the distance between the 99mTc-nanocolloid injection depot and the 125I seed. In retrospect, a group of 21 patients with US-guided 99mTc-nanocolloid administrations was included as a control group. Results The depth difference measured by US and freehand SPECT in ten patients was 1.6 ± 1.6 mm. In the following 36 125I seeds (34 patients), the average difference between the 125I seed and the centre of the 99mTc-nanocolloid injection depot was 10.9 ± 6.8 mm. In the retrospective study, the average distance between the 125I seed and the centre of the 99mTc-nanocolloid injection depot as measured in SPECT/CT was 9.7 ± 6.5 mm and was not significantly different compared to the freehand SPECT-guided group (two-sample Student's t test, p = 0.52). Conclusion We conclude that using freehand SPECT for 99mTc-nanocolloid administration in patients with non-palpable breast cancer with previously implanted 125I seed is feasible. This technique may improve daily clinical logistics, reducing the workload of the radiology department.
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Affiliation(s)
- Bas Pouw
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede 7500 AE, The Netherlands ; Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands
| | - Linda J de Wit-van der Veen
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands
| | - Daan Hellingman
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede 7500 AE, The Netherlands ; Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands
| | - Oscar R Brouwer
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands
| | - Marie-Jeanne Tfd Vrancken Peeters
- Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands
| | - Marcel Pm Stokkel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands
| | - Renato A Valdés Olmos
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands
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