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Nguyen CL, Cui R, Zhou M, Ali F, Easwaralingam N, Chan B, Graham S, Azimi F, Mak C, Warrier S. Cost-Effectiveness of Radar Localisation Versus Wire Localisation for Wide Local Excision of Non-palpable Breast Cancer. Ann Surg Oncol 2024; 31:3916-3925. [PMID: 38472677 PMCID: PMC11076345 DOI: 10.1245/s10434-024-15142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Wire localisation (WL) is the "gold standard" localisation technique for wide local excision (WLE) of non-palpable breast lesions but has disadvantages that have led to the development of wireless techniques. This study compared the cost-effectiveness of radar localisation (RL) to WL. METHODS This was a single-institution study of 110 prospective patients with early-stage breast cancer undergoing WLE using RL with the SCOUT® Surgical Guidance System (2021-2023) compared with a cohort of 110 patients using WL. Margin status, re-excision rates, and surgery delays associated with preoperative localisation were compared. Costs from a third-party payer perspective in Australian dollars (AUD$) calculated by using microcosting, break-even point, and cost-utility analyses. RESULTS A total of 110 WLEs using RL cost a total of AUD$402,281, in addition to the device cost of AUD$77,150. The average additional cost of a surgery delay was AUD$2318. Use of RL reduced the surgery delay rate by 10% (p = 0.029), preventing 11 delays with cost savings of AUD$25,496. No differences were identified in positive margin rates (RL: 11.8% vs. WL: 17.3%, p = 0.25) or re-excision rates (RL: 14.5% vs. WL: 21.8%, p = 0.221). In total, 290 RL cases are needed to break even. The cost of WLE using RL was greater than WL by AUD$567. There was a greater clinical benefit of 1.15 quality-adjusted life-years (QALYs) and an incremental cost-utility ratio of AUD$493 per QALY favouring RL. CONCLUSIONS Routine use of RL was a more cost-effective intervention than WL. Close to 300 RL cases are likely needed to be performed to recover costs of the medical device. CLINICAL TRIAL REGISTRATION ACTRN12624000068561.
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Affiliation(s)
- Chu Luan Nguyen
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia.
| | - Rebecca Cui
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael Zhou
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Fatema Ali
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Neshanth Easwaralingam
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Belinda Chan
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Susannah Graham
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Farhad Azimi
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Cindy Mak
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Sanjay Warrier
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
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Kramer JM, Jordan SG, Chiang JTA. Use of the lateral arm in tomosynthesis-guided SCOUT Reflector placement procedures. Clin Imaging 2024; 109:110130. [PMID: 38490080 DOI: 10.1016/j.clinimag.2024.110130] [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: 12/13/2023] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
Preoperative localization procedures are important for guiding surgical excision of non-palpable findings in the breast. The SCOUT Reflector (Merit Medical, South Jordan UT, USA) is a non-wire-based localization device that has been incorporated into clinical use with great success. SCOUT Reflectors can be placed using several imaging modalities, including tomosynthesis. One drawback to SCOUT Reflector placement under tomosynthesis guidance is an inability to directly visualize the introducer needle tip, a factor that limits precision. In this brief communication, we describe the use of a lateral arm attachment for tomosynthesis guided SCOUT Reflector placement. Precise SCOUT Reflector placement can be achieved using the lateral arm due to the ability to clearly visualize the introducer needle and the SCOUT Reflector within the introducer needle bore prior to deployment.
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Affiliation(s)
- Jennifer M Kramer
- Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA; Banner University Medical Center Tucson, 1625 N Campbell Ave, Tucson, AZ 85719, USA
| | | | - Jing-Tzyh Alan Chiang
- Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA; Banner University Medical Center Tucson, 1625 N Campbell Ave, Tucson, AZ 85719, USA.
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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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4
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Carlson KA, Checka C, Hunt KK, Jung J, Bridges C, Singh P, Refinetti A, Moseley T, Perez F, Mayo C, Tamirisa N. Evaluation of a Surgical Navigation System for Localization and Excision of Nonpalpable Lesions in Breast and Axillary Surgery. Breast J 2023; 2023:9993852. [PMID: 38162957 PMCID: PMC10757656 DOI: 10.1155/2023/9993852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/21/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
Introduction Elucent Medical has introduced a novel EnVisio™ Surgical Navigation system which uses SmartClips™ that generate a unique electromagnetic signal triangulated in 3 dimensions for real-time navigation. The purpose of this study was to evaluate the efficacy and feasibility of the EnVisio Surgical Navigation system in localizing and excising nonpalpable lesions in breast and axillary surgery. Methods This pilot study prospectively examined patients undergoing breast and nodal localization using the EnVisio Surgical Navigation system. SmartClips were placed by designated radiologists using ultrasound (US) or mammographic (MMG) guidance. The technical evaluation focused on successful deployment and subsequent excision of all localized lesions including SmartClips and biopsy clips. Results Eleven patients underwent localization using 27 SmartClips which included bracketed multifocal disease (n = 4) and clipped lymph node (n = 1). The bracketed cases were each localized with 2 SmartClips. Mammography and ultrasound were used (n = 8 and n = 19, respectively) to place the SmartClips. All 27 devices were successfully deployed within 5 mm of the targeted lesion or biopsy clip. All SmartClip devices were identified and retrieved intraoperatively. No patients required a second operation for margin excision. Conclusion In a limited sample, the EnVisio Surgical Navigation system was a reliable technology for the localization of breast and axillary lesions planned for surgical excision. Further comparative studies are required to evaluate its efficacy in relation to the other existing localization modalities.
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Affiliation(s)
- Kjirsten A. Carlson
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Cristina Checka
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Breast Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennifer Jung
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christian Bridges
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Puneet Singh
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ana Refinetti
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Tanya Moseley
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Breast Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frances Perez
- Department of Breast Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Cody Mayo
- Department of Breast Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nina Tamirisa
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Lim HJ, Leong LCH, Tan YY, Ong EMW, Tan VKM, Lim SZ, Yen Woo EK, Lee YS, Sim Y, Madhukumar P, Tee Tan BK, Sim LSJ, Lin Moey TH, Win T, Lim GH. Savi Scout® wireless localisation of breast and axillary lesions: lessons learned from Singapore's early experience. Singapore Med J 2023:389620. [PMID: 38037778 DOI: 10.4103/singaporemedj.smj-2021-412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Hui Jun Lim
- Department of Breast Surgery, Singapore General Hospital, Singapore
| | | | | | | | - Veronique Kiak Mien Tan
- Department of Breast Surgery, Singapore General Hospital; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore; SingHealth Duke-NUS Breast Centre, Singapore
| | - Sue Zann Lim
- Department of Breast Surgery, Singapore General Hospital; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore; SingHealth Duke-NUS Breast Centre, Singapore
| | - Evan Kok Yen Woo
- Evan Woo Breast and Plastic Surgery, Mount Elizabeth Novena Specialist Centre, Singapore
| | - Yien Sien Lee
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, Singapore
| | - Yirong Sim
- Department of Breast Surgery, Singapore General Hospital; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore; SingHealth Duke-NUS Breast Centre, Singapore
| | - Preetha Madhukumar
- Department of Breast Surgery, Singapore General Hospital; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore; SingHealth Duke-NUS Breast Centre, Singapore
| | - Benita Kiat Tee Tan
- Department of Breast Surgery, Singapore General Hospital; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore; SingHealth Duke-NUS Breast Centre; Department of Surgery, Sengkang General Hospital, Singapore
| | | | - Tammy Hui Lin Moey
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Thida Win
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, Singapore
| | - Geok Hoon Lim
- Breast Department, KK Women's and Children's Hospital, Singapore
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Ferrarazzo G, Nieri A, Firpo E, Rattaro A, Mignone A, Guasone F, Manzara A, Perniciaro G, Spinaci S. The Role of Sentinel Lymph Node Biopsy in Breast Cancer Patients Who Become Clinically Node-Negative Following Neo-Adjuvant Chemotherapy: A Literature Review. Curr Oncol 2023; 30:8703-8719. [PMID: 37887530 PMCID: PMC10605278 DOI: 10.3390/curroncol30100630] [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: 08/19/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND In clinically node-positive (cN+) breast cancer (BC) patients who become clinically node-negative (cN0) following neoadjuvant chemotherapy (NACT), sentinel lymph node biopsy (SLNB) after lymphatic mapping with lymphoscintigraphy is not widely accepted; therefore, it has become a topic of international debate. OBJECTIVE Our literature review aims to evaluate the current use of this surgical practice in a clinical setting and focuses on several studies published in the last six years which have contributed to the assessment of the feasibility and accuracy of this practice, highlighting its importance and oncological safety. We have considered the advantages and disadvantages of this technique compared to other suggested methods and strategies. We also evaluated the role of local irradiation therapy after SLNB and state-of-the-art SLN mapping in patients subjected to NACT. METHODS A comprehensive search of PubMed and Cochrane was conducted. All studies published in English from 2018 to August 2023 were evaluated. RESULTS Breast units are moving towards a de-escalation of axillary surgery, even in the NACT setting. The effects of these procedures on local irradiation are not very clear. Several studies have evaluated the oncological outcome of SLNB procedures. However, none of the alternative techniques proposed to lower the false negative rate (FNR) of SLNB are significant in terms of prognosis. CONCLUSIONS Based on these results, we can state that lymphatic mapping with SLNB in cN+ BC patients who become clinically node-negative (ycN0) following NACT is a safe procedure, with a good prognosis and low axillary failure rates.
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Affiliation(s)
- Giulia Ferrarazzo
- Nuclear Medicine, Ospedale Villa Scassi ASL3, 16149 Genova, Italy; (A.M.); (A.M.)
| | - Alberto Nieri
- Nuclear Medicine Unit, Oncological Medical and Specialist Department, University Hospital of Ferrara, 44124 Cona, Italy;
| | - Emma Firpo
- Breast Surgery, Department of Surgery, Ospedale Villa Scassi ASL3, 16149 Genova, Italy; (E.F.); (A.R.); (F.G.)
| | - Andrea Rattaro
- Breast Surgery, Department of Surgery, Ospedale Villa Scassi ASL3, 16149 Genova, Italy; (E.F.); (A.R.); (F.G.)
| | - Alessandro Mignone
- Nuclear Medicine, Ospedale Villa Scassi ASL3, 16149 Genova, Italy; (A.M.); (A.M.)
| | - Flavio Guasone
- Breast Surgery, Department of Surgery, Ospedale Villa Scassi ASL3, 16149 Genova, Italy; (E.F.); (A.R.); (F.G.)
| | - Augusto Manzara
- Nuclear Medicine, Ospedale Villa Scassi ASL3, 16149 Genova, Italy; (A.M.); (A.M.)
| | - Giuseppe Perniciaro
- Division of Plastic and Reconstructive Surgery, Burn Unit, Ospedale Villa Scassi ASL3, 16149 Genova, Italy;
| | - Stefano Spinaci
- Breast Unit, Department of Surgery, Ospedale Villa Scassi ASL3, 16149 Genova, Italy;
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Banys-Paluchowski M, de Boniface J. Axillary staging in node-positive breast cancer converting to node negativity through neoadjuvant chemotherapy: Current evidence and perspectives. Scand J Surg 2023; 112:117-125. [PMID: 36642957 DOI: 10.1177/14574969221145892] [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: 01/17/2023]
Abstract
PURPOSE Over the recent years, axillary staging of initially node-positive breast cancer patients converting to clinical node negativity after neoadjuvant chemotherapy has seen rapid changes. This narrative review aims to give a contemporary overview over published evidence and clinical practice, and thus provide some guidance to the surgical community in the process of re-evaluating and re-shaping surgical practice. METHODS The search strategy aimed at finding relevant studies. Only articles in English were considered. RESULTS The introduction of modern techniques offer more precise staging surgery and thus hopefully reduced arm morbidity. Clinical practice has however diverged both within countries and internationally. While some countries have adapted de-escalated axillary staging techniques such as targeted axillary dissection, targeted lymph node biopsy or sentinel lymph node biopsy, others continue to recommend a full axillary lymph node dissection. With the implementation of new techniques, many questions arise, regarding aspects of oncological safety, technical performance, budget and practicality, patient selection and indications for different levels of axillary staging procedures. CONCLUSIONS There is a growing body of evidence on de-escalation of axillary surgery in the setting of cN+ → ycN0 breast cancer treated with neoadjuvant chemotherapy. However, standards differ between countries and future studies are necessary to fully assess the optimal strategy for these patients.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
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Gabrielova L, Selingerova I, Zatecky J, Zapletal O, Burkon P, Holanek M, Coufal O. Comparison of 3 Different Systems for Non-wire Localization of Lesions in Breast Cancer Surgery. Clin Breast Cancer 2023:S1526-8209(23)00111-8. [PMID: 37301711 DOI: 10.1016/j.clbc.2023.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Localizing breast lesions by marking tumors and their detection using probes during surgery is a common part of clinical practice. Various nonwire localization systems were intended to be compared from different perspectives. METHODS Various measurement experiments were performed. Localization techniques, including radioactive seed (RSLS), magnetically guided (MGLS), or radar (SLS), were compared in signal propagation in water and tissue environments, signal interference by surgical instruments, and the practical experience of surgeons. Individual experiments were thoroughly prospectively planned. RESULTS The RSLS signal was detectable at the largest evaluated distance, ie, 60 mm. The SLS and MGLS signal detection was shorter, up to 25 mm to 45 mm and 30 mm, respectively. The signal intensity and the maximum detection distance in water differed slightly depending on the localization marker orientation to the probe, especially for SLS and MGLS. Signal propagation in the tissue was noted to a depth of 60 mm for RSLS, 50 mm for SLS, and 20 mm for MGLS. Except for the expected signal interferences by approaching surgical instruments from any direction for MGLS, the signal interruption for RSLS and SLS was observed only by inserting instruments directly between the localization marker and probe. Moreover, the SLS signal interference by instrument touch was noted. Based on surgeons' results, individual systems did not differ significantly for most measurement condition settings. CONCLUSION Apparent differences noted among localization systems can help experts choose an appropriate system for a specific situation or reveal small nuances that have not yet been observed in clinical practice.
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Affiliation(s)
- Lucie Gabrielova
- Department of Breast, Skin, and Oncoplastic Surgery, Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Iveta Selingerova
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czech Republic; Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Jan Zatecky
- Department of Breast, Skin, and Oncoplastic Surgery, Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgery, Silesian Hospital in Opava, Opava, Czech Republic; The Institute of Paramedical Health Studies, Faculty of Public Policies, Silesian University, Opava, Czech Republic
| | - Ondrej Zapletal
- Department of Breast, Skin, and Oncoplastic Surgery, Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Burkon
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Milos Holanek
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Oldrich Coufal
- Department of Breast, Skin, and Oncoplastic Surgery, Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Di Paola V, Mazzotta G, Conti M, Palma S, Orsini F, Mola L, Ferrara F, Longo V, Bufi E, D'Angelo A, Panico C, Clauser P, Belli P, Manfredi R. Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know. Cancers (Basel) 2023; 15:cancers15072130. [PMID: 37046791 PMCID: PMC10093304 DOI: 10.3390/cancers15072130] [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: 02/28/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
Targeted axillary dissection (TAD) is an axillary staging technique after NACT that involves the removal of biopsy-proven metastatic lymph nodes in addition to sentinel lymph node biopsy (SLNB). This technique avoids the morbidity of traditional axillary lymph node dissection and has shown a lower false-negative rate than SLNB alone. Therefore, marking positive axillary lymph nodes before NACT is critical in order to locate and remove them in the subsequent surgery. Current localization methods include clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive tracer-based localizers, magnetic seeds, radar reflectors, and radiofrequency identification devices. The aim of this paper is to illustrate the management of axillary lymph nodes based on current guidelines and explain the features of axillary lymph node markers, with relative advantages and disadvantages.
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Affiliation(s)
- Valerio Di Paola
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giorgio Mazzotta
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Conti
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Simone Palma
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Federico Orsini
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Laura Mola
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Ferrara
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Valentina Longo
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Enida Bufi
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Anna D'Angelo
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Camilla Panico
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Radiotherapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Paolo Belli
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Manfredi
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
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Image-Guided Radar Reflector Localization for Small Soft-Tissue Lesions in the Musculoskeletal System. AJR Am J Roentgenol 2023; 220:399-406. [PMID: 36259594 DOI: 10.2214/ajr.22.28399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Preoperative localization of nonpalpable breast lesions using a radar reflector surgical guidance system has become commonplace, but the clinical utility of this emerging technology in the musculoskeletal system has not yet been well established. The system components include a console, a handpiece, an implanted radiofrequency reflector that works as a lesion marker, and an infrared light-emitting probe to guide the surgeon. The reflector can be deployed to localize small nonpalpable nodules within the subcutaneous fat as well as lesions within the deeper soft tissues. It can also be used for lymph nodes and foreign bodies. Localization can be performed both before and after treatment. The objective of this article is to describe the potential applications and our technique and initial experience for radar reflector localization within the musculoskeletal system.
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11
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Horvat JV. High-Risk Lesion Management. Semin Ultrasound CT MR 2023; 44:46-55. [PMID: 36792273 DOI: 10.1053/j.sult.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-risk lesions or lesions of uncertain malignant potential are frequent findings on image-guided needle biopsy of the breast and comprise a number of distinct entities. These lesions are known for having risk of underlying malignancy and are usually associated with an increased lifetime risk for breast cancer. Surgical excision was traditionally recommended for all high-risk lesions but recent studies have demonstrated that vacuum-assisted excision or surveillance may be adequate for some lesions. While management of high-risk lesion varies among institutions, this chapter describes the management recommendations based on recent literature of the most frequent types of lesions.
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Affiliation(s)
- Joao V Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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12
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Vijayaraghavan GR, Ge C, Lee A, Roubil JG, Kandil DH, Dinh KH, Vedantham S. Savi-Scout Radar Localization: Transitioning From the Traditional Wire Localization to Wireless Technology for Surgical Guidance at Lumpectomies. Semin Ultrasound CT MR 2023; 44:12-17. [PMID: 36792268 DOI: 10.1053/j.sult.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Breast-conserving surgery or lumpectomy requires localization of the lesion prior to surgery, which is traditionally accomplished by imaging-guided wire localization. Over the last decade, alternatives to wire localization have emerged. This work reviews the literature on one such wireless technology, SaviScout radar (SSR) system, and shares our experience with using this technology for presurgical tumor localization. The SSR surgical guidance system is non-radioactive. The radiologist implants a reflector device in the breast under mammography or ultrasound guidance at any time prior to surgery. The placement of this reflector can be confirmed from the cadence of a handheld percutaneous probe of a handpiece and console system. Results from several studies show that the surgical outcomes from SSR and wire-localization are similar. SSR provides operational advantages as the scheduling for reflector placement by radiologists is decoupled from surgery, but at an increased cost compared to wire-localization.
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Affiliation(s)
- Gopal R Vijayaraghavan
- Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA.
| | - Connie Ge
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, MA
| | - Amanda Lee
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, MA
| | - John G Roubil
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | - Dina H Kandil
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, MA
| | - Kate H Dinh
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA
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13
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Feinberg JA, Axelrod D, Guth A, Maldonado L, Darvishian F, Pourkey N, Goodgal J, Schnabel F. Radar reflector guided axillary surgery in node positive breast cancer patients. Expert Rev Med Devices 2022; 19:791-795. [DOI: 10.1080/17434440.2022.2139177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Deborah Axelrod
- Department of Surgery, NYU Langone Health, New York, NY, USA
| | - Amber Guth
- Department of Surgery, NYU Langone Health, New York, NY, USA
| | | | | | - Nakisa Pourkey
- Department of Surgery, NYU Langone Health, New York, NY, USA
| | - Jenny Goodgal
- Department of Surgery, NYU Langone Health, New York, NY, USA
| | - Freya Schnabel
- Department of Surgery, NYU Langone Health, New York, NY, USA
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14
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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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15
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Farha MJ, Simons J, Kfouri J, Townsend-Day M. SAVI Scout® System for Excision of Non-Palpable Breast Lesions. Am Surg 2022:31348221096576. [PMID: 35509218 DOI: 10.1177/00031348221096576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The standard localization of non-palpable breast masses is wire/needle localization (WL). Newer technologies have evolved, allowing more efficient scheduling and improving surgeon and patient experiences. These include Radioactive Seed, MagSeed®, and SAVI Scout® (SS). We adopted SS at our program in July of 2017. We are reporting our experience comparing SAVI Scout® with needle localization. STUDY DESIGN This is a retrospective study comparing SS and wire localization techniques for the excision of both benign and malignant lesions. Chart reviews of localized patients between 7/1/2017 and 6/30/2019, recording the age of the patient, date of procedure, localization method, pathology of lesion postexcision, number and status of margins, guidance method (mammogram vs. ultrasound), specimen size, and distance of reflector from biopsy clip, were completed to compare these localization methods with the aim of asserting their equality. RESULTS There were 48 wire and 64 SS localized excisions. Successful lesion excision was achieved in 100% of cases for both techniques. There were 1 SS and 4 WL re-excisions for margin clearance not reaching statistical significance. 51 additional margins were obtained in the SS cases compared to 36 margins in the WL cases without a statistically significant difference. CONCLUSIONS 1- Both SS and WL achieved 100% excision of targeted lesions 2- SS localization was successfully implemented, offering more convenience for patients and providers 3- More re-excisions in the WL group as compared to the SS group did not reach statistical significance and requires further investigation 4- A prospective controlled trial comparing the different localization techniques can address questions related to effectiveness, cost, patient and provider experiences.
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Affiliation(s)
- Maen J Farha
- Department of Surgery, 23436MedStar Union Memorial and Good Samaritan Hospitals, Baltimore, MD, USA
| | - James Simons
- The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Jad Kfouri
- University of Maryland, College Park, MD, USA
| | - Michelle Townsend-Day
- Department of Surgery, 23436MedStar Union Memorial and Good Samaritan Hospitals, Baltimore, MD, USA
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16
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Constantinidis F, Sakellariou S, Chang SL, Linder S, MacPherson B, Seth S, Gill N, Seth A. Wireless localisation of breast lesions with MagSeed. A radiological perspective of 300 cases. Br J Radiol 2022; 95:20211241. [PMID: 35201906 PMCID: PMC10993964 DOI: 10.1259/bjr.20211241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this article is to review the technical and radiological aspects of MagSeed® localisation, to assess its accuracy based on post-localisation mammograms and excision specimen X-rays and to discuss the radiological experience of our institutions. METHODS Two-year data were collected retrospectively from three NHS boards from the West of Scotland. A total of 309 MagSeeds® were inserted under mammographic or ultrasonographic guidance in 300 women with unifocal, multifocal and/or bilateral breast lesions at the day of surgery or up to 30 days prior to it. Radiological review of post-localisation mammograms and intraoperative specimen X-rays as well as a review of the surgical outcomes were performed to assess the accuracy and efficacy of the method. Our experience relating to the technique's strengths and downsides were also noted. RESULTS The MagSeeds® were inserted on average 7.2 days before surgery. The localisation technique was straight forward for the radiologists. In 99% of the cases, the MagSeed® was successfully deployed and 100% of the successfully localised lesions were excised at surgery. There was no difference in the accuracy of the localisation whether this was mammographically or ultrasonographically guided. On post-localisation mammograms, the MagSeed® was radiologically accurately positioned in 97.3% of the cases. No delayed MagSeed® migration was observed. On the specimen X-rays, the lesion was centrally positioned in 45.1%, eccentric within more than 1 mm from the margin in 35.7% and in 14.8% it was at the specimen's margin. The re-excision rate was 18.3%. CONCLUSION The MagSeed® is an accurate and reliable localisation method in breast conserving surgery with good surgical outcomes. ADVANCES IN KNOWLEDGE To our knowledge, the radiological aspects of MagSeed® localisation have not been widely described in peer-reviewed journals thus far.
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Affiliation(s)
| | | | - Sau Lee Chang
- Department of Imaging NHS Greater Glasgow and
Clyde, Glasgow,
UK
| | - Svetlana Linder
- Department of Imaging NHS Greater Glasgow and
Clyde, Glasgow,
UK
| | | | - Subodh Seth
- Department of Surgery NHS Forth Valley,
Larbert, UK
| | - Nicola Gill
- Department of Imaging NHS Forth Valley,
Larbert, UK
| | - Archana Seth
- Department of Imaging NHS Greater Glasgow and
Clyde, Glasgow,
UK
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17
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Semillas radiactivas y no radiactivas como método de localización quirúrgica de las lesiones mamarias no palpables. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Cebrecos I, Sánchez-Izquierdo N, Ganau S, Mensión E, Perissinotti A, Úbeda B, Bargalló X, Alonso I, Vidal-Sicartb S. Radioactive and non-radioactive seeds as surgical localization method of non-palpable breast lesions. Rev Esp Med Nucl Imagen Mol 2022; 41:100-107. [DOI: 10.1016/j.remnie.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
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19
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Magnetic seeds: An alternative to wire localization for non-palpable breast lesions. Clin Breast Cancer 2022; 22:e700-e707. [DOI: 10.1016/j.clbc.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/15/2022]
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20
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Davis KM, Raybon CP, Monga N, Waheed U, Michaels A, Henry C, Spalluto LB. Image-guided Localization Techniques for Nonpalpable Breast Lesions: An Opportunity for Multidisciplinary Patient-centered Care. JOURNAL OF BREAST IMAGING 2021; 3:542-555. [PMID: 38424951 DOI: 10.1093/jbi/wbab061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Indexed: 03/02/2024]
Abstract
Selection of a localization method for nonpalpable breast lesions offers an opportunity for institutions to seek multidisciplinary input to promote value-based, patient-centered care. The diverse range of nonpalpable breast and axillary pathologies identified through increased utilization of screening mammography often necessitates image-guided preoperative localization for accurate lesion identification and excision. Preoperative localization techniques for breast and axillary lesions have evolved to include both wire and nonwire methods, the latter of which include radioactive seeds, radar reflectors, magnetic seeds, and radiofrequency identification tag localizers. There are no statistically significant differences in surgical outcomes when comparing wire and nonwire localization devices. Factors to consider during selection and adoption of image-guided localization systems include physician preference and ease of use, workflow efficiency, and patient satisfaction.
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Affiliation(s)
- Katie M Davis
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN, USA
| | - Courtney P Raybon
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN, USA
| | - Natasha Monga
- Case Western Reserve University, The MetroHealth System, Department of Radiology, Cleveland, OH, USA
| | - Uzma Waheed
- University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Aya Michaels
- Newton Wellesley Hospital, Department of Radiology, Newton, MA, USA
| | - Cameron Henry
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN, USA
| | - Lucy B Spalluto
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN, USA
- Vanderbilt Ingram Cancer Center, Nashville, TN, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA
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21
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Options to Determine Pathological Response of Axillary Lymph Node Metastasis after Neoadjuvant Chemotherapy in Advanced Breast Cancer. Cancers (Basel) 2021; 13:cancers13164167. [PMID: 34439321 PMCID: PMC8394061 DOI: 10.3390/cancers13164167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Neoadjuvant therapy instituted prior to definitive surgery helps to reduce the tumor burden in the breast and axilla. De-escalation of surgery in the axilla may allow removal of just the involved nodes and sentinel nodes for determination of pathological response of previously biopsy proven positive axillary nodes. In order to attain the optimal surgical results with minimum risk of complications, it is important to choose the accurate method of identification of these positive nodes. In this review, we examine the different options to assure identification of the nodes deemed positive before neoadjuvant therapy, at the time of definitive surgery. Abstract Increasing use of neoadjuvant therapy in large tumors or node positive disease in breast cancer patients or hormone negative and HER 2 overexpressing cancers often gives rise to complete clinical response, with resolution of disease in the breast and axilla. These results have raised important questions to deescalate loco-regional surgical treatment options with minimum recurrence risk and treatment related morbidity. Although there is excellent prognosis following clinical response, the primary goal of surgery still remains to confirm complete pathological response in the biopsied node that was previously positive and now clinically/radiologically negative (ycN0). Biopsied lymph nodes are often marked with a clip to allow future identification at the time of definitive surgery. The goal of lymph node surgery in oncology is that it should be accurate, hence the significance of localizing the biopsied node. This article aims to review the different options to localize the deemed positive node at the time of definitive surgery, in order to help determine pathological response after neoadjuvant therapy.
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22
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Richey WL, Heiselman JS, Luo M, Meszoely IM, Miga MI. Impact of deformation on a supine-positioned image-guided breast surgery approach. Int J Comput Assist Radiol Surg 2021; 16:2055-2066. [PMID: 34382176 DOI: 10.1007/s11548-021-02452-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To reduce reoperation rates for image-guided breast-conserving surgery, the enhanced sensitivity of magnetic resonance (MR) supine imaging may be leveraged. However, accurate tissue correspondence between images and their physical counterpart in the surgical presentation is challenging due to breast deformations (e.g., from patient/arm position changes, and operating room table rotation differences). In this study, standard rigid registration methods are employed and tissue deformation is characterized. METHODS On n = 10 healthy breasts, surface displacements were measured by comparing intraoperative fiducial locations as the arm was moved from conventional MR scanning positions (arm-down and arm-up) to the laterally extended surgical configuration. Supine MR images in the arm-down and arm-up positions were registered to mock intraoperative presentations. RESULTS Breast displacements from a supine MR imaging configuration to a mock surgical presentation were 28.9 ± 9.2 mm with shifts occurring primarily in the inferior/superior direction. With respect to supine MR to surgical alignment, the average fiducial, target, and maximum target registration errors were 9.0 ± 1.7 mm, 9.3 ± 1.7 mm, and 20.0 ± 7.6 mm, respectively. Even when maintaining similar arm positions in the MR image and mock surgery, the respective averages were 6.0 ± 1.0 mm, 6.5 ± 1.1 mm, and 12.5 ± 2.8 mm. CONCLUSION From supine MR positioning to surgical presentation, the breast undergoes large displacements (9.9-70.1 mm). The data also suggest that significant nonrigid deformations (9.3 ± 1.7 mm with 20.0 mm average maximum) exist that need to be considered in image guidance and modeling applications.
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Affiliation(s)
- Winona L Richey
- Department of Biomedical Engineering, Vanderbilt University, 1225 Stevenson Center Ln, Nashville, 37235, USA.
- Vanderbilt Institute for Surgery and Engineering, 1161 21st Ave. S, Nashville, 37204, USA.
- Vanderbilt University, 1225 Stevenson Center Ln, Stevenson Center 5824, Nashville, TN, 37240, USA.
| | - Jon S Heiselman
- Department of Biomedical Engineering, Vanderbilt University, 1225 Stevenson Center Ln, Nashville, 37235, USA
- Vanderbilt Institute for Surgery and Engineering, 1161 21st Ave. S, Nashville, 37204, USA
| | - Ma Luo
- Department of Biomedical Engineering, Vanderbilt University, 1225 Stevenson Center Ln, Nashville, 37235, USA
- Vanderbilt Institute for Surgery and Engineering, 1161 21st Ave. S, Nashville, 37204, USA
| | - Ingrid M Meszoely
- Vanderbilt Institute for Surgery and Engineering, 1161 21st Ave. S, Nashville, 37204, USA
- Division of Surgical Oncology, Vanderbilt University Medical Center, 719 Thompson Ln Suite 22100, Nashville, 37232, USA
| | - Michael I Miga
- Department of Biomedical Engineering, Vanderbilt University, 1225 Stevenson Center Ln, Nashville, 37235, USA
- Vanderbilt Institute for Surgery and Engineering, 1161 21st Ave. S, Nashville, 37204, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. S, Nashville, 37232, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
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23
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Dixit N, Daniel BL, Hargreaves BA, Pauly JM, Scott GC. Biopsy marker localization with thermo-acoustic ultrasound for lumpectomy guidance. Med Phys 2021; 48:6069-6079. [PMID: 34287972 DOI: 10.1002/mp.15115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/20/2021] [Accepted: 07/14/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Almost one in four lumpectomies fails to fully remove cancerous tissue from the breast, requiring reoperation. This high failure rate suggests that existing lumpectomy guidance methods are inadequate for allowing surgeons to consistently identify the proper volume of tissue for excision. Current guidance techniques either provide little information about the tumor position or require surgeons to frequently switch between making incisions and manually probing for a marker placed at the lesion site. This article explores the feasibility of thermo-acoustic ultrasound (TAUS) to enable hands-free localization of metallic biopsy markers throughout surgery, which would allow for continuous visualization of the lesion site in the breast without the interruption of surgery. In a TAUS-based localization system, microwave excitations would be transmitted into the breast, and the amplification in microwave absorption around the metallic markers would generate acoustic signals from the marker sites through the thermo-acoustic effect. Detection and ranging of these signals by multiple acoustic receivers on the breast could then enable marker localization through acoustic multilateration. METHODS Physics simulations were used to characterize the TAUS signals generated from different markers by microwave excitations. First, electromagnetic simulations determined the spatial pattern of the amplification in microwave absorption around the markers. Then, acoustic simulations characterized the acoustic fields generated from these markers at various acoustic frequencies. TAUS-based one-dimensional (1D) ranging of two metallic markers-including a biopsy marker that is FDA-approved for clinical use-immersed in saline was also performed using a bench-top setup. To perform TAUS acquisitions, a microwave applicator was driven by 2.66 GHz microwave signals that were amplitude-modulated by chirps at the desired acoustic excitation frequencies, and the resulting TAUS signal from the markers was detected by an ultrasonic transducer. RESULTS The simulation results show that the geometry of the marker strongly impacts the quantity and spatial pattern of both the microwave absorption around the marker and the resulting TAUS signal generated from the marker. The simulated TAUS signal maps and acoustic frequency responses also make clear that the marker geometry plays an important role in determining the overall system response. Using the bench-top setup, TAUS detection and 1D localization of the markers were successfully demonstrated for multiple different combinations of microwave applicator and metallic marker. These initial results indicate that TAUS-based localization of biopsy markers is feasible. CONCLUSIONS Through microwave excitations and acoustic detection, TAUS can be used to localize metallic biopsy markers. With further development, TAUS opens new avenues to enable a more intuitive lumpectomy guidance system that could help to achieve better lumpectomy outcomes.
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Affiliation(s)
- Neerav Dixit
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Bruce L Daniel
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Brian A Hargreaves
- Department of Electrical Engineering, Stanford University, Stanford, California, USA.,Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA
| | - John M Pauly
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Greig C Scott
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
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24
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Choe AI, Ismail R, Mack J, Walter V, Yang AL, Dodge DG. Review of Variables Associated With Positive Surgical Margins Using Scout Reflector Localizations for Breast Conservation Therapy. Clin Breast Cancer 2021; 22:e232-e238. [PMID: 34348869 DOI: 10.1016/j.clbc.2021.07.003] [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: 06/04/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate factors contributing to positive surgical margins associated with reflector guidance for patients undergoing breast conserving therapy for malignancy. MATERIALS AND METHODS A retrospective IRB-approved review of our institutional database was performed for malignant breast lesions preoperatively localized from January 1, 2018 to December 31, 2020. The following data was recorded using electronic medical records: lesion type and grade, lesion location, reflector and wire placement modality, use of intraoperative ultrasound, margin status, patient age, family history, BMI, and final pathology. Statistical analysis was performed with univariate summary statistics and logistic regression. P < .05 was significant. RESULTS A total of 606 image-guided pre-surgical localizations were performed for lumpectomies of breast malignancies. A total of 352 of 606 (58%) wire localizations and 254 of 606 (42%) SCOUT reflector localizations were performed. Sixty out of 352 (17%) of wire-localized patients had positive surgical margins, whereas forty-eight out of 254 (19%) of reflector-localized patients had positive surgical margins. (OR = 1.12, P value: .59). For reflector guided cases, the use of intraoperative ultrasound (IOUS) was associated with decreased positive margin status (OR = 0 .28, 95% CI = [0.14, 0.58]) while in situ disease was associated with increased positive margin status (OR = 1.99, 95% CI = [1.05, 3.75]). No association between modality used for localization (mammography vs. ultrasound) and positive margin status was observed (OR = 0.63, 95% CI = [0.33, 1.19]). No association between positive margins and age, family history, tumor location and BMI was observed. CONCLUSION For reflector guided surgeries, the use of IOUS was associated with decreased positive margins, by contrast the presence of ductal carcinoma in situ was associated with increased positive margins. There was no statistically significant difference in surgical outcomes for reflector-guided localization compared to wire localizations of the breast.
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Affiliation(s)
- Angela I Choe
- Penn State Health Milton S Hershey Medical Center, Hershey, PA.
| | | | - Julie Mack
- Penn State Health Milton S Hershey Medical Center, Hershey, PA
| | - Vonn Walter
- Penn State Health Milton S Hershey Medical Center, Hershey, PA
| | | | - Daleela G Dodge
- Penn State Health Milton S Hershey Medical Center, Hershey, PA
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25
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Cooper K, Allen E, Lancaster R, Woodard S. From the Reading Room to Operating Room: Retrospective Data and Pictorial Review After 806 SCOUT Placements. Curr Probl Diagn Radiol 2021; 51:460-469. [PMID: 34312015 DOI: 10.1067/j.cpradiol.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/12/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Non-wire localization techniques are becoming more common. SCOUT surgical guidance system has been shown to increase flexibility in scheduling patients for surgery. The objective of this article is to provide institutional experiences with pictorial review after placement of 806 SCOUT devices. MATERIALS AND METHODS Radiology procedure reports of SCOUT device placements from January 11, 2018 to May 19, 2020 were reviewed to assess demographics of patient population, imaging method of placement, size of reflector delivery system used, placement approach, and time spent in the radiology suite or Turn Around Time (TAT). TAT was compared to that of wire placement using a Two-tailed Mann-Whitney U Test. Reports were assessed for those with absent signal at time of placement. In cases where signal was absent, migration was found, or complications noted, further case review was performed using the Electronic Medical Record to assess whether the devices were successfully retrieved. RESULTS There were 806 total SCOUT placements identified from radiology procedure reports in patients aged 12-92 with 64.3% (518/806) placed using ultrasound-guidance and 35.7% (288/806) by mammographic-guidance. The most common delivery device was a 7.5 cm needle. Only 0.9% (7/806) of SCOUT reflectors were >1cm from target, all of which were successfully excised. After radiology placement, signal was not heard in 1.4% (9/806) of cases and individual case review revealed that all were successfully excised. In 2019, TATs of SCOUT procedures were significantly lower than TATs from wire localizations (P = 0.00024). CONCLUSIONS SCOUT localization for breast surgery can provide solutions to problems encountered by patients and providers. A year after implementation, SCOUT use was found to result in shorter TATs in radiology. In addition, 100% of devices that were either migrated or inaudible at the time of radiology placement were successfully excised.
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Affiliation(s)
- Kasey Cooper
- The University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Elizabeth Allen
- Department of Radiology, Breast Imaging Section, University of Alabama at Birmingham, Birmingham, A1
| | - Rachael Lancaster
- Division of Surgical Oncology, Breast Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Stefanie Woodard
- Department of Radiology, Breast Imaging Section, University of Alabama at Birmingham, Birmingham, A1.
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Bercovici N, Makarenko V, Vijayaraghavan G, Larkin A, Lafemina J, Clark J, Kandil D. A single-institution analysis of reflector-guided localization using SAVI SCOUT® in nonpalpable breast carcinoma compared to traditional wire localization. Breast J 2021; 27:737-738. [PMID: 34165213 DOI: 10.1111/tbj.14243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Nicholas Bercovici
- Departments of Pathology, Surgery, and Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Vladislav Makarenko
- Departments of Pathology, Surgery, and Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Gopal Vijayaraghavan
- Departments of Pathology, Surgery, and Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Anne Larkin
- Departments of Pathology, Surgery, and Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Jennifer Lafemina
- Departments of Pathology, Surgery, and Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Jennifer Clark
- Departments of Pathology, Surgery, and Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Dina Kandil
- Departments of Pathology, Surgery, and Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, Massachusetts, USA
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Balakrishnan SS, Dev B, Gnanavel H, Chinnappan S, Palanisamy P, Hlondo L. Wired for Surgical Success: Our Experience with Preoperative Ultrasound-Guided Wire Localization of Impalpable Breast Lesions. Indian J Radiol Imaging 2021; 31:124-130. [PMID: 34316120 PMCID: PMC8299497 DOI: 10.1055/s-0041-1730134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims
The purpose of this study was to review our experience with preoperative ultrasound-guided wire localization and to identify our rate of successful localization and subsequent excision.
Materials and Methods
At our institution, we performed preoperative wire localization for 28 impalpable breast lesions in 27 women (1 patient underwent wire localization for bilateral breast lesions), between April 2016 and August 2019. We used a Toshiba APLIO2 ultrasound machine and a linear probe (7–12 MHz) to visualize lesions and needle-wire systems comprising a 20-gauge needle with preloaded wire to localize lesions. We analyzed the percentage of specimen mammograms with wire in situ and percentage of excised specimens showing margins free of tumor, along with imaging features, BI-RADS (Breast Imaging-Reporting and Data System) categories, and histopathological and molecular diagnosis of the lesions.
Results
All specimen mammograms confirmed the presence of wire in situ, except one (96.4%); in the latter case, postponement of surgery due to intractable cough was suspected to have caused wire displacement. All malignant specimens showed margins free of tumor (100%).
Conclusions
Our results show that wire localization is extremely effective in providing crucial preoperative insight into the precise location of an impalpable lesion. Despite the advent of nonwire localization devices such as radioactive seeds, radar reflectors, magnetic seed markers, and radiofrequency identification tags, wire localization remains the most widely practiced method, especially in resource-limited settings. Its high degree of accuracy serves as a key factor in the successful outcome of breast conservation surgery for impalpable breast lesions.
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Affiliation(s)
- Sanchanaa Sree Balakrishnan
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Bhawna Dev
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Harini Gnanavel
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sheela Chinnappan
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Priya Palanisamy
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Lalchhanhimi Hlondo
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Reflector-Guided Localisation of Non-Palpable Breast Lesions: A Prospective Evaluation of the SAVI SCOUT ® System. Cancers (Basel) 2021; 13:cancers13102409. [PMID: 34067552 PMCID: PMC8156313 DOI: 10.3390/cancers13102409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Marking impalpable areas of breast cancer prior to surgery is an important part of the modern treatment of breast cancer. Traditionally, the target lesion would be marked by a wire just before surgery under image guidance and would help the surgeon locate the tumour during surgery. However, this method has some drawbacks, such as patient discomfort, the risk of migration and dislodgement, and the need to couple surgical and radiological schedules. Therefore, there has been a growing interest in this system, thus supporting its potential. In this study, we have evaluated one such system, SAVI SCOUT®, in 63 consecutive patients. Our experience with this system supported its potential role in modern breast surgery. Abstract Wire-guided localisation (WGL) has been the mainstay for localising non-palpable breast lesions before excision. Due to its limitations, various wireless alternatives have been developed. In this prospective study, we evaluate the role of radiation-free wireless localisation using the SAVI SCOUT® system at the London Breast Institute. A total of 72 reflectors were deployed in 67 consecutive patients undergoing breast conserving surgery for non-palpable breast lesions. The mean interval between deployment and surgery for the therapeutic cases was 18.8 days (range: 0–210). The median deployment duration was 5 min (range: 1–15 min). The mean distance from the lesion was 1.1 mm (median distance: 0; range: 0–20 mm). The rate of surgical localisation and retrieval of the reflector was 98.6% and 100%, respectively. The median operating time was 28 min (range: 15–55 min) for the therapeutic excision of malignancy and 17 min (range: 15–24) for diagnostic excision. The incidence of reflector migration was 0%. Radial margin positivity in malignant cases was 7%. The median weight for malignant lesions was 19.6 g (range: 3.5–70 g). Radiologists and surgeons rated the system higher than WGL (93.7% and 98.6%, respectively; 60/64 and 70/71). The patient mean satisfaction score was 9.7/10 (n = 47, median = 10; range: 7–10). One instance of signal failure was reported. In patients who had breast MRI after the deployment of the reflector, the MRI void signal was <5 mm (n = 6). There was no specific technique-related surgical complication. Our study demonstrates that wire-free localisation using SAVI SCOUT® is an effective and time-efficient alternative to WGL with excellent physician and patient acceptance.
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Garzotto F, Comoretto RI, Michieletto S, Franzoso G, Lo Mele M, Gregori D, Bonavina MG, Bozza F, Caumo F, Saibene T. Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: A systematic review and meta-analysis. Breast 2021; 58:93-105. [PMID: 33991806 PMCID: PMC8481910 DOI: 10.1016/j.breast.2021.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022] Open
Abstract
Pre-operative localization of non-palpable breast lesions with non-wired non-ionizing (NWNI) techniques may improve clinical outcomes as reoperation rate, cosmetic outcome and contribute to organizational aspects improvement in breast-conserving surgery (BCS). However only limited literature is available and clinical studies involving these forefront devices are often small and non-randomized. Furthermore, there is a lack of consensus on free margins and cosmetic outcomes definitions. The objective of the present meta-analysis was to determine the crude clinical outcomes reported for the NWNI techniques on BCS. A literature search was performed of PubMed, Embase and Scopus databases up to February 2021 in order to select all prospective or retrospective clinical trials on pre-operative breast lesion localization done with NWNI devices. All studies were assessed following the PRISMA recommendations. Continuous outcomes were described in averages corrected for sample size, while binomial outcomes were described using the weighted average proportion. Twenty-seven studies with a total of 2103 procedures were identified. The technique is consolidated, showing for both reflectors' positioning and localization nearly the 100% rate of success. The re-excision and clear margins rates were 14% (95% CI, 11-17%) and 87% (80-92%), respectively. Overall, positive margins rates were 12% (8-17%). In studies that compared NWNI and wire localization techniques, positive margin rate is lower for the first techniques (12%, 6-22% vs 17%, 12-23%) and re-excision rate is slightly higher using the latter (13%, 9-19% vs 16%, 13-18%). Pre-operative NWNI techniques are effective in the localization of non-palpable breast lesions and are promising in obtaining clear (or negative) margins minimizing the need for re-excision and improving the cosmetic outcomes. Randomized trials are needed to confirm these findings.
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Affiliation(s)
- Francesco Garzotto
- Breast Radiology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
| | - Rosanna Irene Comoretto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Silvia Michieletto
- Breast Surgery Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | | | - Marcello Lo Mele
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, 35121, Italy
| | - Dario Gregori
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | | | - Fernando Bozza
- Breast Surgery Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Francesca Caumo
- Breast Radiology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Tania Saibene
- Breast Surgery Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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30
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Misbach LS, Karimova EJ, Cronin C, James T, Brook A, Dialani V. Implementing radar reflector-guided localization of nonpalpable breast lesions: Feasibility, challenges, outcomes, and lessons learned. Breast J 2021; 27:608-611. [PMID: 33811407 DOI: 10.1111/tbj.14231] [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: 11/04/2020] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
Reflector-guided localization uses a nonradioactive radar implant for wire-free presurgical breast lesion localization. A single-institution retrospective evaluation found lower rates of positive margins and of close margins for reflector-guided localizations compared with wire localizations, resulting in a statistically significant decrease in the re-excision rates (p = 0.015). The two approaches did not show statistically significant difference in localization time and OR time. Technical challenges included particulars inherent in reflector placement, while patient factors included special considerations for reflector placement in the postsurgical breast. Despite novel challenges, we found reflector-guided localization to be accurate and efficient.
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Affiliation(s)
| | | | - Claire Cronin
- Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ted James
- Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alexander Brook
- Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vandana Dialani
- Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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31
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Trent G, Tong C, Brooks AD, Goodacre R, Sataloff D, Englander B. Improving time from check-in to start with preoperative SCOUT localization. Breast J 2021; 27:564-566. [PMID: 33706407 DOI: 10.1111/tbj.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Graham Trent
- Department of Radiology, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Celia Tong
- Department of Radiology, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Ari D Brooks
- Department of Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Robert Goodacre
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Dahlia Sataloff
- Department of Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Brian Englander
- Department of Radiology, Pennsylvania Hospital, Philadelphia, PA, USA
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32
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Franceschini G, Mason EJ, Grippo C, D’Archi S, D’Angelo A, Scardina L, Sanchez AM, Conti M, Trombadori C, Terribile DA, Di Leone A, Carnassale B, Belli P, Manfredi R, Masetti R. Image-Guided Localization Techniques for Surgical Excision of Non-Palpable Breast Lesions: An Overview of Current Literature and Our Experience with Preoperative Skin Tattoo. J Pers Med 2021; 11:jpm11020099. [PMID: 33557072 PMCID: PMC7913802 DOI: 10.3390/jpm11020099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 01/14/2023] Open
Abstract
Breast conserving surgery has become the standard of care and is more commonly performed than mastectomy for early stage breast cancer, with recent studies showing equivalent survival and lower morbidity. Accurate preoperative lesion localization is mandatory to obtain adequate oncological and cosmetic results. Image guidance assures the precision requested for this purpose. This review provides a summary of all techniques currently available, ranging from the classic wire positioning to the newer magnetic seed localization. We describe the procedures and equipment necessary for each method, outlining the advantages and disadvantages, with a focus on the cost-effective preoperative skin tattoo technique performed at our centre. Breast surgeons and radiologists have to consider ongoing technological developments in order to assess the best localization method for each individual patient and clinical setting.
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Affiliation(s)
- Gianluca Franceschini
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Elena Jane Mason
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
- Correspondence: ; Tel.: +39-33-5700-4572
| | - Cristina Grippo
- Dipartimento di Diagnostica per Immagini, Radiologia Terapeutica ed Interventistica, Azienda Ospedaliera Santa Maria Terni, 05100 Terni, Italy;
| | - Sabatino D’Archi
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Anna D’Angelo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Lorenzo Scardina
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Marco Conti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Charlotte Trombadori
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Daniela Andreina Terribile
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alba Di Leone
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Beatrice Carnassale
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Paolo Belli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Riccardo Masetti
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Cornella KN, Repper DC, Palafox BA, Razavi MK, Loh CT, Markle KM, Openshaw LE. A Surgeon's Guide for Various Lung Nodule Localization Techniques and the Newest Technologies. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 16:26-33. [PMID: 33124923 DOI: 10.1177/1556984520966999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Preoperative image-guided localization of lung nodules is necessary for successful intraoperative localization and resection. However, current localization techniques carry significant intraoperative disadvantages for surgeons. Articles were selected through multiple search engines using key search terms and reviewed to compare results, outcomes, advantages, limitations, and complications of various localization methods. Current methods utilize microcoils, hookwires, contrast media, dyes, cyanoacrylate, radiotracers, or fluorescence tracers, which are associated with many intraoperative disadvantages even when paired with other imaging modalities including computed tomography and bronchoscopy techniques. Novel technologies including robotic bronchoscopy, 4-hook anchor, SPiN Thoracic Navigation System, superDimension, Ion Endoluminal System, and the SCOUT system are reviewed including their advantages, which may change the future direction of minimal thoracoscopic surgery with potential to improve intraoperative accuracy and efficiency.
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Affiliation(s)
- Katie N Cornella
- 24338 Department of Thoracic Surgery and Interventional Radiology, St. Joseph Hospital of Orange, CA, USA
| | - Danielle C Repper
- 24338 Department of Thoracic Surgery and Interventional Radiology, St. Joseph Hospital of Orange, CA, USA
| | - Brian A Palafox
- 24338 Department of Thoracic Surgery and Interventional Radiology, St. Joseph Hospital of Orange, CA, USA
| | - Mahmood K Razavi
- 24338 Department of Thoracic Surgery and Interventional Radiology, St. Joseph Hospital of Orange, CA, USA
| | - Christopher T Loh
- 24338 Department of Thoracic Surgery and Interventional Radiology, St. Joseph Hospital of Orange, CA, USA
| | - Kelly M Markle
- 24338 Department of Thoracic Surgery and Interventional Radiology, St. Joseph Hospital of Orange, CA, USA
| | - Lauren E Openshaw
- 24338 Department of Thoracic Surgery and Interventional Radiology, St. Joseph Hospital of Orange, CA, USA
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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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Kuzmiak CM, Kim SJ, Lee SS, Jordan SG, Gallagher KK, Ollila DW, Zeng D. Reflector Localization of Breast Lesions and Parameters Associated with Positive Surgical Margins in Women Undergoing Breast Conservation Surgery. JOURNAL OF BREAST IMAGING 2020; 2:462-470. [PMID: 38424900 DOI: 10.1093/jbi/wbaa051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate our experience with reflector localization of breast lesions and parameters influencing surgical margins in patients with a malignant diagnosis. METHODS A retrospective institution review board-approved review of our institutional database was performed for breast lesions preoperatively localized from September 1, 2016, through December 31, 2017. Wire localizations were excluded. From electronic medical records and imaging, the following data was recorded: breast density, lesion type and size, reflector placement modality and number placed, reflector distance from lesion and skin, excision of lesion and reflector, tissue volume, margin status, and final pathology. Statistical analysis was performed with a Fisher's exact test, Mann-Whitney test, and logistic regression. P < 0.05 was significant. RESULTS A total of 111 reflectors were deployed in the breasts of 103 women with 109 breast lesions. Ninety (81.1%) reflectors were placed under mammographic guidance and 21 (18.9%) under US. The lesions consisted of 68 (62.4%) masses, 17 (15.6%) calcifications, 2 (1.8%) architectural distortions, and 22 (20.2%) biopsy markers. Fourteen (21.2%) of 66 cases with a preoperative malignant diagnosis had a positive surgical margin. Final pathology, including 6 lesions upgraded to malignancy on excision, demonstrated 72 (66.0%) malignant, 22 (20.2%) high-risk, and 15 (13.8%) benign lesions. Univariate and multivariate analysis revealed no statistically significant parameters (lesion type or size, placement modality, reflector distance to skin or lesion, specimen radiography or pathology) were associated with a positive surgical margin. CONCLUSION Reflector localization is an alternative to wire localization of breast lesions. There were no lesion-specific or technical parameters affecting positive surgical margins.
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Affiliation(s)
- Cherie M Kuzmiak
- University of North Carolina, Department of Radiology, Chapel Hill, NC
| | - Suk Jung Kim
- Inje University College of Medicine, Haeundae Paik Hospital, Department of Radiology, Busan, Korea
| | - Sheila S Lee
- University of North Carolina, Department of Radiology, Chapel Hill, NC
| | - Sheryl G Jordan
- University of North Carolina, Department of Radiology, Chapel Hill, NC
| | | | - David W Ollila
- University of North Carolina, Department of Surgery, Chapel Hill, NC
| | - Donglin Zeng
- University of North Carolina, Gillings School of Global Public Health, Department of Biostatistics, Chapel Hill, NC
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Layeequr Rahman R, Puckett Y, Habrawi Z, Crawford S. A decade of intraoperative ultrasound guided breast conservation for margin negative resection - Radioactive, and magnetic, and Infrared Oh My…. Am J Surg 2020; 220:1410-1416. [PMID: 32958157 DOI: 10.1016/j.amjsurg.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/11/2020] [Accepted: 09/03/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The oncologic goal of margin-negative breast conservation requires adequate localization of tumor. Intraoperative ultrasound remains most feasible but under-utilized method to localize the tumor and assess margins. METHODS A prospectively maintained breast cancer database over a decade was queried for margin status in breast cancer patients undergoing breast conservation. Techniques of tumor localization, margin re-excision and closest margins were analyzed. Rate of conversion to mastectomy was determined. RESULTS Of the 945 breast cancer patients treated at a university-based Breast Center of Excellence between January 1, 2009 and December 31, 2018, 149(15.8%) had ductal carcinoma in situ; 712(75.3%) had invasive ductal carcinoma, and 63(6.7%) had invasive lobular carcinoma. Clinical stage distribution was: T1 = 372(39.4%); T2 = 257(27.2%); T3 = 87(9.2%). Five hundred and eighty three (61.7%) patients underwent breast conservation. The median (25th -75th centile) closest margin was 6(2.5, 10.0) mm. Thirty five (6.0%) patients underwent margin re-excision, of which 9(25%) were converted to mastectomy. Tumor localization was achieved with ultrasound in 521(89.4%) patients and with wire localization in 62(10.6%) patients. The median (25th-75th centile) closest margin with wire localization was 5.0(2.0, 8.5) mm versus 5.0 (2.0, 8.0) mm with ultrasound guidance [p = 0.6635]. The re-excision rate with wire localization was 14.5% versus 4.9% with ultrasound guidance [p = 0.0073]. The unadjusted Odds Ratio (95% CI) for margin revision in wire localized group compared with ultrasound was 3.2 (7.14, 1.42) [p = 0.0045]; multivariate adjusted OR (95%) was 4(9.09, 1.7) [p = 0.0013]. CONCLUSIONS Ultrasound guidance for localization of breast cancer remains the most effective option for margin negative breast conservation.
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Affiliation(s)
- Rakhshanda Layeequr Rahman
- Texas Tech University Health Sciences Center, Department of Surgery, MS 8312, 3601 Fourth Street Lubbock, Texas, 79430, USA.
| | - Yana Puckett
- Texas Tech University Health Sciences Center, Department of Surgery, MS 8312, 3601 Fourth Street Lubbock, Texas, 79430, USA.
| | - Zaina Habrawi
- Texas Tech University Health Sciences Center, Department of Surgery, MS 8312, 3601 Fourth Street Lubbock, Texas, 79430, USA.
| | - Sybil Crawford
- University of Massachusetts, Medical School Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Shaw Building Room 228, Worcester, Massachusetts, 01655, USA.
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Sun J, Henry DA, Carr MJ, Yazdankhahkenary A, Laronga C, Lee MC, Hoover SJ, Sun W, Czerniecki BJ, Khakpour N, Kiluk JV. Feasibility of Axillary Lymph Node Localization and Excision Using Radar Reflector Localization. Clin Breast Cancer 2020; 21:e189-e193. [PMID: 32893094 DOI: 10.1016/j.clbc.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) is commonly used for patients with clinically detected nodal metastases. Sentinel lymph node biopsy (SLNB) after NAC is feasible. Excision of biopsy-proven positive lymph nodes in addition to SLNB, termed targeted axillary dissection (TAD), decreases the false-negative rate of SLNB alone. Positive nodes can be marked with radar reflector-localization (RRL) clips. We report our institutional experience with RRL-guided TAD and demonstrate its safety and feasibility. PATIENTS AND METHODS We performed an institutional review board-approved retrospective review of consecutive clinically node-positive female patients with breast cancer treated with NAC and RRL-guided TAD between January 2017 and September 2019. Clinicopathologic and treatment data were collected; descriptive statistics are reported. RESULTS Forty-five patients were analyzed; the median age was 55 years (range, 20-72 years), and the median body mass index was 27.2 kg/m2 (range, 16.5-40.4 kg/m2). All patients received NAC, primary breast surgery, and TAD. All clinically detected nodal metastases were confirmed with percutaneous biopsy and marked with a biopsy clip. RRL clips were implanted a median of 8 days (range, 1-167 days) prior to surgery; all were retrieved without complications. The RRL node was identified as the sentinel lymph node in 36 (80%) patients. Twenty-five patients had positive nodes, of which 24 were identified by RRL node excision, and 1 (4%) patient had a positive node identified by SLNB but not RRL. Over a median follow-up time of 29.6 months, 5 patients recurred (1 local, 4 distant). CONCLUSIONS RRL-guided TAD after NAC is safe and feasible. This technique allows for adequate assessment of the nodal basin and helps confirm excision of the previously biopsied positive axillary node.
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Affiliation(s)
- James Sun
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL; Present affiliation: Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Danielle A Henry
- Breast Care Center, Orlando Health - UF Health Cancer Center, Orlando, FL
| | - Michael J Carr
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL
| | - Adel Yazdankhahkenary
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL; Present affiliation: Tehran University of Medical Sciences, Tehran, Iran
| | | | - M Catherine Lee
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL
| | - Susan J Hoover
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL
| | - Weihong Sun
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL
| | | | | | - John V Kiluk
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL.
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Sanders LM, Morgan D, Polini N, Mehta A. Preoperative Wire Localization of the Breast on the Day Before Surgery. JOURNAL OF BREAST IMAGING 2020; 2:240-249. [PMID: 38424980 DOI: 10.1093/jbi/wbaa015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To assess the feasibility and accuracy of preoperative wire localization performed one day prior to surgery and the relationship between the time interval following wire placement with migration distance within the time-window examined. METHODS Two trials were performed with next-day mammography to assess migration. Trial 1 used a standard hooked wire (50 patients, 61 wires). Trial 2 employed a looped wire (50 patients, 59 wires). A third trial was subsequently performed (16 patients, 18 wires) using the looped wire without repeat mammograms. Complications were recorded. Comparative statistical analyses were performed between patients in Trial 1 and Trial 2. RESULTS In Trials 1 and 2, no wires required readjustment on the day of surgery. Mean and maximum migration were less with the looped wire (range: 0-7 mm) compared to the hooked wire (range: 0-18 mm), allowing for the elimination of next-day mammograms in Trial 3. A Mann-Whitney U test showed no significant difference between the migration distances for the first two trials (P = 0.11). A Chi-square test showed no significant difference in the direction of the migration between the two trials (P = 0.15). There was no correlation between the time interval of localization and needle migration in the first two trials (r = -0.16, P = 0.22 and -0.12, P = 0.36). Specimen radiographs demonstrated the lesion/biopsy marker clip in all cases in all three trials. No infections or bleeding occurred. Two patients developed an allergic reaction to adhesive. CONCLUSION Wire localization performed on the day before surgery is feasible, inexpensive, did not compromise accuracy, and successfully unlinked the radiologic and surgical procedures.
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Affiliation(s)
| | - Dina Morgan
- Ambulatory Care Breast Center, Livingston, NJ
| | | | - Avani Mehta
- Ambulatory Care Breast Center, Livingston, NJ
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Lee MK, Sanaiha Y, Kusske AM, Thompson CK, Attai DJ, Baker JL, Fischer CP, DiNome ML. A comparison of two non-radioactive alternatives to wire for the localization of non-palpable breast cancers. Breast Cancer Res Treat 2020; 182:299-303. [PMID: 32451679 DOI: 10.1007/s10549-020-05707-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Multiple wire-free technologies for localization of non-palpable breast cancers have emerged as satisfactory alternatives to wire. However, no study has compared two non-radioactive wire-free approaches to one another. The purpose of this study was to compare outcomes among LOCalizer™ radiofrequency identification (RFID), SAVI Scout® (SAVI), and wire localization (WL). METHODS This was a retrospective, cross-sectional cohort study of patients undergoing lumpectomy for non-palpable breast cancer at a single institution between August 2017 and February 2019. Patients were divided into three cohorts based on localization technique: RFID, SAVI or WL. Operative times and average tumor volumes were compared using one-way analysis of variance. Positive margin and re-excision rates were compared with Fisher's exact test. RESULTS Among 104 patients who underwent lumpectomy for non-palpable breast cancer, 33 patients (31.7%) had RFID, 21 (20.2%) had SAVI, and 50 (48.0%) had WL. Operative times were 79 min for RFID, 81 min for SAVI, and 78 min for WL (p = 0.91). Volume of tissue resected was 36.3 cm3, 31.7 cm3, and 35.3 cm3 for RFID, SAVI, and WL, respectively (p = 0.84). Positive margin rates (RFID 3.0% vs SAVI 9.5% vs WL 8.0%, p = 0.67) and re-excision rates (RFID 6.1% vs SAVI 9.5% vs WL 10.0%, p = 0.82) were similar across groups. CONCLUSIONS Wire-free localization technologies have been compared to WL demonstrating similar efficacy. Our study suggests that RFID and SAVI Scout also perform similarly to one another. Physicians and institutions may consider more nuanced features of each localization system rather than performance alone when choosing a wire-free alternative.
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Affiliation(s)
- Minna K Lee
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Yas Sanaiha
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Amy M Kusske
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Carlie K Thompson
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Deanna J Attai
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Jennifer L Baker
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Cheryce P Fischer
- Department of Radiologic Sciences, University of California Los Angeles, 1260 15th Street, Santa Monica, CA, 90404, USA
| | - Maggie L DiNome
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
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Pieszko K, Wichtowski M, Cieciorowski M, Jamont R, Murawa D. Evaluation of the nonradioactive inducible magnetic seed system Magseed for preoperative localization of nonpalpable breast lesions - initial clinical experience. Contemp Oncol (Pozn) 2020; 24:51-54. [PMID: 32514238 PMCID: PMC7265964 DOI: 10.5114/wo.2020.93677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/02/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Many early-stage breast cancers are not palpable and thus must be localized before surgery. Detecting these lesions is crucial before they become clinically symptomatic to avoid morbidity and mortality. Nowadays, there are several new alternative techniques to traditional needle/wire localization available. These methods allow for better surgical margins, decreased costs and operating room delays, as well as improved patient satisfaction. The purpose of this study is to evaluate the nonradioactive inducible magnetic seed system Magseed (Endomagnetics Ltd, Cambridge, UK) for preoperative localization of nonpalpable breast lesions. To our knowledge, this report documents the first clinical experience with Magseed in Poland. MATERIAL AND METHODS A single-institution case report of 10 women with nonpalpable breast lesions localized and excised by using the Magseed surgical guidance system between November 2017 and May 2018. RESULTS AND CONCLUSIONS Magseed is an easy, sensitive and effective localization method. It is beneficial for oncoplastic outcomes and for scheduling efficiency, which overcomes many limitations of other localization methods. Surgical specimen margins were evaluated in 90% of cases as negative, with no additional re-excision. Only one patient with ductal carcinoma in situ had a positive tumor margin at the axillary side.
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Affiliation(s)
- Karolina Pieszko
- Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences, University of Zielona Gora, Poland
- Department of Plastic Surgery and Burns, Hospital in Nowa Sol, Poland
| | - Mateusz Wichtowski
- Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences, University of Zielona Gora, Poland
| | - Marcin Cieciorowski
- Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences, University of Zielona Gora, Poland
| | - Robert Jamont
- Department of Plastic Surgery and Burns, Hospital in Nowa Sol, Poland
| | - Dawid Murawa
- Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences, University of Zielona Gora, Poland
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Funaro K, Prather A, Niell B, Jared Weinfurtner R. Tissue marker migration after MRI‐guided breast biopsy: Migration frequency and associated factors. Breast J 2020; 26:440-445. [DOI: 10.1111/tbj.13486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Kimberly Funaro
- H. Lee Moffitt Cancer Center and Research Institute Tampa Florida
| | | | - Bethany Niell
- H. Lee Moffitt Cancer Center and Research Institute Tampa Florida
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Look Hong N, Wright FC, Semple M, Nicolae AM, Ravi A. Results of a phase I, non-randomized study evaluating a Magnetic Occult Lesion Localization Instrument (MOLLI) for excision of non-palpable breast lesions. Breast Cancer Res Treat 2019; 179:671-676. [PMID: 31754951 PMCID: PMC6997262 DOI: 10.1007/s10549-019-05499-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/12/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Magnetic Occult Lesion Localization Instrument (MOLLI) is a wireless, non-radioactive alternative for non-palpable breast lesion localization. The primary objective of this first-in-human study was to evaluate the clinical feasibility of using MOLLI for intraoperative localization of non-palpable breast lesions. METHODS Twenty women with non-palpable breast lesions at a single institution received a lumpectomy using the MOLLI guidance system. Patients were co-localized with magnetic and radioactive markers up to 7 days before excision by a dedicated breast radiologist under sonographic guidance. Both markers were localized intraoperatively using dedicated hand-held probes. The primary outcome was successful excision of the magnetic marker, confirmed radiographically and pathologically. Demographic data, margin positivity, and re-excision rates were collected. Surgical oncologists, radiologists, and pathology staff were surveyed for user satisfaction. RESULTS Post-radiological analysis: Post-implant mammograms verified that 17/20 markers were placed directly in the lesion center. Radiologists reported that all marker implantations procedures were "easy" or "very easy" following a single training session. Post-surgical analysis: All MOLLI markers were successfully removed with the specimen during surgical excision. In all cases, surgeons ranked the MOLLI guidance system as "very easy" for lesion localization. Pathologic analysis: All patients had negative margins. All anatomic pathology staff ranked the MOLLI system as "very easy" to localize markers. CONCLUSIONS The MOLLI guidance system is a reliable and accurate method for intraoperative localization of non-palpable breast lesions. Further evaluation of the MOLLI system in studies against current standards of care is required to demonstrate system cost-effectiveness and improved patient-reported outcomes.
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Affiliation(s)
- Nicole Look Hong
- Department of Surgery, Sunnybrook Odette Cancer Centre, Toronto, ON, M4N-3M5, Canada
| | - Frances C Wright
- Department of Surgery, Sunnybrook Odette Cancer Centre, Toronto, ON, M4N-3M5, Canada
| | - Mark Semple
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, 2075 Bayview Ave, Toronto, ON, M4N-3M5, Canada
| | - Alexandru M Nicolae
- Clinical Research Program, Sunnybrook Research Institute, Toronto, ON, M4N-3M5, Canada
| | - Ananth Ravi
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, 2075 Bayview Ave, Toronto, ON, M4N-3M5, Canada.
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Kapoor MM, Patel MM, Scoggins ME. The Wire and Beyond: Recent Advances in Breast Imaging Preoperative Needle Localization. Radiographics 2019; 39:1886-1906. [PMID: 31560614 DOI: 10.1148/rg.2019190041] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Many patients with breast cancer are candidates for breast conservation therapy. This group includes individuals with small nonpalpable tumors detected at screening mammography and those with sufficient tumor shrinkage after neoadjuvant chemotherapy. Breast conservation surgery often requires the use of an imaging-guided preoperative localization procedure, during which a device is placed within or adjacent to the target lesion to guide the surgeon intraoperatively. For decades, wire localization has been the standard for preoperative localization in breast imaging. With this method, a wire is placed in the breast percutaneously, with the distal wire segment positioned adjacent to the abnormality and the proximal wire segment remaining outside the breast. Because of the external component of the wire, the patient must be compliant, and care must be taken to not disturb the wire's position before surgery. Scheduling flexibility is also limited because the wire localization must be performed on the same day as the subsequent surgery. More recently, the available options for performing preoperative localization have expanded greatly and now include the use of nonwire devices such as radioactive and magnetic seeds, radar reflectors, and radiofrequency identification tags. Nonwire localization devices can be placed days in advance of the surgery, at the patient's convenience, to avoid wire-related challenges and complications. They are placed percutaneously within or adjacent to the target breast lesion and detected intraoperatively by using a probe outside the breast.©RSNA, 2019.
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Affiliation(s)
- Megha Madhukar Kapoor
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Miral Mahesh Patel
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Marion Elizabeth Scoggins
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
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Preoperative localization of breast lesions: Current techniques. Clin Imaging 2019; 56:1-8. [DOI: 10.1016/j.clinimag.2019.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/12/2018] [Accepted: 01/15/2019] [Indexed: 11/18/2022]
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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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Patel R, MacKerricher W, Tsai J, Choy N, Lipson J, Ikeda D, Pal S, De Martini W, Allison KH, Wapnir IL. Pretreatment Tattoo Marking of Suspicious Axillary Lymph Nodes: Reliability and Correlation with Sentinel Lymph Node. Ann Surg Oncol 2019; 26:2452-2458. [PMID: 31087176 DOI: 10.1245/s10434-019-07419-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tattooing is an alternative method for marking biopsied axillary lymph nodes (ALNs) before initiation of treatments for newly diagnosed breast cancer. Detection of black ink-stained nodes is performed under direct visualization at surgery and is combined with sentinel node (SLN) mapping procedures. METHODS Women with newly diagnosed breast cancer who underwent fine or core-needle biopsy of suspicious ALNs were recruited. The nodal cortex and perinodal soft tissue was injected with 0.1-1.0 ml of Spot™ (GI Supply) black ink under ultrasound guidance. Intraoperatively, black stained nodes were removed along with SLNs, noting concordance between the two. RESULTS Sixty-six evaluable patients were enrolled (2013-2017). Nineteen received surgery first (Group 1) and 47 neoadjuvant therapy (NAT, Group 2). The average number of nodes tattooed was 1.16 for Group 1 and 1.04 for Group 2. The average interval from tattoo to surgery was 21 days (range 1-62) for Group 1 and 148 days (range 71-257) for Group 2. The tattooed node(s) were visually identified at surgery and corresponded to the sentinel lymph node(s) in 98.5% of cases (18/19 in Group 1 and 47/47 in Group 2). Of the 14 patients in Group 2 whose nodes remained positive following NAT, the tattooed node was the SLN associated with carcinoma. CONCLUSIONS Tattooing is an alternative method for marking biopsied ALNs. Tattooed nodes coincided with SLNs in 98.5% of cases. This technique is advantageous, because it allows for fewer procedures and lower costs compared with other methods.
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Affiliation(s)
- Rupa Patel
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Wendy MacKerricher
- Department of Pathology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Jacqueline Tsai
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Nicole Choy
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Jafi Lipson
- Department of Radiology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Debra Ikeda
- Department of Radiology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Sunita Pal
- Department of Radiology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Wendy De Martini
- Department of Radiology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Irene L Wapnir
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA.
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Cornella KN, Palafox BA, Razavi MK, Loh CT, Markle KM, Openshaw LE. SAVI SCOUT as a Novel Localization and Surgical Navigation System for More Accurate Localization and Resection of Pulmonary Nodules. Surg Innov 2019; 26:469-472. [PMID: 31027475 DOI: 10.1177/1553350619843757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Current techniques for localization and resection of lung nodules carry many intraoperative challenges for surgeons. This article proposes a new localization method for diagnosis and treatment of pulmonary nodules, which provides a navigational system for more accurate lung resection. Methods. We report the case of a 77-year-old female with a pulmonary nodule of the right lower lobe. A nonradioactive localization technology, known as SAVI SCOUT (Cianna Medical Inc, Aliso Viejo, CA), was placed by interventional radiology under computed tomography guidance preoperatively. Using the SCOUT Wire-Free Radar Localization System, the pulmonary nodule was robotically localized and resected. SCOUT removal was confirmed using the Trident Specimen Radiology System. The efficacy of this procedure was evaluated in terms of ease of use and procedure time by interventional radiology, surgical resection accuracy, diagnostic accuracy, simplicity, and ease to implement this technology in an existing hospital. Results. The SCOUT system allowed for the first reported case of successful SCOUT placement in lung tissue, targeted the pulmonary nodule intraoperatively, and facilitated accurate lung resection. Conclusions. The SCOUT system shows promising advancements in the ability to eliminate many challenges currently seen with lung nodule localization and resection.
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Microchipping the breast: an effective new technology for localizing non-palpable breast lesions for surgery. Breast Cancer Res Treat 2019; 175:165-170. [DOI: 10.1007/s10549-019-05143-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
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Spalluto LB, DeBenedectis CM, Morrow MS, Lourenco AP. Advances in Breast Localization Techniques: An Opportunity to Improve Quality of Care and Patient Satisfaction. Semin Roentgenol 2018; 53:270-279. [PMID: 30449345 DOI: 10.1053/j.ro.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN; Veteran's Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education Clinical Center, Nashville, TN.
| | - Carolynn M DeBenedectis
- Department of Radiology, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA
| | - Michael S Morrow
- Department of Radiology, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA
| | - Ana P Lourenco
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
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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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