1
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Li Y, Li M, Zhang Y. A single-institution retrospective evaluation of noninvasive localization for non-palpable breast microcalcification. Asian J Surg 2024; 47:1776-1780. [PMID: 38143169 DOI: 10.1016/j.asjsur.2023.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023] Open
Abstract
TECHNIQUE From January 1, 2018, to December 31, 2021, we localized the breast microcalcification of 40 patients before the surgical excision. We measured the distance between the nipple and the center of the calcification on the CC view and the ML view, respectively. The operation proceeded around the intersection between two lines, slightly larger than the diameter of the microcalcification. We also analyze the pathological findings. RESULTS All 40 patients successfully detected calcification by mammograms preoperatively using the method mentioned above. 38 patients have the microcalcification removal within the one-time operation, while the other two underwent an extended lumpectomy. 20 of 40 calcifications (50 %) were malignant and 12(30 %) were precancerous lesions. In the group of women older than 45 years old, the percentages of malignant and atypical hyperplasias are 56.25 % (18/32) and 31.25 % (10/32) respectively. CONCLUSION Our non-invasive method of preoperative localization is safe and cost-effective. Furthermore, initial observations suggest that there may be a link between age and malignant microcalcification.
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Affiliation(s)
- Yunpeng Li
- Department of Interventional Therapy, The First Affiliated Hospital of Dalian Medical University, Dalian City, China; Department of Interventional Therapy, The Third Affiliated Hospital of Dalian Medical University, Dalian City, China
| | - Min Li
- Department of Mammary Gland, Dalian Women and Children's Medical Center (Group), Dalian City, China
| | - Yueqiu Zhang
- Department of Mammary Gland, Dalian Women and Children's Medical Center (Group), Dalian City, China.
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2
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Hefelfinger L, Doherty A, Wahab R, Rosen L, Shaughnessy EA, Lewis JD. Evaluation of the SmartClip™ Nonradioactive Seed, a Novel Wireless Localization Method for the Breast: Initial Clinical Experience and Surgical Outcome. Am Surg 2024; 90:592-599. [PMID: 37749932 DOI: 10.1177/00031348231199171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Wire localization has been the gold standard for breast localization of non-palpable lesions for decades. This technique remains robust but has disadvantages relative to scheduling, complications of vasovagal reactions in placement, wire migration, or transection. With more modern technologies available, several implantable markers have been developed to allow uncoupling of localization by radiology and the surgical procedure on the same day. This study summarizes our experience with the EnVisio Navigation System™ utilizing SmartClip™ as the implantable tissue localization marker. METHODS An IRB-approved retrospective database of benign and malignant breast disease was used to perform a review of 100 consecutive patients who underwent SmartClip™ localized breast and axillary procedures in 2021. Demographic information, localization accuracy, associated surgical procedure(s) with resultant pathology findings, margin status for malignancies, and re-excision rate were collected. RESULTS The localized breast lesion or lymph node was excised and SmartClip™ retrieved in all cases, confirmed by intraoperative specimen radiograph. The distribution of gender and race/ethnicity among the patients who underwent surgery reflects the community population and frequency of breast cancer development among men versus women. 45.1% of the cases involved malignancy, as determined pre-operatively. Positive margins requiring re-excision constituted 18.2% of cases. In twenty-six patients, two or three SmartClips™ were placed per case for either a bracketed lesion, two separate breast lesions, and/or a breast lesion and lymph node. CONCLUSION Although this study is limited in patient number, it demonstrates safety of this technique and its reliability in guiding the surgeon directly to the lesion(s) of concern.
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Affiliation(s)
- Leah Hefelfinger
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Rifat Wahab
- Department of Radiology, Division of Breast Imaging, University of Cincinnati, Cincinnati, OH, USA
| | - Lauren Rosen
- Department of Pathology, Section of Surgical Pathology within the Division of Anatomic Pathology, University of Cincinnati, Cincinnati, OH, USA
| | - Elizabeth A Shaughnessy
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Jaime D Lewis
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati, Cincinnati, OH, USA
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3
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Ferreira HHJ, de Souza CD, Pozzo L, Ribeiro MS, Rostelato MECM. Radioactive Seed Localization for Nonpalpable Breast Lesions: Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:441. [PMID: 38396480 PMCID: PMC10887864 DOI: 10.3390/diagnostics14040441] [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: 11/11/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND This study is a systematic review with meta-analysis comparing radioactive seed localization (RSL) versus radio-guided occult lesion localization (ROLL) and wire-guided localization (WGL) for patients with impalpable breast cancer undergoing breast-conserving surgery and evaluating efficacy, safety, and logistical outcomes. The protocol is registered in PROSPERO with the number CRD42022299726. METHODS A search was conducted in the Embase, Lilacs, Pubmed, Scielo, Web of Science, and clinicaltrials.gov databases, in addition to a manual search in the reference list of relevant articles, for randomized clinical trials and cohort studies. Studies selected were submitted to their own data extraction forms and risk of bias analysis according to the ROB 2 and ROBINS 1 tools. A meta-analysis was performed, considering the random effect model, calculating the relative risk or the mean difference for dichotomous or continuous data, respectively. The quality of the evidence generated was analyzed by outcome according to the GRADE tool. Overall, 46 articles met the inclusion criteria and were included in this systematic review; of these, 4 studies compared RSL and ROLL with a population of 1550 women, and 43 compared RSL and WGL with a population of 19,820 women. RESULTS The results showed that RSL is a superior method to WGL in terms of surgical efficiency in the impalpable breast lesions' intraoperative localization, and it is at least equivalent to ROLL. Regarding security, RSL obtained results equivalent to the already established technique, the WGL. In addition to presenting promising results, RSL has been proven to be superior to WGL and ROLL technologies.
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Affiliation(s)
| | - Carla Daruich de Souza
- Nuclear and Energy Research Institute (IPEN/CNEN—SP), University of São Paulo (USP), Av. Professor Lineu Prestes 2242, São Paulo 05508-000, SP, Brazil; (H.H.J.F.); (L.P.); (M.S.R.); (M.E.C.M.R.)
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4
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Žatecký J, Coufal O, Zapletal O, Kubala O, Kepičová M, Faridová A, Rauš K, Gatěk J, Kosáč P, Peteja M. Ideal marker for targeted axillary dissection (IMTAD): a prospective multicentre trial. World J Surg Oncol 2023; 21:252. [PMID: 37596658 PMCID: PMC10439625 DOI: 10.1186/s12957-023-03147-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Targeted axillary dissection (TAD) is an established method for axillary staging in patients with breast cancer after neoadjuvant chemotherapy (NAC). TAD consists of sentinel lymph node biopsy and initially pathological lymph node excision, which must be marked by a reliable marker before NAC. METHODS The IMTAD study is a prospective multicentre trial comparing three localisation markers for lymph node localisation (clip + iodine seed, magnetic seed, carbon suspension) facilitating subsequent surgical excision in the form of TAD. The primary outcome was to prospectively compare the reliability, accuracy, and safety according to complication rate during marker implantation and detection and marker dislodgement. RESULTS One hundred eighty-nine patients were included in the study-in 135 patients clip + iodine seed was used, in 30 patients magnetic seed and in 24 patients carbon suspension. The complication rate during the marker implantation and detection were not statistically significant between individual markers (p = 0.263; p = 0.117). Marker dislodgement was reported in 4 patients with clip + iodine seed localisation (3.0%), dislodgement did not occur in other localisation methods (p = 0.999). The false-negativity of sentinel lymph node (SLN) was observed in 8 patients, the false-negativity of targeted lymph nodes (TLN) wasn´t observed at all, the false-negativity rate (FNR) from the subcohort of ypN + patients for SLN is 9.6% and for TLN 0.0%. CONCLUSION The IMTAD study indicated, that clip + iodine seed, magnetic seed and carbon suspension are statistically comparable in terms of complications during marker implantation and detection and marker dislodgement proving their safety, accuracy, and reliability in TAD. The study confirmed, that the FNR of the TLN was lower than the FNR of the SLN proving that the TLN is a better marker for axillary lymph node status after NAC. TRIAL REGISTRATION NCT04580251. Name of registry: Clinicaltrials.gov. Date of registration: 8.10.2020.
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Affiliation(s)
- Jan Žatecký
- Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.
- Department of Surgery, Silesian Hospital in Opava, Opava, Czech Republic.
- Faculty of Public Policies, The Institute of Paramedical Health Studies, Silesian University, Opava, Czech Republic.
| | - Oldřich Coufal
- Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondřej Zapletal
- Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Otakar Kubala
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Markéta Kepičová
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Adéla Faridová
- Oncogynecology Centre, The Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Karel Rauš
- Oncogynecology Centre, The Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Jiří Gatěk
- Department of Surgery, EUC Clinic Zlín, Zlín, Czech Republic
- Tomáš Baťa University in Zlín, Zlín, Czech Republic
| | - Peter Kosáč
- Department of Surgery, EUC Clinic Zlín, Zlín, Czech Republic
| | - Matúš Peteja
- Department of Surgery, Silesian Hospital in Opava, Opava, Czech Republic
- Faculty of Public Policies, The Institute of Paramedical Health Studies, Silesian University, Opava, Czech Republic
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5
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Ooi WL, Becker B, Phillips M, Saunders C, Taylor D. Iodine-125 seed versus hook-wire guided breast conserving surgery: do post operative complication rates differ? ANZ J Surg 2023; 93:876-880. [PMID: 36797222 DOI: 10.1111/ans.18329] [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: 10/08/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Radio-guided occult lesion localisation using iodine 125 seeds (ROLLIS) is used to localize impalpable breast cancers for breast conserving surgery (BCS). Previous studies have suggested improved efficiency and patient outcomes with ROLLIS compared with hook-wire localisation (HWL). The aim of this report is to compare the post-operative complication rates and safety profiles of ROLLIS versus hook-wire guided surgery. METHODS Between September 2013 and March 2018, 690 women with non-palpable breast cancer eligible for breast-conserving surgery were randomly assigned to either pre-operative localisation with 125 I seed or hook-wire as part of the ROLLIS clinical trial. Medical record review of 170 women (30% of the total participants) from three tertiary hospitals in Western Australia was performed. Post-operative complications were classified using the Common Terminology Criteria for Adverse Events(CTCAE) grade I to V. RESULTS Total of 170 surgeries were performed: 82 by ROLLIS and 88 by hook-wire. The overall complication rate in the ROLLIS group was 19.5%, with 15.9% being grade II and 3.66% grade III. In the HWL group, the complication rate was 22.7% with 20.5% being grade II and 2.27% grade III. There was no statistically significant difference in complication grades between the 2 groups. No grade IV or grade V complications were reported. Complications observed included drainable seroma, drainable haematoma and surgical site infection. CONCLUSION ROLLIS is a safe method of localisation for surgical resection with similar complication rates as hookwires. We encourage its use as an alternative localisation technique as it has demonstrable superiority and efficacy.
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Affiliation(s)
- Wei Ling Ooi
- Breast Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Brenno Becker
- General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Michael Phillips
- Harry Perkins Institute for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Christobel Saunders
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Donna Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Surgery, University of Western Australia, Perth, Western Australia, Australia
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6
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Nuez-Martínez M, Queralt-Martín M, Muñoz-Juan A, Aguilella VM, Laromaine A, Teixidor F, Viñas C, Pinto CG, Pinheiro T, Guerreiro JF, Mendes F, Roma-Rodrigues C, Baptista PV, Fernandes AR, Valic S, Marques F. Boron clusters (ferrabisdicarbollides) shaping the future as radiosensitizers for multimodal (chemo/radio/PBFR) therapy of glioblastoma. J Mater Chem B 2022; 10:9794-9815. [PMID: 36373493 DOI: 10.1039/d2tb01818g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Glioblastoma multiforme (GBM) is the most common and fatal primary brain tumor, and is highly resistant to conventional radiotherapy and chemotherapy. Therefore, the development of multidrug resistance and tumor recurrence are frequent. Given the poor survival with the current treatments, new therapeutic strategies are urgently needed. Radiotherapy (RT) is a common cancer treatment modality for GBM. However, there is still a need to improve RT efficiency, while reducing the severe side effects. Radiosensitizers can enhance the killing effect on tumor cells with less side effects on healthy tissues. Herein, we present our pioneering study on the highly stable and amphiphilic metallacarboranes, ferrabis(dicarbollides) ([o-FESAN]- and [8,8'-I2-o-FESAN]-), as potential radiosensitizers for GBM radiotherapy. We propose radiation methodologies that utilize secondary radiation emissions from iodine and iron, using ferrabis(dicarbollides) as iodine/iron donors, aiming to achieve a greater therapeutic effect than that of a conventional radiotherapy. As a proof-of-concept, we show that using 2D and 3D models of U87 cells, the cellular viability and survival were reduced using this treatment approach. We also tested for the first time the proton boron fusion reaction (PBFR) with ferrabis(dicarbollides), taking advantage of their high boron (11B) content. The results from the cellular damage response obtained suggest that proton boron fusion radiation therapy, when combined with boron-rich compounds, is a promising modality to fight against resistant tumors. Although these results are encouraging, more developments are needed to further explore ferrabis(dicarbollides) as radiosensitizers towards a positive impact on the therapeutic strategies for GBM.
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Affiliation(s)
- Miquel Nuez-Martínez
- Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, Campus Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - María Queralt-Martín
- Laboratory of Molecular Biophysics, Department of Physics, Universitat Jaume I, 12071 Castelló, Spain
| | - Amanda Muñoz-Juan
- Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, Campus Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - Vicente M Aguilella
- Laboratory of Molecular Biophysics, Department of Physics, Universitat Jaume I, 12071 Castelló, Spain
| | - Anna Laromaine
- Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, Campus Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - Francesc Teixidor
- Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, Campus Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - Clara Viñas
- Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, Campus Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - Catarina G Pinto
- Centro de Ciências e Tecnologias Nucleares and Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10, 2695-066 Bobadela LRS, Portugal.
| | - Teresa Pinheiro
- iBB - Instituto de Bioengenharia e Biociências, Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Joana F Guerreiro
- Centro de Ciências e Tecnologias Nucleares and Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10, 2695-066 Bobadela LRS, Portugal.
| | - Filipa Mendes
- Centro de Ciências e Tecnologias Nucleares and Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10, 2695-066 Bobadela LRS, Portugal.
| | - Catarina Roma-Rodrigues
- UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, NOVA School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal.,Associate Laboratory i4HB - Institute for Health and Bioeconomy, NOVA School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Pedro V Baptista
- UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, NOVA School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal.,Associate Laboratory i4HB - Institute for Health and Bioeconomy, NOVA School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Alexandra R Fernandes
- UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, NOVA School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal.,Associate Laboratory i4HB - Institute for Health and Bioeconomy, NOVA School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Srecko Valic
- Ruđer Bošković Institute, Bijenička 54, HR-10000 Zagreb, Croatia
| | - Fernanda Marques
- Centro de Ciências e Tecnologias Nucleares and Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10, 2695-066 Bobadela LRS, Portugal.
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7
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Shaughnessy E, Vijapura C, Reyna C, Lewis J, Lewis K, Lee S, Sobel L, Wahab R, Rosen L, Brown A. Exploiting the advantages of a wireless seed localization system that differentiates between the seeds: Breast cancer resection following neoadjuvant chemotherapy. Cancer Rep (Hoboken) 2022; 6:e1690. [PMID: 35940632 PMCID: PMC9875611 DOI: 10.1002/cnr2.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/03/2022] [Accepted: 07/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most wireless localization methods utilize only one means of detection for the surgeon, sufficient to localize a single small breast lesion for excision. Complex cases requiring bracketing of a larger lesion or localization of two or more close lesions can superimpose the signal from separate "seeds" with such methods. The lack of discernment between the localization "seeds" can disorient the surgeon, risking a missed lesion on excision and longer operative times. with the use of neoadjuvant chemotherapy prior to breast surgery, the necessity of localizing both a breast lesion and an axillary lymph node previously biopsied is becoming frequent. CASE A 44 year-old woman underwent neoadjuvant chmotherapy for a breast cancer the did not express estrogen receptor, progesterone receptor, or HER2 receptor. In establishing the extent of disease, a suspicious ipsilateral lymph node was biopsied and found to contain metastatic disease. She had an excellent response to the chemotherapy, with decreased size of the primary tumor and the previously biopsied lymph node. The patient desired breast conservation. The primary tumor and associated calcifications were bracketed using two different Smartclips™, with a third localizing the lymph node biopsied. CONCLUSION This report illustrates how the use of three SmartClips™, within the EnVisioTM system, allowed for separate tracking of each "seed" throughout a complex surgery in a patient following neoadjuvant chemotherapy. This resulted in successful resection of both the tumor and the tagged lymph node.
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Affiliation(s)
- Elizabeth Shaughnessy
- Department of Surgery, Section of Breast Surgery within Division of Surgical OncologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Charmi Vijapura
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Chantal Reyna
- Department of SurgeryCrozer Health SystemSpringfieldPennsylvaniaUSA
| | - Jaime Lewis
- Department of Surgery, Section of Breast Surgery within Division of Surgical OncologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Kyle Lewis
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Su‐Ju Lee
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Lawrence Sobel
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Rifat Wahab
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Lauren Rosen
- Department of Pathology, Section of Surgical Pathology within Division of Anatomic PathologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Ann Brown
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
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8
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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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9
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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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10
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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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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: 4] [Impact Index Per Article: 1.0] [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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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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13
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Konen J, Murphy S, Berkman A, Ahern TP, Sowden M. Intraoperative Ultrasound Guidance With an Ultrasound-Visible Clip: A Practical and Cost-effective Option for Breast Cancer Localization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:911-917. [PMID: 31737930 DOI: 10.1002/jum.15172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/14/2019] [Accepted: 10/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES In partial mastectomy (PM) or lumpectomy, ultrasound (US) localization avoids discomfort and additional procedures associated with wire localization. The purpose of this study was to evaluate the association between ultrasound-visible clip (UVC) use at the time of biopsy and US use during resection, hypothesizing that UVCs facilitate US localization and reduce costs compared with traditional radiopaque clips or no clip placement. METHODS The study population consisted of adult female patients with breast cancer undergoing PM or lumpectomy at our institution between 2014 and 2016. The core biopsy clip type and localization method during PM were characterized as wire localization versus US localization, and associations were estimated with multivariable regression models. For the cost evaluation, breast biopsy data were obtained from the Department of Radiology. RESULTS Among 674 patients, 490 had data on localization and the clip type. Ultrasound-visible clip placement at biopsy increased US use during resection by 13% (95% confidence interval, 6%-21%). There was no difference in the total specimen weight with US versus wire localization. The cost savings for using UVCs for the 2209 patients who underwent breast biopsy from 2014 to 2016 was $36,000. CONCLUSIONS This study demonstrates that US localization for PM is feasible at a single institution and cost-effective when facilitated by UVCs. Placement of a UVC at the time of biopsy is recommended, as it is cost-effective and avoids the discomfort and inconvenience of wire localization.
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Affiliation(s)
- John Konen
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Serena Murphy
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Amy Berkman
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Thomas P Ahern
- Division of Surgical Research, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Michelle Sowden
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
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14
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Bick U, Trimboli RM, Athanasiou A, Balleyguier C, Baltzer PAT, Bernathova M, Borbély K, Brkljacic B, Carbonaro LA, Clauser P, Cassano E, Colin C, Esen G, Evans A, Fallenberg EM, Fuchsjaeger MH, Gilbert FJ, Helbich TH, Heywang-Köbrunner SH, Herranz M, Kinkel K, Kilburn-Toppin F, Kuhl CK, Lesaru M, Lobbes MBI, Mann RM, Martincich L, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Schiaffino S, Sella T, Thomassin-Naggara I, Tardivon A, Ongeval CV, Wallis MG, Zackrisson S, Forrai G, Herrero JC, Sardanelli F. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 2020; 11:12. [PMID: 32025985 PMCID: PMC7002629 DOI: 10.1186/s13244-019-0803-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022] Open
Abstract
We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as "high-risk" or B3 lesions). Finally, seven frequently asked questions are answered.
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Affiliation(s)
- Ulrich Bick
- Clinic of Radiology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Rubina M Trimboli
- PhD Course in Integrative Biomedical Research, Department of Biomedical Science for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Corinne Balleyguier
- Department of Radiology, Gustave-Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Luca A Carbonaro
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Enrico Cassano
- Breast Imaging Division, European Institute of Oncology, Milan, Italy
| | - Catherine Colin
- Radiology Unit, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Femme Mère Enfant, 59 Boulevard Pinel, 69 677, Bron Cedex, France
| | - Gul Esen
- School of Medicine, Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Andrew Evans
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Tom McDonald Avenue, Dundee, UK
| | - Eva M Fallenberg
- Diagnostic and Interventional Breast Imaging, Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael H Fuchsjaeger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Michel Herranz
- CyclotronUnit, GALARIA-SERGAS, Nuclear Medicine Department and Molecular ImagingGroup, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
| | - Karen Kinkel
- Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, 1224 Chêne-Bougeries, Genève, Switzerland
| | - Fleur Kilburn-Toppin
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Marc B I Lobbes
- Department of Radiology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Laura Martincich
- Unit of Radiodiagnostics ASL AT, Via Conte Verde 125, 14100, Asti, Italy
| | - Pietro Panizza
- Breast Imaging Unit, Scientific Institute (IRCCS) Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Sorbonne Université, APHP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Anne Tardivon
- Department of Radiology, Institut Curie, Paris, France
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthew G Wallis
- Cambridge Breast Unit and NIHR Biomedical Research Unit, Box 97, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | | | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
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Sánchez Sánchez R, González Jiménez A, Rebollo Aguirre A, Mendoza Arnau I, Menjón Beltrán S, Vergara Alcaide M, Osorio Ceballos J, Llamas Elvira J. 125I radioactive seed localization for non-palpable lesions in breast cancer. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Madeley C, Kessell M, Madeley C, Taylor D. A comparison of stereotactic and tomosynthesis-guided localisation of impalpable breast lesions. J Med Radiat Sci 2019; 66:170-176. [PMID: 31347295 PMCID: PMC6745377 DOI: 10.1002/jmrs.348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 05/23/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Impalpable breast cancers require precise pre-operative lesion localisation to minimise re-excision rates. Conventional techniques include hookwire insertion using stereotactic guidance. Newer techniques include the use of tomosynthesis guidance and the use of iodine-125 seeds. This study compares the accuracy of lesion localisation with hookwire or seed insertion using prone stereotactic or upright tomosynthesis guidance. METHODS This registered quality improvement activity did not require formal ethics approval. The post-localisation images for 116 lesions were reviewed. The distance from the lesion or breast biopsy marker to the hookwire or seed was measured on post-insertion mammograms. The relative placement accuracy of hookwire or seed using prone stereotactic or upright tomosynthesis guidance was compared. A lesion to seed or wire distance > 10 mm was considered technically unsatisfactory. RESULTS 94.8% of the seeds and wires inserted via prone stereotactic guidance were accurately placed, compared with 89.6% of those inserted via upright tomosynthesis. There were twice as many technically unsatisfactory insertions under upright tomosynthesis guidance. The majority of the unsatisfactory insertions using upright tomosynthesis occurred when the lesion was at or below the level of the nipple and the insertion was performed craniocaudally. CONCLUSION The degree of accuracy of pre-operative localisation of impalpable breast lesions is significantly higher with the use of prone stereotactic rather than upright tomosynthesis guidance. This was most evident with the placement of I-125 seeds, and in cases where the target lesion was located below the level of the nipple.
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Affiliation(s)
- Carolyn Madeley
- Department of Diagnostic and Interventional RadiologyRoyal Perth HospitalPerthWestern AustraliaAustralia
- Breast Screen Western AustraliaPerthWestern AustraliaAustralia
| | - Meredith Kessell
- Department of Diagnostic and Interventional RadiologyRoyal Perth HospitalPerthWestern AustraliaAustralia
| | | | - Donna Taylor
- Department of Diagnostic and Interventional RadiologyRoyal Perth HospitalPerthWestern AustraliaAustralia
- Medical School, Faculty of Health and Medical SciencesUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
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17
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125I radioactive seed localization for non-palpable lesions in breast cancer. Rev Esp Med Nucl Imagen Mol 2019; 38:343-347. [PMID: 31248796 DOI: 10.1016/j.remn.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/26/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022]
Abstract
AIM Marking of non-palpable breast lesions with 125I radioactive seeds is an alternative to the use of the surgical wire. The objective of this work is to present the results that we have obtained using radioactive seed localization compared to the reference technique in our center, the wire localization of non-palpable breast lesions. MATERIAL AND METHOD Longitudinal prospective study that includes patients with histological diagnostic of breast cancer, with non-palpable lesions that are candidates to primary surgical treatment by radioactive seed localization (2016-2018) and by wire localization (2015-2016). Histological analysis of the surgical specimen was performed determining the status of surgical margins. The volume of the surgical specimen was calculated. RESULTS A total of 146 patients were included, 95 who underwent surgery by radioactive seed localization and 51 by wire localization. The mean cube volume of the specimens were 135.67cm3 vs. 190.77cm3 (p=0.017), respectively. Eleven patients who underwent surgery by radioactive seed localization showed affected margins of the specimen (11.6%), versus 7 (13.2%) of wire localization group (p=0.084). Reintervention was performed in 9 of the patients marked with seeds and in 7 marked with wires (p=0.49). CONCLUSION The use of 125I radioactive seeds is feasible in non-palpable breast lesions, with a low rate of reintervention and volumes of surgical specimens significantly lower than those obtained by wire localization.
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18
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Woods RW, Camp MS, Durr NJ, Harvey SC. A Review of Options for Localization of Axillary Lymph Nodes in the Treatment of Invasive Breast Cancer. Acad Radiol 2019; 26:805-819. [PMID: 30143401 DOI: 10.1016/j.acra.2018.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 02/09/2023]
Abstract
Invasive breast cancer is a common disease, and the most common initial site of metastatic disease are the axillary lymph nodes. As the standard of care shifts towards less invasive surgery in the axilla for patients with invasive breast cancer, techniques have been developed for axillary node localization that allow targeted dissection of specific lymph nodes without requiring full axillary lymph node dissection. Many of these techniques have been adapted from technologies developed for localization of lesions within the breast and include marker clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive seeds, magnetic seeds, radar reflectors, and radiofrequency identification devices.The purpose of this article is to summarize these methods and describe benefits and drawbacks of each method for performing localization of lymph nodes in the axilla.
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19
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Angarita FA, Acuna SA, Down N, Leung CS, Pirmoradi F, Osman F. Comparison of Radioactive Seed Localized Excision and Wire Localized Excision of Breast Lesions: A Community Hospital's Experience. Clin Breast Cancer 2019; 19:e364-e369. [PMID: 30718114 DOI: 10.1016/j.clbc.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Most data comparing wire localized excision (WLE) and radioactive seed localized excision (RSLE) derive from academic institutions with limited data from community hospitals. This study aimed to compare positive margin rates between WLE and RSLE and to determine if there were any differences in specimen volume and operation time. PATIENTS AND METHODS A retrospective cohort study was conducted on patients who underwent WLE or RSLE at a Canadian community hospital. Group characteristics were compared as appropriate. Multivariable logistic regression was used determine if the localization techniques were independently associated with having a positive margin. Statistical significance was set as P < .05. RESULTS The cohort consisted of 747 (WLE) and 577 (RSLE) patients. Both groups had similar mean age, mean tumor (invasive and ductal carcinoma-in-situ) size, histologic grade distribution, presence of lymphovascular invasion, and extensive intraductal component, nodal status, and hormone receptor and HER2 status. Compared to WLE, patients who underwent RSLE had significantly lower invasive positive margin rates (8.1% vs. 12.3%, P = .03), shorter operation time (39.5 minutes vs. 68.7 minutes, P = .0001), and smaller surgical specimens (21.4 cm³ vs. 30.2 cm³, P = .008). Ductal carcinoma-in-situ positive margin rates were not different between the groups. However, the localization technique was not independently associated with having a positive margin (odds ratio = 1.55; 95% confidence interval, 0.99-2.44). CONCLUSION RSLE led to a shorter operation time and smaller surgical specimens compared to WLE, but there was no difference in positive margin rates. RSLE is an effective technique to excise nonpalpable breast lesions in the community setting.
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Affiliation(s)
- Fernando A Angarita
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sergio A Acuna
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Down
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, North York Hospital, Toronto, Ontario, Canada
| | - Chung Shan Leung
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Pathology, North York Hospital, Toronto, Ontario, Canada
| | | | - Fahima Osman
- Department of Surgery, North York Hospital, Toronto, Ontario, Canada.
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Samreen N, Lee CU, Bhatt AA. Nonconventional Options for Tumor Localization in Breast and Axillary Lymph Nodes: A Pictorial How-To. J Clin Imaging Sci 2018; 8:54. [PMID: 30652057 PMCID: PMC6302552 DOI: 10.4103/jcis.jcis_57_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/23/2018] [Indexed: 11/04/2022] Open
Abstract
Preoperative localization of breast malignancies using traditional ultrasound and digital techniques can be challenging, particularly after neoadjuvant chemotherapy when the target is not conspicuous. The purpose of this paper is to pictorially present nontraditional techniques that have been helpful in preoperative localization before surgery. We will discuss techniques for breast lesion localization using computed tomography (CT) and magnetic resonance imaging (MRI) as well as axillary lymph node localization using tomosynthesis, CT, and MRI.
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Affiliation(s)
- Naziya Samreen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine U Lee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Asha A Bhatt
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Evaluation of a Nonradioactive Magnetic Marker Wireless Localization Program. AJR Am J Roentgenol 2018; 211:940-945. [DOI: 10.2214/ajr.18.19637] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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22
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Schaarup-Jensen H, Jensen AI, Hansen AE, El Ali HH, Hammershøj P, Jølck RI, Kjær A, Andresen TL, Clausen MH. Injectable iodine-125 labeled tissue marker for radioactive localization of non-palpable breast lesions. Acta Biomater 2018; 65:197-202. [PMID: 29056556 DOI: 10.1016/j.actbio.2017.10.029] [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: 06/18/2017] [Revised: 09/22/2017] [Accepted: 10/17/2017] [Indexed: 11/25/2022]
Abstract
We have developed a 125I-radiolabeled injectable fiducial tissue marker with the potential to replace current methods used for surgical guidance of non-palpable breast tumors. Methods in routine clinical use today such as radioactive seed localization, radio-guided occult lesion localization and wire-guided localization suffers from limitations that this injectable fiducial tissue marker offers solutions to. The developed 125I-radiolabeled injectable fiducial tissue marker is based on highly viscous sucrose acetate isobutyrate. The marker was readily inserted in NMRI mice and proved to be spatially well-defined and stable over a seven day period with excellent CT contrast (>1500 HU), enabling fluoroscopic visualization of the marker during placement. The radioactivity remains strongly associated with the marker during the implantation period, which limits exposure to healthy tissue. Biodistribution studies show that there is negligible radioactivity in all non-tumor tissues sampled, with the exception of the thyroid gland, where limited accumulation was observed (0.06% of injected dose after 7 days). Based on the excellent performance of the marker and the fact that it can be delivered through thin hypodermic needles (≥27G), the marker holds great promise for clinical application, since patient discomfort is reduced significantly compared to current methods. STATEMENT OF SIGNIFICANCE A new type of tissue marker for local administration to non-palpable breast tumors has been developed. The surgical guidance marker is based on derivatives of the biomaterial sucrose acetate isobutyrate and unlike currently used markers it is injectable in the tissue using thin needles, reducing the discomfort to the patients significantly. The marker confers CT contrast and has radioactive properties, meaning it also could find use in brachytherapy. The design of the iodine-125 labeled fiducial tissue marker enables control of dosimetry as well as a choice of iodine isotope used. The marker is anticipated to be clinical applicable due to its contrast performance in mice and its potential for enhanced flexibility in surgical procedures, compared to current methods.
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Jadeja PH, Mango V, Patel S, Friedlander L, Desperito E, Ayala-Bustamante E, Wynn R, Chen-Seetoo M, Taback B, Feldman S, Ha R. Utilization of multiple SAVI SCOUT surgical guidance system reflectors in the same breast: A single-institution feasibility study. Breast J 2017; 24:531-534. [DOI: 10.1111/tbj.12979] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/23/2017] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Priya H. Jadeja
- Columbia University Medical Center; New-York Presbyterian Hospital; New York NY USA
| | - Victoria Mango
- Department of Radiology; Memorial Sloan Kettering Cancer Center; New York NY USA
| | - Sejal Patel
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | - Lauren Friedlander
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | - Elise Desperito
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | | | - Ralph Wynn
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | - Margaret Chen-Seetoo
- Columbia University Medical Center; New-York Presbyterian Hospital; New York NY USA
| | - Bret Taback
- Columbia University Medical Center; New-York Presbyterian Hospital; New York NY USA
| | | | - Richard Ha
- Department of Radiology; Columbia University Medical Center; New York NY USA
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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] [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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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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Zhang Y, Seely J, Cordeiro E, Hefler J, Thavorn K, Mahajan M, Domina S, Aro J, Ibrahim AM, Arnaout A, Gravel D, Nessim C. Radioactive Seed Localization Versus Wire-Guided Localization for Nonpalpable Breast Cancer: A Cost and Operating Room Efficiency Analysis. Ann Surg Oncol 2017; 24:3567-3573. [DOI: 10.1245/s10434-017-6084-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Indexed: 11/18/2022]
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Radioactive Seed Localization or Wire-guided Localization of Nonpalpable Invasive and In Situ Breast Cancer. Ann Surg 2017; 266:29-35. [DOI: 10.1097/sla.0000000000002101] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Romanoff A, Schmidt H, McMurray M, Burnett A, Condren A, Port E. Physician preference and patient satisfaction with radioactive seed versus wire localization. J Surg Res 2017; 210:177-180. [PMID: 28457325 DOI: 10.1016/j.jss.2016.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nonpalpable breast lesions require localization before excision. This is most commonly performed with a wire (WL) or a radioactive seed (SL), which is placed into the breast under radiographic guidance. Although there are advantages of each modality, there are no guidelines to address which patients should undergo WL versus SL. We investigated factors influencing the selection of SL versus WL at our institution and assessed patient satisfaction with each procedure. METHODS Patients undergoing preoperative localization of nonpalpable breast lesions from May 2014 through August 2015 were included. Physicians were surveyed on surgical scheduling to evaluate factors influencing the decision to perform SL or WL. Patient satisfaction was evaluated with a survey at the first postoperative visit. Retrospective chart review was performed. RESULTS 341 patients were included: 104 (30%) patients underwent SL and 237 (70%) underwent WL. There was no difference in patient age, benign versus malignant disease, or need for concomitant axillary surgery comparing the SL versus WL groups. Physician survey indicated that 18% of patients were candidates for WL only. Of the patients who were eligible for both, 88 (41%) ultimately underwent SL and 126 (59%) had WL. The most commonly cited reason for selection of one localization method or the other was physician preference, followed by patient preference or avoiding additional visit. There was no significant difference in self-reported preoperative anxiety level, convenience of the localization procedure, pain of the localization procedure, operative experience, postoperative pain level or medication requirement, or overall patient satisfaction comparing patients who underwent SL and WL. CONCLUSIONS SL and WL offer patients similar comfort and satisfaction. Factors influencing selection of one modality over the other include both logistic and clinical considerations.
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Affiliation(s)
- Anya Romanoff
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hank Schmidt
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew McMurray
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annika Burnett
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Audree Condren
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elisa Port
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York.
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Mango VL, Wynn RT, Feldman S, Friedlander L, Desperito E, Patel SN, Gomberawalla A, Ha R. Beyond Wires and Seeds: Reflector-guided Breast Lesion Localization and Excision. Radiology 2017; 284:365-371. [PMID: 28430555 DOI: 10.1148/radiol.2017161661] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate outcomes of Savi Scout (Cianna Medical, Aliso Viejo, Calif) reflector-guided localization and excision of breast lesions by analyzing reflector placement, localization, and removal, along with target excision and rates of repeat excision (referred to as re-excision). Materials and Methods A single-institution retrospective review of 100 women who underwent breast lesion localization and excision by using the Savi Scout surgical guidance system from June 2015 to May 2016 was performed. By using image guidance 0-8 days before surgery, 123 nonradioactive, infrared-activated, electromagnetic wave reflectors were percutaneously inserted adjacent to or within 111 breast targets. Twenty patients had two or three reflectors placed for bracketing or for localizing multiple lesions, and when ipsilateral, they were placed as close as 2.6 cm apart. Target and reflector were localized intraoperatively by one of two breast surgeons who used a handpiece that emitted infrared light and electromagnetic waves. Radiographs of the specimen and pathologic analysis helped verify target and reflector removal. Target to reflector distance was measured on the mammogram and radiograph of the specimen, and reflector depth was measured on the mammogram. Pathologic analysis was reviewed. Re-excision rates and complications were recorded. By using statistics software, descriptive statistics were generated with 95% confidence intervals (CIs) calculated. Results By using sonographic (40 of 123; 32.5%; 95% CI: 24.9%, 41.2%) or mammographic (83 of 123; 67.5%; 95% CI: 58.8% 75.1%) guidance, 123 (100%; 95% CI: 96.4%, 100%) reflectors were placed. Mean mammographic target to reflector distance was 0.3 cm. All 123 (100%; 95% CI: 96.4%, 100%) targets and reflectors were excised. Pathologic analysis yielded 54 of 110 malignancies (49.1%; 95% CI: 39.9%, 58.3%; average, 1.0 cm; range, 0.1-5 cm), 32 high-risk lesions (29.1%; 95% CI: 21.4%, 38.2%), and 24 benign lesions (21.8%; 95% CI: 115.1%, 30.4%). Four of 54 malignant cases (7.4%; 95% CI: 2.4%, 18.1%) demonstrated margins positive for cancer that required re-excision. Five of 110 radiographs of the specimen (4.5%; 95% CI: 1.7%, 10.4%) demonstrated increased distance between the target and reflector distance of greater than 1.0 cm (range, 1.1-2.6 cm) compared with postprocedure mammogram the day of placement, three of five were associated with hematomas, two of five migrated without identifiable cause. No related postoperative complications were identified. Conclusion Savi Scout is an accurate, reliable method to localize and excise breast lesions with acceptable margin positivity and re-excision rates. Bracketing is possible with reflectors as close as 2.6 cm. Savi Scout overcomes many limitations of other localization methods, which warrants further study. © RSNA, 2017.
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Affiliation(s)
- Victoria L Mango
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Ralph T Wynn
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Sheldon Feldman
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Lauren Friedlander
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Elise Desperito
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Sejal N Patel
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Ameer Gomberawalla
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Richard Ha
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
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Schermers B, van der Hage JA, Loo CE, Vrancken Peeters MTFD, Winter-Warnars HAO, van Duijnhoven F, Ten Haken B, Muller SH, Ruers TJM. Feasibility of magnetic marker localisation for non-palpable breast cancer. Breast 2017; 33:50-56. [PMID: 28282587 DOI: 10.1016/j.breast.2017.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Accurate tumour localisation is essential for breast-conserving surgery of non-palpable tumours. Current localisation technologies are associated with disadvantages such as logistical challenges and migration issues (wire guided localisation) or legislative complexities and high administrative burden (radioactive localisation). We present MAgnetic MArker LOCalisation (MaMaLoc), a novel technology that aims to overcome these disadvantages using a magnetic marker and a magnetic detection probe. This feasibility study reports on the first experience with this new technology for breast cancer localisation. MATERIALS AND METHODS Fifteen patients with unifocal, non-palpable breast cancer were recruited. They received concurrent placement of the magnetic marker in addition to a radioactive iodine seed, which is standard of care in our clinic. In a subset of five patients, migration of the magnetic marker was studied. During surgery, a magnetic probe and gammaprobe were alternately used to localise the markers and guide surgery. The primary outcome parameter was successful transcutaneous identification of the magnetic marker. Additionally, data on radiologist and surgeon satisfaction were collected. RESULTS Magnetic marker placement was successful in all cases. Radiologists could easily adapt to the technology in the clinical workflow. Migration of the magnetic marker was negligible. The primary endpoint of the study was met with an identification rate of 100%. Both radiologists and surgeons reflected that the technology was intuitive to use and that it was comparable to radioactive iodine seed localisation. CONCLUSION Magnetic marker localisation for non-palpable breast cancer is feasible and safe, and may be a viable non-radioactive alternative to current localisation technologies.
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Affiliation(s)
- B Schermers
- The Netherlands Cancer Institute, Department of Surgery, The Netherlands; University of Twente, MIRA Institute, The Netherlands.
| | - J A van der Hage
- The Netherlands Cancer Institute, Department of Surgery, The Netherlands
| | - C E Loo
- The Netherlands Cancer Institute, Department of Radiology, Division of Diagnostic Oncology, The Netherlands
| | | | - H A O Winter-Warnars
- The Netherlands Cancer Institute, Department of Radiology, Division of Diagnostic Oncology, The Netherlands
| | - F van Duijnhoven
- The Netherlands Cancer Institute, Department of Surgery, The Netherlands
| | - B Ten Haken
- University of Twente, MIRA Institute, The Netherlands
| | - S H Muller
- The Netherlands Cancer Institute, Department of Clinical Physics, The Netherlands
| | - T J M Ruers
- The Netherlands Cancer Institute, Department of Surgery, The Netherlands; University of Twente, MIRA Institute, The Netherlands
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Preoperative radioactive seed localization of nonpalpable soft tissue masses: an established localization technique with a new application. Skeletal Radiol 2017; 46:209-216. [PMID: 27885379 DOI: 10.1007/s00256-016-2529-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/27/2016] [Accepted: 10/30/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the technique of iodine125 (I125) seed deployment into nonpalpable soft tissue masses under direct ultrasound (US) or CT guidance for intraoperative localization. MATERIALS AND METHODS Patients considered candidates for radioactive seed localization (RSL) based on advanced imaging findings underwent an ultrasound examination of the area of concern to verify sonographic visualization of the targeted mass. If the mass was not visible sonographically, CT was used for guidance. Patients were scheduled for surgery 1-4 days after seed implantation. Intraoperative frozen section pathological analysis was performed on all patients. Operative time, specimen volume, intraoperative margin status, and final margin status were recorded. Following the surgery, patients and surgeons completed satisfaction surveys. RESULTS Ten patients underwent seed placement between 1 and 4 days prior to surgery. All patients had successful surgical resection of the targeted mass with removal of all implanted radioactive seed(s). There was no seed migration. Intraoperative frozen-section margins were negative (>2 mm) in 6/10 patients. Final surgical margins were negative in 9/10 patients. The patient with a positive margin at final pathology did not undergo further resection due to the benign nature of the mass. Patient and surgeon satisfaction survey results were highly positive. All four surgeons reported a strong preference for seed localization over wire localization. CONCLUSIONS RSL is an effective, reliable, and safe technique for preoperative localization of nonpalpable soft tissue masses and yields high patient and surgeon satisfaction.
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Efficacy of localization of non-palpable, invasive breast cancer: Wire localization vs. Iodine-125 seed: A historical comparison. Breast 2016; 29:8-13. [DOI: 10.1016/j.breast.2016.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 04/18/2016] [Accepted: 06/11/2016] [Indexed: 11/23/2022] Open
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Comparison of margin status and lesional size between radioactive seed localized vs conventional wire localized breast lumpectomy specimens. Ann Diagn Pathol 2016; 21:47-52. [DOI: 10.1016/j.anndiagpath.2016.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/15/2016] [Indexed: 11/23/2022]
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Imaging Factors That Influence Surgical Margins After Preoperative 125I Radioactive Seed Localization of Breast Lesions: Comparison With Wire Localization. AJR Am J Roentgenol 2016; 206:1112-8. [PMID: 27007608 DOI: 10.2214/ajr.15.14715] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to compare the potential influence of imaging variables on surgical margins after preoperative radioactive seed localization (RSL) and wire localization (WL) techniques. MATERIALS AND METHODS A total of 565 women with 660 breast lesions underwent RSL or WL between May 16, 2012, and May 30, 2013. Patient age, lesion type (mass, calcifications, mass with associated calcifications, other), lesion size, number of seeds or wires used, surgical margin status (close positive or negative margins), and reexcision and mastectomy rates were recorded. RESULTS Of 660 lesions, 127 (19%) underwent RSL and 533 (81%) underwent WL preoperatively. Mean lesion size was 1.8 cm in the RSL group and 1.8 cm in the WL group (p = 0.35). No difference in lesion type was identified in the RSL and WL groups (p = 0.63). RSL with a single seed was used in 105 of 127 (83%) RSLs compared with WL with a single wire in 349 of 533 (65%) WLs (p = 0.0003). The number of cases with a close positive margin was similar for RSLs (26/127, 20%) and WLs (104/533, 20%) (p = 0.81). There was no difference between the RSL group and the WL group in close positive margin status (20% each, p = 0.81), reexcision rates (20% vs 16%, respectively; p = 0.36), or mastectomy rates (6% each, p = 0.96). Lesions containing calcifications were more likely to require more than one wire (odds ratio [OR], 4.44; 95% CI, 2.8-7.0) or more than one seed (OR, 7.03; 95% CI, 1.6-30.0) when compared with masses alone (p < 0.0001). Increasing lesion size and the presence of calcifications were significant predictors of positive margins, whereas the use of more than one wire or seed was not (OR, 0.9; 95% CI, 0.5-1.5) (p = 0.75). CONCLUSION Close positive margin, reexcision, and mastectomy rates remained similar in the WL group and RSL group. The presence of calcifications and increasing lesion size increased the odds of a close positive margin in both the WL and RSL groups, whereas the use of one versus more than one seed or wire did not.
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Bourke AG, Taylor DB, Westcott E, Hobbs M, Saunders C. Iodine-125 seeds to guide removal of impalpable breast lesions: radio-guided occult lesion localization - a pilot study. ANZ J Surg 2016; 87:E178-E182. [DOI: 10.1111/ans.13460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Anita G. Bourke
- Sir Charles Gairdner Hospital; Perth Western Australia Australia
- School of Surgery; University of Western Australia; Perth Western Australia Australia
- BreastScreen WA; Perth Western Australia Australia
| | - Donna B. Taylor
- School of Surgery; University of Western Australia; Perth Western Australia Australia
- BreastScreen WA; Perth Western Australia Australia
- Royal Perth Hospital; Perth Western Australia Australia
| | - Eliza Westcott
- Sir Charles Gairdner Hospital; Perth Western Australia Australia
- School of Physics; University of Western Australia; Perth Western Australia Australia
| | - Max Hobbs
- Royal Perth Hospital; Perth Western Australia Australia
| | - Christobel Saunders
- School of Surgery; University of Western Australia; Perth Western Australia Australia
- Royal Perth Hospital; Perth Western Australia Australia
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Volders JH, Haloua MH, Krekel NMA, Meijer S, van den Tol PM. Current status of ultrasound-guided surgery in the treatment of breast cancer. World J Clin Oncol 2016; 7:44-53. [PMID: 26862490 PMCID: PMC4734937 DOI: 10.5306/wjco.v7.i1.44] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/02/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing “blind” surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast tumours in the search for better oncological and cosmetic outcomes.
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38
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Bloomquist EV, Ajkay N, Patil S, Collett AE, Frazier TG, Barrio AV. A Randomized Prospective Comparison of Patient-Assessed Satisfaction and Clinical Outcomes with Radioactive Seed Localization versus Wire Localization. Breast J 2015; 22:151-7. [PMID: 26696461 DOI: 10.1111/tbj.12564] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Radioactive seed localization (RSL) has emerged as an alternative to wire localization (WL) in patients with nonpalpable breast cancer. Few studies have prospectively evaluated patient satisfaction and outcomes with RSL. We report the results of a randomized trial comparing RSL to WL in our community hospital. We prospectively enrolled 135 patients with nonpalpable breast cancer between 2011 and 2014. Patients were randomized to RSL or WL. Patients rated the pain and the convenience of the localization on a 5-point Likert scale. Characteristics and outcomes were compared between groups. Of 135 patients enrolled, 10 were excluded (benign pathology, palpable cancer, mastectomy, and previous ipsilateral cancer) resulting in 125 patients. Seventy patients (56%) were randomized to RSL and 55 (44%) to WL. Fewer patients in the RSL group reported moderate to severe pain during the localization procedure compared to the WL group (12% versus 26%, respectively, p = 0.058). The overall convenience of the procedure was rated as very good to excellent in 85% of RSL patients compared to 44% of WL patients (p < 0.0001). There was no difference between the volume of the main specimen (p = 0.67), volume of the first surgery (p = 0.67), or rate of positive margins (p = 0.53) between groups. RSL resulted in less severe pain and higher convenience compared to WL, with comparable excision volume and positive margin rates. High patient satisfaction with RSL provides another incentive for surgeons to strongly consider RSL as an alternative to WL.
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Affiliation(s)
| | - Nicolas Ajkay
- Department of Surgery, The Bryn Mawr Hospital, Bryn Mawr, Pennsylvania
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Abigail E Collett
- Department of Surgery, The Bryn Mawr Hospital, Bryn Mawr, Pennsylvania
| | - Thomas G Frazier
- Department of Surgery, The Bryn Mawr Hospital, Bryn Mawr, Pennsylvania
| | - Andrea V Barrio
- Department of Surgery, The Bryn Mawr Hospital, Bryn Mawr, Pennsylvania.,Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Janssen NNY, Nijkamp J, Alderliesten T, Loo CE, Rutgers EJT, Sonke JJ, Vrancken Peeters MTFD. Radioactive seed localization in breast cancer treatment. Br J Surg 2015; 103:70-80. [DOI: 10.1002/bjs.9962] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/10/2015] [Accepted: 09/04/2015] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Breast cancer screening, improved imaging and neoadjuvant systemic therapy (NST) have led to increased numbers of non-palpable tumours suitable for breast-conserving surgery (BCS). Accurate tumour localization is essential to achieve a complete resection in these patients. This study evaluated the role of radioactive seed localization (RSL) in improving breast- and axilla-conserving surgery in patients with breast cancer with or without NST.
Methods
Patients who underwent RSL between 2007 and 2014 were included. Learning curves were analysed by the rates of minimally involved (in situ/invasive tumour cells on a length of 0–4 mm on ink) and positive resection margins (over 4 mm on ink) after BCS, and the median resection volume over time.
Results
A total of 367 patients with in situ carcinomas and 199 with non-palpable invasive breast cancer underwent RSL before primary surgery. A further 697 patients had RSL before NST, of whom 206 also underwent RSL of a histologically verified axillary lymph node metastasis. BCS was performed in 93·2 and 87·9 per cent of patients undergoing primary surgery for in situ and invasive tumours respectively, and 57·5 per cent of those in the NST group. The rate of BCS with positive resection margins was low and stable over time in the three groups (9·1, 9·7 and 11·2 per cent respectively). The median resection volume decreased significantly with time in the invasive cancer and NST groups.
Conclusion
In the present study of more than 1200 patients and 7 years of experience, RSL was shown to facilitate breast- and axilla-conserving surgery in a diverse patient population. There was a significant reduction in resection volume while maintaining low positive resection margin rates after BCS.
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Affiliation(s)
- N N Y Janssen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Nijkamp
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Alderliesten
- Department of Radiation Oncology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C E Loo
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E J T Rutgers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J-J Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Radio-guided seed localization for breast cancer excision: an ex-vivo specimen-based study to establish the accuracy of a freehand-SPECT device in predicting resection margins. Nucl Med Commun 2015; 35:961-6. [PMID: 24977476 DOI: 10.1097/mnm.0000000000000159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Radioactive seed localization (RSL) uses an iodine-125 ((125)I) seed as a marker for tumour location. The (125)I seed is implanted into the tumour and enables intraoperative localization with a conventional gamma probe. However, specimen margins in relation to the (125)I seed are estimated on the basis of gamma-probe readings only. A novel device, freehand SPECT, is capable of measuring the distance from the resection plane to the (125)I seed. The aim of this feasibility study was to establish the accuracy of this device in predicting resection margins in ex-vivo tumour specimens excised with RSL guidance. PATIENTS AND METHODS In this feasibility study 10 patients with nonpalpable breast cancer scheduled for wide local excision with RSL were included. After surgery, the specimens containing the breast tumour and the (125)I seed were scanned using freehand SPECT. Measurements from five directions were taken and compared with distances measured by means of an ex-vivo computed tomographic (CT) scan and related to the pathology report. RESULTS The difference between freehand SPECT and CT measurements was 2.9±2.7 mm (mean±SD). One patient had a positive margin based on freehand SPECT. This specimen contained a focal irradical resection ventral of the tumour based on the pathology report. The smallest distance to the (125)I seed was 4 mm for the freehand SPECT and 5 mm for the CT scan. CONCLUSION Accurate ex-vivo measurements of the tumour resection margins using (125)I seeds and freehand SPECT are feasible in patients undergoing breast-conserving surgery. Incorporation of the freehand-SPECT device in RSL protocols may enable a real-time estimation of resection margins, which may be useful for surgeons to adjust resection planes.
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41
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Landercasper J, Attai D, Atisha D, Beitsch P, Bosserman L, Boughey J, Carter J, Edge S, Feldman S, Froman J, Greenberg C, Kaufman C, Morrow M, Pockaj B, Silverstein M, Solin L, Staley A, Vicini F, Wilke L, Yang W, Cody H. Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients: The American Society of Breast Surgeons Consensus Conference. Ann Surg Oncol 2015; 22:3174-83. [PMID: 26215198 PMCID: PMC4550635 DOI: 10.1245/s10434-015-4759-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Multiple recent reports have documented significant variability of reoperation rates after initial lumpectomy for breast cancer. To address this issue, a multidisciplinary consensus conference was convened during the American Society of Breast Surgeons 2015 annual meeting. METHODS The conference mission statement was to "reduce the national reoperation rate in patients undergoing breast conserving surgery for cancer, without increasing mastectomy rates or adversely affecting cosmetic outcome, thereby improving value of care." The goal was to develop a toolbox of recommendations to reduce the variability of reoperation rates and improve cosmetic outcomes. Conference participants included providers from multiple disciplines involved with breast cancer care, as well as a patient representative. Updated systematic reviews of the literature and invited presentations were sent to participants in advance. After topic presentations, voting occurred for choice of tools, level of evidence, and strength of recommendation. RESULTS The following tools were recommended with varied levels of evidence and strength of recommendation: compliance with the SSO-ASTRO Margin Guideline; needle biopsy for diagnosis before surgical excision of breast cancer; full-field digital diagnostic mammography with ultrasound as needed; use of oncoplastic techniques; image-guided lesion localization; specimen imaging for nonpalpable cancers; use of specialized techniques for intraoperative management, including excisional cavity shave biopsies and intraoperative pathology assessment; formal pre- and postoperative planning strategies; and patient-reported outcome measurement. CONCLUSIONS A practical approach to performance improvement was used by the American Society of Breast Surgeons to create a toolbox of options to reduce lumpectomy reoperations and improve cosmetic outcomes.
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Affiliation(s)
- Jeffrey Landercasper
- Gundersen Health System Norma J. Vinger Center for Breast Care, La Crosse, WI, USA,
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Ahmed M, Rubio IT, Klaase JM, Douek M. Surgical treatment of nonpalpable primary invasive and in situ breast cancer. Nat Rev Clin Oncol 2015; 12:645-63. [PMID: 26416152 DOI: 10.1038/nrclinonc.2015.161] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Breast cancer is the most-common cancer among women worldwide, and over one-third of all cases diagnosed annually are nonpalpable at diagnosis. The increasingly widespread implementation of breast-screening programmes, combined with the use of advanced imaging modalities, such as magnetic resonance imaging (MRI), will further increase the numbers of patients diagnosed with this disease. The current standard management for nonpalpable breast cancer is localized surgical excision combined with axillary staging, using sentinel-lymph-node biopsy in the clinically and radiologically normal axilla. Wire-guided localization (WGL) during mammography is a method that was developed over 40 years ago to enable lesion localization preoperatively; this technique became the standard of care in the absence of a better alternative. Over the past 20 years, however, other technologies have been developed as alternatives to WGL in order to overcome the technical and outcome-related limitations of this technique. This Review discusses the techniques available for the surgical management of nonpalpable breast cancer; we describe their advantages and disadvantages, and highlight future directions for the development of new technologies.
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Affiliation(s)
- Muneer Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Isabel T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Joost M Klaase
- Department of Surgery, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, Netherlands
| | - Michael Douek
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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Goudreau SH, Joseph JP, Seiler SJ. Preoperative Radioactive Seed Localization for Nonpalpable Breast Lesions: Technique, Pitfalls, and Solutions. Radiographics 2015; 35:1319-34. [PMID: 26274097 DOI: 10.1148/rg.2015140293] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Iodine 125 ((125)I) radioactive seed localization has emerged as a reliable and safe alternative to wire localization for guidance during the surgical resection of nonpalpable breast lesions. The breast imager has a responsibility to be familiar with the general principles of this evolving technique, including its advantages and disadvantages as well as the technical differences involved in placement of seeds versus traditional wire localization. Although placement of (125)I seeds is conceptually similar to wire placement, there are additional technical considerations and safety measures that need to be addressed and implemented when radioactive seeds are used. We draw from our experience with more than 1000 cases of radioactive seed localization since inception of our program in 2009 to provide illustrative examples of not only the proper technique of radioactive seed localization, but also mishaps that may occur during this procedure, along with practical suggestions to prevent these problems. We examine some of the difficulties that we have encountered during radioactive seed localization at our institution, including bone wax mimicking the seed, the inadvertent deployment of seeds, the need for multiple seeds or supplemental wires, problematic seed locations, and difficulty in surgical retrieval of the seed. Recognizing the potential pitfalls of radioactive seed localization and understanding the appropriate guidelines and precautions for the safe, secure handling and placement of radioactive seeds is essential for a successful radioactive seed localization program.
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Affiliation(s)
- Sally H Goudreau
- From the Department of Radiology, University Hospital Breast Imaging Services, University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390-8585
| | - Jamie P Joseph
- From the Department of Radiology, University Hospital Breast Imaging Services, University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390-8585
| | - Stephen J Seiler
- From the Department of Radiology, University Hospital Breast Imaging Services, University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390-8585
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Jakub J, Gray R. Starting a Radioactive Seed Localization Program. Ann Surg Oncol 2015; 22:3197-202. [DOI: 10.1245/s10434-015-4719-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Indexed: 11/18/2022]
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Al-Hilli Z, Glazebrook KN, McLaughlin SA, Chan DM, Robinson KT, Giesbrandt JG, Slomka EL, Pizzitola VJ, Gray RJ, Jakub JW. Utilization of Multiple I-125 Radioactive Seeds in the Same Breast is Safe and Feasible: A Multi-institutional Experience. Ann Surg Oncol 2015. [DOI: 10.1245/s10434-015-4749-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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46
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Radioactive seed localization versus wire localization for lumpectomies: a comparison of outcomes. AJR Am J Roentgenol 2015; 204:872-7. [PMID: 25794081 DOI: 10.2214/ajr.14.12743] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare outcomes of radioactive seed localization (RSL) versus wire localization using surgical margin size, reexcision and reoperation rates, specimen size, radiology resource utilization, and cosmesis as measures. MATERIALS AND METHODS Patients who underwent RSL before segmental mastectomy from April 1, 2011, to March 1, 2012, for biopsy-proven cancer were selected. Each was matched using tumor size, type, and surgeon to a wire localization control case, resulting in 232 cases. Width of the closest surgical margin, reexcision rate, and reoperation rate were compared as were the ratios of tumor volume to initial surgical specimen volume and tumor volume to all surgically excised volume (including reexcisions and reoperations). Cosmetic outcome was analyzed by comparison of Harvard scores and specimen volume with breast volume. Radiology resource utilization was compared before and after RSL implementation. RESULTS No significant differences between methods were found in closest surgical margin (RSL mean, 0.45 cm; wire localization mean, 0.45 cm; p=0.972), reexcision rate (RSL mean, 21.1%; wire localization mean, 26.3%; p=0.360), reoperation rate (RSL, 11.4%; wire localization, 12.7%; p=0.841), ratio of the tumor volume to initial surgical specimen volume (RSL mean, 0.027; wire localization mean, 0.028; p=0.886), ratio of the tumor volume to total volume resected (RSL mean, 0.024; wire localization mean, 0.024; p=0.997), or in clinical or computed cosmesis scores (clinical p=0.5; calculated p=0.060). There was a 34% increase in scheduled biopsy slot utilization, 50% savings in time spent scheduling, and a 4.1-day average decrease in biopsy wait time after RSL institution. CONCLUSION RSL is an acceptable alternative to wire localization and offers significant improvements in workflow.
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Taylor DB, Bourke AG, Westcott E, Burrage J, Latham B, Riley P, Ballal H, Kamyab R, Frost F, Dissanayake D, Landman J, Phillips M, Saunders C. Radioguided occult lesion localisation using iodine‐125 seeds (‘
ROLLIS
’) for removal of impalpable breast lesions: First
A
ustralian experience. J Med Imaging Radiat Oncol 2015; 59:411-420. [DOI: 10.1111/1754-9485.12302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Donna B. Taylor
- School of SurgeryUniversity of Western Australia Perth Western Australia Australia
- Department of RadiologyRoyal Perth Hospital Perth Western Australia Australia
| | - Anita G. Bourke
- School of SurgeryUniversity of Western Australia Perth Western Australia Australia
- Breast CentreDepartment of RadiologySir Charles Gairdner Hospital Perth Western Australia Australia
| | - Eliza Westcott
- Department of Medical Technology and PhysicsSir Charles Gairdner HospitalQEII Medical Centre Perth Western Australia Australia
- School of PhysicsUniversity of Western Australia Perth Western Australia Australia
| | - John Burrage
- Department of Medical Engineering and PhysicsRoyal Perth Hospital Perth Western Australia Australia
| | - Bruce Latham
- PathWest Laboratory MedicineRoyal Perth Hospitial Perth Western Australia Australia
- School of MedicineNotre Dame University Fremantle Western Australia Australia
| | - Paul Riley
- Breast CentreDepartment of RadiologySir Charles Gairdner Hospital Perth Western Australia Australia
| | - Helen Ballal
- Breast CentreDepartment of RadiologySir Charles Gairdner Hospital Perth Western Australia Australia
| | - Roshi Kamyab
- Breast CentreDepartment of RadiologySir Charles Gairdner Hospital Perth Western Australia Australia
| | - Felicity Frost
- PathWest Laboratory MedicineQEII Medical Centre Perth Western Australia Australia
| | - Deepthi Dissanayake
- Department of RadiologyRoyal Perth Hospital Perth Western Australia Australia
| | - Joanne Landman
- Department of Nuclear MedicineRoyal Perth Hospital Perth Western Australia Australia
| | - Michael Phillips
- Harry Perkins Institute for Medical ResearchUniversity of Western Australia Perth Western Australia Australia
| | - Christobel Saunders
- School of SurgeryUniversity of Western Australia Perth Western Australia Australia
- Department of RadiologyRoyal Perth Hospital Perth Western Australia Australia
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Sentinel lymph node localization with contrast-enhanced ultrasound and an I-125 seed: An ideal prospective development study. Int J Surg 2015; 14:1-6. [DOI: 10.1016/j.ijsu.2014.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/17/2014] [Indexed: 11/21/2022]
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49
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Simultaneous use of an 125I-seed to guide tumour excision and 99mTc-nanocolloid for sentinel node biopsy in non-palpable breast-conserving surgery. Eur J Surg Oncol 2015; 41:71-8. [DOI: 10.1016/j.ejso.2014.10.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/01/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022] Open
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50
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Barentsz M, Postma E, van Dalen T, van den Bosch M, Miao H, Gobardhan P, van den Hout L, Pijnappel R, Witkamp A, van Diest P, van Hillegersberg R, Verkooijen H. Prediction of positive resection margins in patients with non-palpable breast cancer. Eur J Surg Oncol 2015; 41:106-12. [DOI: 10.1016/j.ejso.2014.08.474] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/13/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022] Open
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