Magnetic Localization of Breast Lesions: A Large-Scale European Evaluation in a National Cancer Institute

Innovations in the localization techniques for non-palpable breast lesions: Make invisible visible

Non-palpable breast cancer lesions pose a challenge for surgeons to resect cancer lesions. Making 'invisible' lesions 'visible' is the main strategy. Currently, multiple preoperative localization techniques have been applied in clinical. Among them, wire-guided localization (WGL) is the most common procedure due to its convenience and low cost. However, its limitations including discomfort, wire migration and the coupling of localization and operation procedures cause troubles for surgeons and patients. The desire for localization methods improvement, accompanied by the advance of emerging science and technology, leads to the development of a series of locating approaches for breast non-palpable lesions, aiming to improve locating accuracy while reducing adverse events. These emerging methods have undergone improvements from steel wire to functional particles, from radioactivity to non-radioactive, which help doctors and patients choose a more appropriate scheme. This review outlines the principles, procedures, advantages and disadvantages of these locating methods, and highlights the latest progress and related clinical data on innovative locating approaches. Finally, we briefly discuss the current challenges and future opportunities for the clinical application of these localization approaches.

Wire-guided localisation vs HOLOGIC® LOCalizer™ radiofrequency identification (RFID) tag localisation of non-palpable breast lesions; a comparative analysis of ease of use and accuracy of localisation

BACKGROUND

Breast cancer screening programs have increased the detection of nonpalpable breast lesions. Given its accuracy and low failure rate, wire-guided localisation has long been the gold-standard prior to breast conserving surgery (BCS). Recently, several non-invasive localisation modalities have been developed, with varied efficacy reported. This study aimed to evaluate tag localisation's impact on margin positivity and re-excision rates and utility in management of benign lesions compared to wire-guided localisation.

METHODS

A retrospective comparative study was performed of patients, who underwent wide local excision (WLE) from 2020 to 2023, in a single institution. Descriptive statistics were performed on patient, tumour and radiological findings. Binary regression analysis was used to assess the association between localisation techniques and margin positivity and re-excision rates.

RESULTS

Of 680 patients included, 123 (18.1 %) underwent tag localisation, 298 (43.8 %) underwent ultrasound (US) guided wire localisation and 259 (38.1 %) underwent mammogram (MG) guided wire localisation. Tag localisation was associated with a significantly lower rate of positive margins compared to wire guided localisation (p < 0.03). While not statistically significant, a trend towards lower re-excision rates was observed post tag localisation (11.24 %) compared to both US guided wire localisation (18.99 %) and MG guided wire localisation (20.66 %). However, tag localisation was significantly more likely to fail and require a subsequent wire (0 = 0.0003).

CONCLUSION

While associated with fewer positive margins, tag localisation did not significantly lower re-excision rates and was more likely to fail than wire-guided localisation. Further studies may elucidate its possible benefits in select patients.

Scout In, Scout out: Savi scout reflector traversing a dilated duct to the nipple in breast cancer localisation-a case report

INTRODUCTION

Savi scout system is being widely used for localising and excising breast tumours. While the migration of scout reflectors has been documented, this is the first case of a Savi Scout reflector migrating through a dilated duct near the lesion and coming out of the nipple.

CASE PRESENTATION

A 56-year-old postmenopausal woman with a history of right breast intraductal papilloma which transformed to Grade II Invasive Ductal Carcinoma (IDC) has a Savi Scout reflector placed in the tumour. However, it migrated through a dilated duct and emerged at the nipple, causing severe pain. The reflector was then surgically removed, and the patient subsequently underwent wide local excision with skin marker localisation.

CONCLUSION

Anatomical variations such as presence of dilated ducts need to be considered before placing scout reflectors. Appropriate positioning would prevent them from migrating through such ducts avoiding patient discomfort and further procedures for localisation.

Magnetic surgical marker navigation for excision of non-palpable ultrasound visible breast lesions: first 200 cases in a French cancer center

Wire guided localization is widely used as the standard method of pre-operative localization of breast lesions. The aim was to assess outcomes following the introduction of a novel non-wire guided, magnetic surgical marker navigation system. A prospective study between May 2022 and June 2023 established a data base of the first 200 procedures performed using the Sirius Pintuition GPS Detect magnetic marker. The primary outcome measures were the successful excision of the target lesion and retrieval of the magnetic marker. The primary lesion was excised and the magnetic marker was retrieved in all 200 procedures. In 17 procedures (8.5% of the total sample), the magnetic marker was dislodged during surgery; however, the primary lesion was still effectively excised with clear margins without the need for an additional procedure or radiologic assistance. The re-excision rate to achieve margin clearance was 9%. Insertion of the marker was classified as "easy" and "in contact with the target" by the radiologist in all cases (100%). This study has shown that surgical marker navigation reliably localizes lesions and is associated with low re-excision rates. We also perceived improvement in theater planning.

Non-palpable breast lesions localization techniques - A new priority: Results of a Senonetwork survey among breast centers in Italy

INTRODUCTION

Non palpable breast tumors are increasingly diagnosed because of screening programs, and their localization during surgery is essential to ensure an adequate resection. Little is known regarding which techniques are used in "real world".

MATERIALS AND METHODS

A national web-based survey, with a 21-items questionnaire, was conducted among Breast Centers (BCs) in Italy in 2023.

RESULTS

Among 153 BCs, 110 (72 %) participated. Wire-guided localization was reported to be the most used technique, regardless of the volume of malignant tumors treated by each Center (N = 36, 33 %). However, newer techniques such as Radioactive occult lesion localization and magnetic seeds, were reported to be employed in 34 (31 %) BCs, and more often among high-volume BCs (>300 cases/year) (N = 32, 29 % vs. N = 13, 12 %; p = 0.02). Logistic problems of localization were reported to cause delays to the scheduled surgery at least once or in multiple occasions in 26 (24 %) and in 4 (3.5 %) BCs, respectively. Although the majority of BCs declared they were satisfied (N = 48, 44 %) or somewhat satisfied (N = 41, 37 %) with the procedure used in their center, responders stated that they would change their technique, or that they were strongly considering this possibility in 24 (22 %) and in 38 (35 %) cases, respectively. The main barrier to introducing a new technique was associated with procedure costs (90 BCs, 82 %).

CONCLUSIONS

There are several critical issues regarding localization techniques at a national level. This should be recognized as a priority because of its impact on both patients and clinical practices.

Breast-Conserving Surgery Guided with Magnetic Seeds vs. Wires: A Single-Institution Experience

PURPOSE

The aim of this study is to describe our initial experience using magnetic seeds (Magseed®) to guide breast-conserving surgery in non-palpable breast lesions and compare the use of magnetic seed with wires to guide breast-conserving surgery in terms of clinical and pathological characteristics.

METHODS

We performed a retrospective study including all breast-conserving surgeries for non-palpable breast lesions under 16 mm from June 2018 to May 2021. We compared breast-conserving surgeries guided with magnetic seeds (Magseed®) to those guided with wires, analyzing tumor and patient characteristics, surgical time, and pathological results of the surgical specimens.

RESULTS

Data from 225 cases were collected, including 149 cases guided by magnetic seeds and 76 cases guided by wires. The breast lesion was localized in every case. Both cohorts were similar regarding clinical and pathological characteristics. We found significant statistical differences (p < 0.02) in terms of the median volume (cm3) of the excised specimen, which was lower (29.3%) in the magnetic seed group compared with the wire group (32.5 [20.5-60.0]/46.0 [20.3-118.7]). We did not find significant differences regarding surgical time (min) or the affected or close margins.

CONCLUSION

In our experience, the use of magnetic seed (Magseed®) is a feasible option to guide breast-conserving surgery of non-palpable lesions and enabled us to resect less breast tissue.