1
|
Gonzalez L, Johnson NC, Jones VC, Taylor L, Rand J, Fong Y, Kruper L. An Observational Cohort Study Comparing Positive Margin Rates Using an Electromagnetic Navigational System Versus Wire Localization in Breast Conservation Surgery. Ann Surg Oncol 2024; 31:3669-3671. [PMID: 38381208 DOI: 10.1245/s10434-024-15028-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Lorena Gonzalez
- Department of Surgery, Division of Breast Surgery, City of Hope National Medical Center, Duarte, CA, USA.
| | - Natalie C Johnson
- Department of Surgery, Division of Breast Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Veronica C Jones
- Department of Surgery, Division of Breast Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Lesley Taylor
- Department of Surgery, Division of Breast Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Jamie Rand
- Department of Surgery, Division of Breast Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Yuman Fong
- Department of Surgery, Division of Breast Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Laura Kruper
- Department of Surgery, Division of Breast Surgery, City of Hope National Medical Center, Duarte, CA, USA
| |
Collapse
|
2
|
Easwaralingam N, Nguyen CL, Ali F, Chan B, Graham S, Azimi F, Mak C, Warrier S. Radar localization of breast and axillary lesions with SCOUT: a prospective single institution pilot study. ANZ J Surg 2024. [PMID: 38741456 DOI: 10.1111/ans.19022] [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: 11/13/2023] [Revised: 04/06/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Wire-guided localization has been the mainstay of localization techniques for non-palpable breast and axillary lesions prior to excision. Evidence is still growing for relatively newer localization technologies. This study evaluated the efficacy of the wireless localization technology, SCOUT®, for both breast and axillary surgery. METHODS Data were extracted from a prospective database (2021-2023) of consecutive patients undergoing wide local excision, excisional biopsy, targeted axillary dissection, or axillary lymph node dissection with SCOUT at a high-volume tertiary centre. Rates of successful reflector placement, intraoperative lesion localization, and reflector retrieval were evaluated. A survey of surgeon-reported ease of lesion localization and reflector retrieval was also evaluated. CLINICAL TRIAL REGISTRATION ACTRN386751. RESULTS One-hundred-ninety-five reflectors were deployed in 172 patients. Median interval between deployment and surgery was 3 days (range 1-20) and mean distance from reflector to lesion was 3.2 mm (standard deviation, SD 3.1). Rate of successful localization and reflector retrieval was 100% for both breast and axillary procedures. Mean operating time was 65.8 min (SD 33). None of the reflectors migrated. No reflector deployment or localization-related complications occurred. Ninety-eight percent of surgeons were satisfied with ease of localization for the first half of cases. CONCLUSION SCOUT is an accurate and reliable method to localize and excise both breast and axillary lesions, and it may overcome some of the limitations of wire-guided localization.
Collapse
Affiliation(s)
- Neshanth Easwaralingam
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Surgery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Chu Luan Nguyen
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Surgery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Fatema Ali
- Department of Surgery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Belinda Chan
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Susannah Graham
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Fred Azimi
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Department of Surgery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Cindy Mak
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Department of Surgery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sanjay Warrier
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Department of Surgery, The University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
3
|
Veluponnar D, Dashtbozorg B, Guimaraes MDS, Peeters MJTFDV, de Boer LL, Ruers TJM. Resection Ratios and Tumor Eccentricity in Breast-Conserving Surgery Specimens for Surgical Accuracy Assessment. Cancers (Basel) 2024; 16:1813. [PMID: 38791892 PMCID: PMC11119905 DOI: 10.3390/cancers16101813] [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: 04/17/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
This study aims to evaluate several defined specimen parameters that would allow to determine the surgical accuracy of breast-conserving surgeries (BCS) in a representative population of patients. These specimen parameters could be used to compare surgical accuracy when using novel technologies for intra-operative BCS guidance in the future. Different specimen parameters were determined among 100 BCS patients, including the ratio of specimen volume to tumor volume (resection ratio) with different optimal margin widths (0 mm, 1 mm, 2 mm, and 10 mm). Furthermore, the tumor eccentricity [maximum tumor-margin distance - minimum tumor-margin distance] and the relative tumor eccentricity [tumor eccentricity ÷ pathological tumor diameter] were determined. Different patient subgroups were compared using Wilcoxon rank sum tests. When using a surgical margin width of 0 mm, 1 mm, 2 mm, and 10 mm, on average, 19.16 (IQR 44.36), 9.94 (IQR 18.09), 6.06 (IQR 9.69) and 1.35 (IQR 1.78) times the ideal resection volume was excised, respectively. The median tumor eccentricity among the entire patient population was 11.29 mm (SD = 3.99) and the median relative tumor eccentricity was 0.66 (SD = 2.22). Resection ratios based on different optimal margin widths (0 mm, 1 mm, 2 mm, and 10 mm) and the (relative) tumor eccentricity could be valuable outcome measures to evaluate the surgical accuracy of novel technologies for intra-operative BCS guidance.
Collapse
Affiliation(s)
- Dinusha Veluponnar
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marcos Da Silva Guimaraes
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marie-Jeanne T. F. D. Vrancken Peeters
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lisanne L. de Boer
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Theo J. M. Ruers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Guzmán-Arocho YD, Collins LC. Pragmatic guide to the macroscopic evaluation of breast specimens. J Clin Pathol 2024; 77:204-210. [PMID: 38373781 DOI: 10.1136/jcp-2023-208833] [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: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 02/21/2024]
Abstract
The pathological assessment of a breast surgical specimen starts with macroscopic evaluation, arguably one of the most critical steps, as only a small percentage of the tissue is examined microscopically. To properly evaluate and select tissue sections from breast specimens, it is essential to correlate radiological findings, prior biopsies, procedures and treatment with the gross findings. Owing to its fatty nature, breast tissue requires special attention for proper fixation to ensure appropriate microscopic evaluation and performance of ancillary studies. In addition, knowledge of the information necessary for patient management will ensure that these data are collected during the macroscopic evaluation, and appropriate sections are taken to obtain the information needed from the microscopic evaluation. Herein, we present a review of the macroscopic evaluation of different breast specimen types, including processing requirements, challenges and recommendations.
Collapse
Affiliation(s)
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Beekman KE, DePalo DK, Parker LM, Elleson KM, Mullinax JE, Sarnaik AA, Sondak VK, Zager JS. Radar-Guided Localization and Resection for Metastatic Nodal and Soft Tissue Melanoma: A Single-Institution Retrospective Study. Cancer Control 2024; 31:10732748241237907. [PMID: 38429650 PMCID: PMC10908225 DOI: 10.1177/10732748241237907] [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: 01/20/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Radar-guided localization (RGL) offers a wire-free, nonradioactive surgical guidance method consisting of a small percutaneously-placed radar reflector and handheld probe. This study investigates the feasibility, timing, and outcomes of RGL for melanoma metastasectomy. METHODS We retrospectively identified patients at our cancer center who underwent RGL resection of metastatic melanoma between December 2020-June 2023. Data pertaining to patients' melanoma history, management, reflector placement and retrieval, and follow-up was extracted from patient charts and analyzed using descriptive statistics. RESULTS Twenty-three RGL cases were performed in patients with stage III-IV locoregional or oligometastatic disease, 10 of whom had reflectors placed prior to neoadjuvant therapy. Procedures included soft tissue nodule removals (8), index lymph node removals (13), and therapeutic lymph node dissections (2). Reflectors were located and retrieved intraoperatively in 96% of cases from a range of 2 to 282 days after placement; the last reflector was not able to be located during surgery via probe or intraoperative ultrasound. One retrieved reflector had migrated from the index lesion, thus overall success rate of reflector and associated index lesion removal was 21 of 23 (91%). All RGL-localized and retrieved index lesions that contained viable tumor (10) had microscopically negative margins. There were no complications attributable to reflector insertion and no unexpected complications of RGL surgery. CONCLUSION In our practice, RGL is a safe and effective surgical localization method for soft tissue and nodal melanoma metastases. The inert nature of the reflector enables implantation prior to neoadjuvant therapy with utility in index lymph node removal.
Collapse
Affiliation(s)
- Kate E. Beekman
- USF Health Morsani College of Medicine, Tampa, FL, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Lily M. Parker
- USF Health Morsani College of Medicine, Tampa, FL, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kelly M. Elleson
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - John E. Mullinax
- Sarcoma Department, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Amod A. Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Vernon K. Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Jonathan S. Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, USF Health Morsani College of Medicine, Tampa, FL, USA
| |
Collapse
|
7
|
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
| |
Collapse
|
8
|
Heeling E, van de Kamer JB, Methorst M, Bruining A, van de Meent M, Vrancken Peeters MJTFD, Lok CAR, van der Ploeg IMC. The Safe Use of 125I-Seeds as a Localization Technique in Breast Cancer during Pregnancy. Cancers (Basel) 2023; 15:3229. [PMID: 37370839 DOI: 10.3390/cancers15123229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Some aspects of the treatment protocol for breast cancer during pregnancy (PrBC) have not been thoroughly studied. This study provides clarity regarding the safety of the use of 125I-seeds as a localization technique for breast-conserving surgery in patients with PrBC. METHODS To calculate the exposure to the fetus of one 125I-seed implanted in a breast tumor, we developed a model accounting for the decaying 125I-source, time to surgery, and the declining distance between the 125I-seed and the fetus. The primary outcome was the maximum cumulative fetal dose of radiation at consecutive gestational ages (GA). RESULTS The cumulative fetal dose remains below 1 mSv if a single 125I-seed is implanted at a GA of 26 weeks. After a GA of 26 weeks, the fetal dose can be at a maximum of 11.6 mSv. If surgery takes place within two weeks of implantation from a GA of 26 weeks, and one week above a GA of 32 weeks, the dose remains below 1 mSv. CONCLUSION The use of 125I-seeds is safe in PrBC. The maximum fetal exposure remains well below the threshold of 100 mSv, and therefore, does not lead to an increased risk of fetal tissue damage. Still, we propose keeping the fetal dose as low as possible, preferably below 1 mSv.
Collapse
Affiliation(s)
- Eva Heeling
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Michelle Methorst
- Department of Gynaecologic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Annemarie Bruining
- Department of Radiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Mette van de Meent
- Department of Obstetrics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - Christianne A R Lok
- Department of Gynaecologic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Iris M C van der Ploeg
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| |
Collapse
|
9
|
Gante I, Maldonado JP, Figueiredo Dias M. Marking Techniques for Targeted Axillary Dissection Among Patients With Node-Positive Breast Cancer Treated With Neoadjuvant Chemotherapy. Breast Cancer (Auckl) 2023; 17:11782234231176159. [PMID: 37255883 PMCID: PMC10226338 DOI: 10.1177/11782234231176159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/28/2023] [Indexed: 06/01/2023] Open
Abstract
Invasive breast cancer with axillary lymph node (LN) invasion is a continuing problem worldwide. The morbidity associated with axillary LN dissection along with the high rate of nodal downstaging after neoadjuvant chemotherapy (NACT) made the standard treatment shift towards less invasive surgery. Sentinel lymph node biopsy (SLNB) after NACT is associated with high false-negative rates (13%-14%). To overcome this problem, it was concluded that the positive nodes should first be indicated with image-detectable markers and then removed together with SLNB: targeted axillary dissection (TAD). This review aims to describe and evaluate the different marking techniques for TAD in patients with node-positive breast cancer treated with NACT, namely: clip placement and guidewire localization; clip placement and 125I-labelled radioactive seed localization; clip placement and skin mark; clip placement and intraoperative ultrasound; tattooing with a sterile black carbon suspension; magnetic seeds; radar and infrared light technology localization. Targeted axillary dissection techniques have shown false-negative rates below 9% and identification rates above 95%. The most studied technique is guidewire localization, as it is also the oldest one. However, according to data gathered from this review, some newer techniques have shown to be very promising due to their statistical results and management factors.
Collapse
Affiliation(s)
- Inês Gante
- Department of Gynecology, Coimbra
Hospital and Universitary Centre, Coimbra, Portugal
- Gynecologic University Clinic, Faculty
of Medicine, University of Coimbra, Coimbra, Portugal
- Area of Environment, Genetics and
Oncobiology (CIMAGO), Coimbra Institute for Clinical and Biomedical Research (iCBR),
Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Pedro Maldonado
- Gynecologic University Clinic, Faculty
of Medicine, University of Coimbra, Coimbra, Portugal
| | - Margarida Figueiredo Dias
- Department of Gynecology, Coimbra
Hospital and Universitary Centre, Coimbra, Portugal
- Gynecologic University Clinic, Faculty
of Medicine, University of Coimbra, Coimbra, Portugal
- Area of Environment, Genetics and
Oncobiology (CIMAGO), Coimbra Institute for Clinical and Biomedical Research (iCBR),
Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Rella R, Conti M, Bufi E, Trombadori CML, Di Leone A, Terribile D, Masetti R, Zagaria L, Mulè A, Morciano F, Franceschini G, Belli P. Selective Axillary Dissection after Neoadjuvant Chemotherapy in Patients with Lymph-Node-Positive Breast Cancer (CLYP Study): The Radio-Guided Occult Lesion Localization Technique for Biopsy-Proven Metastatic Lymph Nodes. Cancers (Basel) 2023; 15:cancers15072046. [PMID: 37046707 PMCID: PMC10093210 DOI: 10.3390/cancers15072046] [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: 02/26/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: To help to refine the accuracy of sentinel lymph node biopsy (SLNB) in breast cancer (BC) patients with biopsy-proven nodal disease prior to neoadjuvant chemotherapy (NACT), a method of marking the biopsy-proven positive LN at diagnosis to enable its removal during surgery was proposed. The aim of this study was to evaluate the accuracy of the Radio-Guided Occult Lesion Localization (ROLL) technique of biopsy-proven metastatic LN in nodal staging after NACT among node-positive BC patients. (2) Methods: Patients with invasive BC and biopsy-proven axillary metastases receiving NACT were enrolled. A clip marker was placed on the sampled LN (clipped lymph node, CLN) before NACT. Before surgery, the ROLL procedure (radioactive tracer injection into CLN under ultrasound guidance) was performed, and the CLN was surgically resected. The correspondence between the CLNs and SLNs was evaluated. The pathologic findings of the CLNs and SLN(s) were compared with remaining axillary nodes at ALND to determine false negative rates (FNRs). (3) Results: Seventy-two patients were analyzed. Surgery successfully identified the CLN in 70/72 procedures (97.2%). For 60/72 patients who underwent ALND, the FNRs dropped from 19.35% for SLNB to 3.13% for CLN biopsy. (4) Conclusions: The ROLL procedure got CLNs is accurate in axillary nodal staging after NACT in node-positive BC patients at diagnosis.
Collapse
Affiliation(s)
- Rossella Rella
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Conti
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Enida Bufi
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Charlotte Marguerite Lucille Trombadori
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Alba Di Leone
- Centro Integrato di Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Daniela Terribile
- Centro Integrato di Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Masetti
- Centro Integrato di Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Luca Zagaria
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonino Mulè
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Unità di Gineco-Patologia e Patologia Mammaria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Morciano
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Gianluca Franceschini
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Unità di Gineco-Patologia e Patologia Mammaria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Paolo Belli
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| |
Collapse
|
13
|
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.
Collapse
|
14
|
Banys-Paluchowski M, Kühn T, Masannat Y, Rubio I, de Boniface J, Ditsch N, Karadeniz Cakmak G, Karakatsanis A, Dave R, Hahn M, Potter S, Kothari A, Gentilini OD, Gulluoglu BM, Lux MP, Smidt M, Weber WP, Aktas Sezen B, Krawczyk N, Hartmann S, Di Micco R, Nietz S, Malherbe F, Cabioglu N, Canturk NZ, Gasparri ML, Murawa D, Harvey J. Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411). Cancers (Basel) 2023; 15:cancers15041173. [PMID: 36831516 PMCID: PMC9954476 DOI: 10.3390/cancers15041173] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Surgical excision of a non-palpable breast lesion requires a localization step. Among available techniques, wire-guided localization (WGL) is most commonly used. Other techniques (radioactive, magnetic, radar or radiofrequency-based, and intraoperative ultrasound) have been developed in the last two decades with the aim of improving outcomes and logistics. METHODS We performed a systematic review on localization techniques for non-palpable breast cancer. RESULTS For most techniques, oncological outcomes such as lesion identification and clear margin rate seem either comparable with or better than for WGL, but evidence is limited to small cohort studies for some of the devices. Intraoperative ultrasound is associated with significantly higher negative margin rates in meta-analyses of randomized clinical trials (RCTs). Radioactive techniques were studied in several RCTs and are non-inferior to WGL. Smaller studies show higher patient preference towards wire-free localization, but little is known about surgeons' and radiologists' attitudes towards these techniques. CONCLUSIONS Large studies with an additional focus on patient, surgeon, and radiologist preference are necessary. This review aims to present the rationale for the MELODY (NCT05559411) study and to enable standardization of outcome measures for future studies.
Collapse
Affiliation(s)
- Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
- Correspondence:
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Die Filderklinik, 70794 Filderstadt, Germany
| | - Yazan Masannat
- Aberdeen Breast Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Isabel Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, 28027 Madrid, Spain
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Surgery, Capio St. Göran’s Hospital, 11219 Stockholm, Sweden
| | - Nina Ditsch
- Breast Cancer Center, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Güldeniz Karadeniz Cakmak
- Breast and Endocrine Unit, General Surgery Department, Zonguldak BEUN The School of Medicine, Kozlu/Zonguldak 67600, Turkey
| | - Andreas Karakatsanis
- Department for Surgical Sciences, Faculty of Pharmacy and Medicine, Uppsala University, 75236 Uppsala, Sweden
- Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, 75236 Uppsala, Sweden
| | - Rajiv Dave
- Nightingale & Genesis Breast Cancer Prevention Centre, Manchester University NHS Foundation Trust, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Markus Hahn
- Department for Women’s Health, University of Tübingen, 72076 Tübingen, Germany
| | - Shelley Potter
- Bristol Medical School (THS), Bristol Population Health Science Institute, Bristol BS8 1QU, UK
| | - Ashutosh Kothari
- Guy’s & St Thomas NHS Foundation Trust, Kings College, London SE1 9RT, UK
| | - Oreste Davide Gentilini
- Department of Breast Surgery, San Raffaele University and Research Hospital, 20132 Milan, Italy
| | - Bahadir M. Gulluoglu
- Department of Surgery, Breast Surgery Unit, Marmara University School of Medicine and SENATURK Turkish Academy of Senology, Istanbul 34854, Turkey
| | - Michael Patrick Lux
- Department of Gynecology and Obstetrics, St. Louise Frauen-und Kinderklinik, 33098 Paderborn, Germany
| | - Marjolein Smidt
- Department of Surgical Oncology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Walter Paul Weber
- Division of Breast Surgery, Department of Surgery, Basel University Hospital, 4031 Basel, Switzerland
| | - Bilge Aktas Sezen
- European Breast Cancer Research Association of Surgical Trialists (EUBREAST), 73730 Esslingen, Germany
| | - Natalia Krawczyk
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Steffi Hartmann
- Department of Gynecology and Obstetrics, University Hospital Rostock, 18059 Rostock, Germany
| | - Rosa Di Micco
- Department of Breast Surgery, San Raffaele University and Research Hospital, 20132 Milan, Italy
| | - Sarah Nietz
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Francois Malherbe
- Breast and Endocrine Surgery Unit, Groote Schuur Hospital, University of Cape Town, Cape Town 7935, South Africa
| | - Neslihan Cabioglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul 34093, Turkey
| | - Nuh Zafer Canturk
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli 41001, Turkey
| | - Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, 6900 Lugano, Switzerland
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale, Via Pietro Capelli 1, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Via Giuseppe Buffi 13, 6900 Lugano, Switzerland
| | - Dawid Murawa
- General Surgery and Surgical Oncology Department, Collegium Medicum, University in Zielona Gora, 65-417 Zielona Góra, Poland
| | - James Harvey
- Nightingale & Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester M13 9PL, UK
| |
Collapse
|
15
|
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
| |
Collapse
|
16
|
Invited Commentary. J Am Coll Surg 2022; 234:1099-1100. [PMID: 35703804 DOI: 10.1097/xcs.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Intraoperative Margin Trials in Breast Cancer. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Purpose of Review
Obtaining negative margins in breast conservation surgery continues to be a challenge. Re-excisions are difficult for patients and expensive for the health systems. This paper reviews the literature on current strategies and intraoperative clinical trials to reduce positive margin rates.
Recent Findings
The best available data demonstrate that intraoperative imaging with ultrasound, intraoperative pathologic assessment such as frozen section, and cavity margins have been the most successful intraoperative strategies to reduce positive margins. Emerging technologies such as optical coherence tomography and fluorescent imaging need further study but may be important adjuncts.
Summary
There are several proven strategies to reduce positive margin rates to < 10%. Surgeons should utilize best available resources within their institutions to produce the best outcomes for their patients.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Ross FA, Elgammal S, Reid J, Henderson S, Kelly J, Flinn R, Miller G, Sarafilovic H, Tovey SM. Magseed localisation of non-palpable breast lesions: experience from a single centre. Clin Radiol 2022; 77:291-298. [PMID: 35177228 DOI: 10.1016/j.crad.2022.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/06/2022] [Indexed: 11/03/2022]
Abstract
AIM To prospectively analyse patients undergoing magnetic seed (Magseed) localisation (MSL) to evaluate the outcome, and to retrospectively compare re-excision rates for MSL with previous wire-guided localisation (WGL) to assess the hypothesis that the introduction of MSL may lead to a lower re-excision rate. MATERIALS AND METHODS MSL commenced at University Hospital Crosshouse in December 2017. No other changes were made to radiological or surgical practice during this time. Data were collected prospectively on all patients undergoing MSL between December 2017 and December 2019, in a single breast unit. Data were gathered retrospectively on patients who had undergone localised breast procedures between January 2016 and December 2019 for comparison of re-excision rates. RESULTS Two hundred and fifty-five patients underwent MSL surgery between December 2017 and December 2019. Of those, 98% (n=250) patients underwent successful MSL at the first attempt. The Magseed was identified intraoperatively in 100% patients and surgical excision was performed. The re-excision rate reduced from 18.9% in 2016/2017, to 11.6% in 2018/2019 (p=0.098). CONCLUSION In conclusion, Magseed localisation has proved to be a safe and effective way of localising breast lesions, with the advantage of high accuracy. The reduction in re-excision rates at University Hospital Crosshouse with the introduction of Magseed® localisation is a potential benefit, which requires further study.
Collapse
Affiliation(s)
- F A Ross
- Department of Surgery, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, East Ayrshire KA2 0BE, UK.
| | - S Elgammal
- Department of Surgery, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, East Ayrshire KA2 0BE, UK
| | - J Reid
- Department of Surgery, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, East Ayrshire KA2 0BE, UK
| | - S Henderson
- Department of Radiology, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, East Ayrshire KA2 0BE, UK
| | - J Kelly
- Department of Radiology, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, East Ayrshire KA2 0BE, UK
| | - R Flinn
- Department of Surgery, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, East Ayrshire KA2 0BE, UK
| | - G Miller
- Department of Surgery, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, East Ayrshire KA2 0BE, UK
| | - H Sarafilovic
- Department of Surgery, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, East Ayrshire KA2 0BE, UK
| | - S M Tovey
- Department of Surgery, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, East Ayrshire KA2 0BE, UK
| |
Collapse
|
21
|
Prospective Evaluation of Radar-Localized Reflector-Directed Targeted Axillary Dissection in Node-Positive Breast Cancer Patients after Neoadjuvant Systemic Therapy. J Am Coll Surg 2022; 234:538-545. [PMID: 35290273 DOI: 10.1097/xcs.0000000000000098] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND This is a prospective, single-institution study to evaluate feasibility and accuracy of radar-localized reflector (RLR)-targeted axillary dissection (TAD) in node-positive breast cancer patients after neoadjuvant systemic therapy (NST). METHODS Patients with biopsy-proven T1-2, N1-3 disease were eligible. Before NST, a marker clip and/or RLR was placed into the positive node. After NST, RLR was inserted if not placed previously. All patients underwent RLR TAD followed by axillary lymph node dissection (ALND). Primary end points of the trial were feasibility of RLR TAD and false negative rate (FNR). RESULTS Between 2017 and 2021, 101 patients with N1-3 disease underwent NST. Five patients withdrew from the study, 1 was ineligible, and there were 9 technical failures, thus our final study cohort comprised 86 patients. RLR TAD was performed with probe guidance and confirmed with intraoperative specimen radiograph. After RLR TAD, ALND was performed. Median number of RLR TAD nodes removed was 2 (range 1-10), and the RLR TAD nodes remained positive in 56 patients. Median number of ALND nodes removed was 18 (range 4-46). Accounting for 9 technical failures, feasibility was 90%. All technical failures occurred with attempted placement of RLR after NST. Feasibility rate was 100% when RLR placement occurred at diagnosis. Of the evaluable 86 patients, RLR TAD accurately predicted axillary status in 83 patients, with FNR of 5.1%. CONCLUSION We demonstrate high accuracy of RLR TAD, especially when RLR is placed before NST. For patients who present with N1-3 disease, this is another step towards axillary surgery de-escalation strategies.
Collapse
|
22
|
den Dekker BM, Christenhusz A, van Dalen T, Jongen LM, van der Schaaf MC, Dassen AE, Pijnappel RM. A multicenter prospective cohort study to evaluate feasibility of radio-frequency identification surgical guidance for nonpalpable breast lesions: design and rationale of the RFID Localizer 1 Trial. BMC Cancer 2022; 22:305. [PMID: 35317766 PMCID: PMC8939217 DOI: 10.1186/s12885-022-09394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer screening and improving imaging techniques have led to an increase in the detection rate of early, nonpalpable breast cancers. For early breast cancer, breast conserving surgery is an effective and safe treatment. Accurate intraoperative lesion localization during breast conserving surgery is essential for adequate surgical margins while sparing surrounding healthy tissue to achieve optimal cosmesis. Preoperative wire localization and radioactive seed localization are accepted standard methods to guide surgical excision of nonpalpable breast lesions. However, these techniques present significant limitations. Radiofrequency identification (RFID) technology offers a new, nonradioactive method for localizing nonpalpable breast lesions in patients undergoing breast conserving surgery. This study aims to evaluate the feasibility of RFID surgical guidance for nonpalpable breast lesions. METHODS This multicenter prospective cohort study was approved by the Institutional Review Board of the University Medical Center Utrecht. Written informed consent is obtained from all participants. Women with nonpalpable, histologically proven in situ or invasive breast cancer, who can undergo breast conserving surgery with RFID localization are considered eligible for participation. An RFID tag is placed under ultrasound guidance, up to 30 days preoperatively. The surgeon localizes the RFID tag with a radiofrequency reader that provides audible and visual real-time surgical guidance. The primary study outcome is the percentage of irradical excisions and reexcision rate, which will be compared to standards of the National Breast Cancer Organisation Netherlands (NABON)(≤ 15% irradical excisions of invasive carcinomas). Secondary outcomes include user acceptability/experiences, learning curve, duration and ease of the placement- and surgical procedure and adverse events. DISCUSSION This study evaluates the feasibility of RFID surgical guidance for nonpalpable breast lesions. Results may have implications for the future localization techniques in women with nonpalpable breast cancer undergoing breast conserving surgery. TRIAL REGISTRATION Netherlands National Trial Register, NL8019 , registered on September 12th 2019.
Collapse
Affiliation(s)
- Bianca M den Dekker
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Anke Christenhusz
- Department of Surgery, Medisch Spectrum Twente Enschede, University of Twente, Enschede, the Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Lisa M Jongen
- Department of Radiology, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | | | - Anneriet E Dassen
- Department of Surgery, Medisch Spectrum Twente Enschede, University of Twente, Enschede, the Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Dutch Expert Centre for Screening, Nijmegen, the Netherlands
| |
Collapse
|
23
|
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]
|
24
|
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]
|
25
|
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]
|
26
|
Anderson TL, Johnson MP, Viers LD, Khanani S. Practice Patterns of Preoperative Breast and Axillary Localizations. Curr Probl Diagn Radiol 2022; 51:707-711. [DOI: 10.1067/j.cpradiol.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
|
27
|
The Evolving Role of Radiofrequency Guided Localisation in Breast Surgery: A Systematic Review. Cancers (Basel) 2021; 13:cancers13194996. [PMID: 34638480 PMCID: PMC8508195 DOI: 10.3390/cancers13194996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/17/2021] [Accepted: 10/02/2021] [Indexed: 12/24/2022] Open
Abstract
Wire-guided localisation (WGL) has been the gold-standard for localising non-palpable breast lesions before excision. Due to its drawbacks, various wireless alternatives have been developed, including LOCalizer™, which is based on radio-frequency identification (RFID) technology. In this systematic review, we consulted EMBASE, Medline and PubMed databases using appropriate search terms regarding the use of RFID technology in the localisation of occult breast lesions. Retrospective and prospective studies were included if they quoted the number of patients, rate of successful placement, retrieval rate, margin positivity rate and the re-excision rate. In addition, studies comparing RFID to WGL were also included and analysed separately. Seven studies were included in this systematic review spanning 1151 patients and 1344 tags. The pooled deployment rate was 99.1% and retrieval rate was 100%. Re-excision rate was 13.9%. One complication was identified. Two studies compared RFID with WGL (128 vs. 282 patients respectively). For both techniques the re-excision rate was 15.6% (20/128 vs. 44/282 respectively, p value is 0.995). Based on our review, LOCalizer™ is safe and non-inferior to WGL in terms of successful localisation and re-excision rates. However, further research is required to assess the cost effectiveness of this approach and its impact on the aesthetic outcome compared with WGL and other wire free technologies to better inform decision making in service planning and provision.
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
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.
Collapse
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.
| |
Collapse
|
31
|
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.
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
Rao R, Sun L, Acevedo C, Concepcion A, Concepcion D, Sanchez J, Alicea C, Franco L, Frias R, Flores A, Vega A, Baez J, Soler N, Alvarez S, Taback B, Rao M, Wiechmann L. Presenting for Duty: Lessons From A Specialty Surgery Division at the Pandemic Epicenter. ANNALS OF SURGERY OPEN 2020; 1:e014. [PMID: 37637449 PMCID: PMC10455142 DOI: 10.1097/as9.0000000000000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022] Open
Abstract
MINI-ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic has had catastrophic repercussions across the world and here in the United States. The healthcare system in New York City, the epicenter, has faced significant disruptions due to the sheer volume of cases and critical care needs of severely ill patients. For surgical specialty services, the postponement of all elective surgeries, redeployment of faculty and staff, and cancellation of outpatient clinics became a rapid reality. These circumstances required a nimble restructuring of services and communications to facilitate continued support of academic and clinical missions. Throughout the course of the pandemic, significant adjustments were made in regards to duties, patient services, and communication. The frameworks and techniques utilized are described along with the relevant outcomes. Immediate restructuring of tumor boards, a focused multidisciplinary approach to management that incorporated the barriers presented by the pandemic, optimization of telehealth services, inclusive communication, and a service-oriented approach to redeployment were critical to sustaining the Division of Breast, Melanoma, and Soft Tissue surgery.
Collapse
Affiliation(s)
- Roshni Rao
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Luona Sun
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Charise Acevedo
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Ana Concepcion
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Dionisia Concepcion
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Josenny Sanchez
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Catherine Alicea
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Lisa Franco
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Rosanna Frias
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Adrianna Flores
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Armisia Vega
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Jennifer Baez
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Nancy Soler
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Sylvia Alvarez
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Bret Taback
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Madhu Rao
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| | - Lisa Wiechmann
- From the Division of Surgery for Breast, Melanoma, and Soft Tissue Tumors, Department of Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY
| |
Collapse
|
35
|
Miller ME, Patil N, Li P, Freyvogel M, Greenwalt I, Rock L, Simpson A, Teresczuk M, Carlisle S, Peñuela M, Thompson CL, Shenk R, Dietz J. Hospital System Adoption of Magnetic Seeds for Wireless Breast and Lymph Node Localization. Ann Surg Oncol 2020; 28:3223-3229. [PMID: 33170457 DOI: 10.1245/s10434-020-09311-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/15/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND As an alternative to traditional wire localization, an inducible magnetic seed system can be used to identify and remove nonpalpable breast lesions and axillary lymph nodes intraoperatively. We report the largest single-institution experience of magnetic seed placement for operative localization to date, including feasibility and short-term outcomes. METHODS Patients who underwent placement of a magnetic seed in the breast or lymph node were identified from July 2017 to March 2019. Imaging findings, core needle biopsy, surgical pathology results, and type of surgery were collected. Outcomes included procedural complications, magnetic seed and biopsy clip retrieval rates, and need for additional surgery. RESULTS A total of 842 magnetic seeds were placed by nine radiologists in 673 patients and retrieved by six surgeons at six operative locations. The majority of breast lesions were malignant (395/659, 59.9%); 136 seeds were placed for lymph node localization. The overall magnetic seed retrieval rate was 98.6%, whereas the biopsy clip retrieval rate was 90.9%. Only six patients (0.7%) experienced a complication from magnetic seed placement. Reexcision was performed in 15.2% of patients with breast cancer; 9.6% of benign/high risk lesions were upgraded to malignancy at surgical excision. CONCLUSIONS The magnetic seed technique is safe, effective, and accurate for localization of breast lesions and lymph nodes, and importantly uncouples surgery from the localization procedure. The high magnetic seed retrieval rate and low reexcision rate may reflect the accuracy of magnetic marker placement as a "second chance" localization procedure, especially in cases with biopsy clip migration.
Collapse
Affiliation(s)
- Megan E Miller
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Nirav Patil
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Pamela Li
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mary Freyvogel
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ian Greenwalt
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lisa Rock
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ashley Simpson
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mary Teresczuk
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Maria Peñuela
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Cheryl L Thompson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert Shenk
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jill Dietz
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
36
|
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.
Collapse
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
| |
Collapse
|
37
|
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.
Collapse
|
38
|
Broman KK, Joyce D, Binitie O, Letson GD, Gonzalez RJ, Choi J, Mullinax JE. Intraoperative Localization Using an Implanted Radar Reflector Facilitates Resection of Non-Palpable Trunk and Extremity Sarcoma. Ann Surg Oncol 2020; 28:3366-3374. [PMID: 33073344 DOI: 10.1245/s10434-020-09229-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Resecting non-palpable soft tissue tumors presents a unique challenge, particularly with recurrent disease in which surrounding tissue has been surgically manipulated and often irradiated. SAVI SCOUT® is a radar-based localization device that was developed for breast tumor localization and was recently FDA-approved for localization of soft tissue tumors. Application of this technology to soft tissue sarcoma has not been previously reported. METHODS We assembled a single-institution retrospective case series of patients with trunk and extremity sarcomas resected by five sarcoma surgeons using SAVI SCOUT® from December 2018 to May 2020. Reflectors were placed preoperatively using image-guidance, and the radar detector was used intraoperatively to localize the target lesion. Clinical variables were abstracted from the electronic medical record including treatment history, pathology, and early oncologic outcomes. Using a focused review, we compared margin status and recurrence rates with previously published cohorts. RESULTS Ten SAVI SCOUT®-localized sarcoma resections were performed. Eight were for locally recurrent disease, of which seven (83%) had prior radiation. The remaining lesions became non-palpable after neoadjuvant chemotherapy. SAVI SCOUT® facilitated resection in all cases with a margin-negative resection rate (77%) comparable to prior cohorts. In this high-risk population with a median follow-up of 14 months, only one patient recurred locally 7.5 months after SAVI SCOUT®-localized resection, requiring re-resection. CONCLUSION SAVI SCOUT® technology facilitated resection of non-palpable recurrent sarcoma of the trunk and extremities in all ten cases attempted. In a high-risk patient population, the pattern of recurrence has been primarily distant with one instance of local tumor recurrence.
Collapse
Affiliation(s)
- Kristy Kummerow Broman
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - David Joyce
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Odion Binitie
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - G Douglas Letson
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Ricardo J Gonzalez
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Junsung Choi
- Radiology Department, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33629, USA
| | - John E Mullinax
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
| |
Collapse
|
39
|
Srour MK, Kim S, Amersi F, Giuliano AE, Chung A. Comparison of Multiple Wire, Radioactive Seed, and Savi Scout ® Radar Localizations for Management of Surgical Breast Disease. Ann Surg Oncol 2020; 28:2212-2218. [PMID: 32989660 DOI: 10.1245/s10434-020-09159-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Radioactive seed localization (RSL) and the Savi Scout® radar (SSR) are newer alternatives to wire-guided localization (WL) for nonpalpable breast lesions. OBJECTIVE The aim of this study was to compare three localization devices when multiple devices were used for preoperative localization for breast surgery. METHODS Between July 2017 and July 2018, 68 patients had a partial mastectomy (n = 54) or breast biopsy (n = 14) with preoperative image-guided localization using multiple wires or device placement for nonpalpable lesions. Operative timing, outcomes, and 30-day complications were evaluated. RESULTS Overall, 41 patients (60%) had WL, 11 patients (16%) had RSL, and 16 patients (24%) had SSR localization. Fifty-four patients (79.4%) had localization of two lesions and 13 patients (19.1%) had localization of three lesions. Twenty-three patients (33.8%) had a lesion that was bracketed. There was no difference in retained biopsy clip among the groups (average 7.4%; p = 0.962). For operations performed in the hospital, there was no difference in operative time among the groups, with a median of 77.5 min (p = 0.705) or total perioperative time of 508 min (p = 0.210). Among operations with delayed start times, there was a longer average delay of 95.5 min in WL, compared with 42 min in SSR (p = 0.004). A greater volume of tissue was excised in the WL group (29.5 g WL vs. 15.9 g RSL vs. 12.1 g SSR; p = 0.022). There was no difference in positive margin rate and 30-day complications among groups. CONCLUSION SSR and RSL can be used to localize multiple breast lesions, with no difference in positive margin rates or complications and less tissue excised compared with WL.
Collapse
Affiliation(s)
- Marissa K Srour
- Department of Surgery, Division of Surgical Oncology, Cedars-Sinai Medical Center, 310 North San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Sungjin Kim
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Farin Amersi
- Department of Surgery, Division of Surgical Oncology, Cedars-Sinai Medical Center, 310 North San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Armando E Giuliano
- Department of Surgery, Division of Surgical Oncology, Cedars-Sinai Medical Center, 310 North San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Alice Chung
- Department of Surgery, Division of Surgical Oncology, Cedars-Sinai Medical Center, 310 North San Vicente Blvd, Los Angeles, CA, 90048, USA.
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Micha AE, Sinnett V, Downey K, Allen S, Bishop B, Hector LR, Patrick EP, Edmonds R, Barry PA, Krupa KDC, Rusby JE. Patient and clinician satisfaction and clinical outcomes of Magseed compared with wire-guided localisation for impalpable breast lesions. Breast Cancer 2020; 28:196-205. [PMID: 32974810 PMCID: PMC7796883 DOI: 10.1007/s12282-020-01149-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023]
Abstract
Background Guide-wire localisation remains the most commonly used technique for localisation of impalpable breast lesions in the UK. One alternative is magnetic seed localisation. We aimed to investigate patient and clinician satisfaction in two consecutive cohorts, describe re-excision and positive margin rates, and explore reasons for positive margins and the implications for localisation techniques. Methods A single-institution prospective service evaluation of two cohorts of consecutive cases of wire and then Magseed localisation was carried out. Data were collected on patient and clinician satisfaction, clinico-pathological findings, and causes of involved margins. T tests were used to compare continuous variables and Chi-squared test for satisfaction outcomes. Results 168 consecutive cases used wire-guided localisation (WGL) and 128 subsequent cases used Magseeds. Patients reported less anxiety between localisation and surgery in the Magseed group, and clinicians reported greater ease of use of Magseeds. There were no differences in lesion size, surgical complexity, or re-excision rate between the groups. In a subset of patients receiving standard wide local excision (i.e., excluding mammoplasties), the impact on margin involvement was investigated. There was no significant difference in radiological under-sizing or accuracy of localisation. However, specimen weight and eccentricity of the lesion were statistically significantly lower in the Magseed group. Despite this, re-excision rates were not significantly different (p = 0.4). Conclusions This is the first large study of satisfaction with localisation and showed clinician preference for Magseed and a reduction in patient anxiety. It also demonstrated similar positive margin rates despite smaller specimen weights in the Magseed group. Magnetic seed localisation offers an acceptable clinical alternative to guide wire localisation. The impact on local service provision should also be considered.
Collapse
Affiliation(s)
- Aikaterini E Micha
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Victoria Sinnett
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Kate Downey
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Steve Allen
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Briony Bishop
- Royal Marsden NHS Foundation Trust, London, UK
- Bedfordshire Hospitals NHS Trust, South Wing, Kempston Rd, Bedford, MK42 9DJ, UK
| | - Lauren R Hector
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Elaine P Patrick
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | | | - Peter A Barry
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Institute for Cancer Research, Sutton, UK
| | - Katherine D C Krupa
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Jennifer E Rusby
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK.
- Institute for Cancer Research, Sutton, UK.
| |
Collapse
|
42
|
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.
Collapse
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.
| |
Collapse
|
43
|
Laws A, Dillon K, Kelly BN, Kantor O, Hughes KS, Gadd MA, Smith BL, Lamb LR, Specht M. Node-Positive Patients Treated with Neoadjuvant Chemotherapy Can Be Spared Axillary Lymph Node Dissection with Wireless Non-Radioactive Localizers. Ann Surg Oncol 2020; 27:4819-4827. [PMID: 32740737 DOI: 10.1245/s10434-020-08902-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/30/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Targeted axillary dissection (TAD) involves sentinel lymph node biopsy (SLNB) and excision of a biopsy-proven node marked by a clip. This study evaluates the feasibility of non-radioactive wireless localizers for targeted excision of clipped axillary lymph nodes. METHODS We identified biopsy-proven, node-positive breast cancer patients treated with neoadjuvant therapy (NAT) and TAD from 2016 to 2020, and included those with a clipped node localized using SAVI SCOUT, Magseed, or RFID Tag. Primary outcome measures were (1) successful localization (ultrasound or mammographic-guided placement < 10 mm from target), and (2) retrieval of the clipped node during TAD, documented by specimen radiography or gross visualization. Secondary outcomes included rates of completion axillary lymph node dissection (cALND) and complications. RESULTS Overall, 57 patients were included; 1 (1.8%) patient had no clip visible at the time of localization, and no radiographic confirmation of clip placement at the time of biopsy, and was therefore excluded. In the remaining 56 patients, localization was successful in 53 (94.6%) patients and the clipped node was retrieved during TAD in 51 (91.1%) patients. Twenty-three of 27 (85.2%) ypN0 patients were spared cALND; 3 (11.1%) patients had cALND for failed clipped node retrieval during TAD, and 1 (3.7%) for false-positive frozen section. In patients with TAD alone, the rates of axillary seroma and infection were 20.0% and 8.6%, respectively. CONCLUSIONS Wireless non-radioactive localizers are feasible for axillary localization after NAT, with high success rates of retrieving clipped nodes. The lack of signal decay is an advantage of these devices, allowing flexibility in timing of placement.
Collapse
Affiliation(s)
- Alison Laws
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Kayla Dillon
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Bridget N Kelly
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Olga Kantor
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Kevin S Hughes
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Michele A Gadd
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Barbara L Smith
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Leslie R Lamb
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle Specht
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
| |
Collapse
|
44
|
Tingen JS, McKinley BP, Rinkliff JM, Cornett WR, Lucas C. Savi Scout Radar Localization Versus Wire Localization for Breast Biopsy Regarding Positive Margin, Complication, and Reoperation Rates. Am Surg 2020; 86:1029-1031. [PMID: 32721172 DOI: 10.1177/0003134820939903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed noncutaneous malignancy and remains the second leading cause of cancer deaths in women. The Savi Scout (Cianna Medical, Merit Medical Systems, Inc. South Jordan, UT) is a wireless, nonradioactive, wave reflection implant system that enables surgeons to remove targeted breast lesions. Our study aims to be the largest comparison of wire and Savi Scout localization techniques for positive margin, complication, and reoperation rates. METHODS Single-institution retrospective review of 512 patients that had Savi Scout Surgical Guidance System breast lesion biopsy or wire localized breast biopsy from May 2017 to December 2018. A RedCaps database was created and reviewed for outcomes. RESULTS For 320 Savi scout patients, margins were positive or less than 1 mm in 18 cases (5.6%). 17 (5.3%) patients required reoperation. Surgical site occurrence was found in 7 (2.1%) patients, and 2 patients required intervention (0.6%). For 175 wire localization patients, margins were positive or less than 1 mm in 24 patients, and all required reoperation (13.7%). A surgical site occurrence was found in 13 (7.4%) patients and 5 patients required intervention (2.8%). DISCUSSION In our series, the Savi Scout localization system resulted in a lower rate of positive margins, reoperation, and surgical site occurrence. These data suggest that Savi Scout localization is a reasonable replacement to wire localization for breast lesions and might produce superior results.
Collapse
Affiliation(s)
- Joseph S Tingen
- Prisma Health, Department of Surgery, School of Medicine, University of South Carolina, Greenville, SC, USA
| | - Brian P McKinley
- Prisma Health, Department of Surgery, School of Medicine, University of South Carolina, Greenville, SC, USA
| | - John M Rinkliff
- Prisma Health, Department of Surgery, School of Medicine, University of South Carolina, Greenville, SC, USA
| | - Wendy R Cornett
- Prisma Health, Department of Surgery, School of Medicine, University of South Carolina, Greenville, SC, USA
| | - Claiborne Lucas
- Prisma Health, Department of Surgery, School of Medicine, University of South Carolina, Greenville, SC, USA
| |
Collapse
|
45
|
Wazir U, Tayeh S, Perry N, Michell M, Malhotra A, Mokbel K. Wireless Breast Localization Using Radio-frequency Identification Tags: The First Reported European Experience in Breast Cancer. In Vivo 2020; 34:233-238. [PMID: 31882483 DOI: 10.21873/invivo.11765] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Wire-guided localisation (WGL) has been the mainstay for localisation of clinically occult breast lesions before excision. However, it has restrictive scheduling requirements, and causes patient discomfort. This has prompted the development of various wireless alternatives. In this prospective study we shall evaluate the role of radiation-free wireless localisation using a radiofrequency identification (RFID) tag and a hand-held reader (LOCalizer™) in the management of occult breast lesions. PATIENTS AND METHODS This technique was evaluated in a prospective cohort of 10 patients. The evaluation focused on: i) successful deployment, ii) identification and retrieval, iii) the status of surgical margins and need for re-operation, iv) resected specimen weight, v) marker migration rates (>5mm), and vi) acceptance by patients, radiologists and surgeons. RESULTS RFID tags (n=11) were deployed under ultrasound guidance pre-operatively to localise occult breast lesions in 10 patients. The mean time for deployment of the RFID tag was 5.4 min (range=2-20). The mean distance from the lesion was 0.45 mm (range=0-3). The mean duration for retrieval was 10.2 min (range=6-20). Mean specimen weight was 19.6 g for malignant lesions (range=4.5-42). All tags were identified, and none had migrated. There were no positive margins, re-operations, nor complications. Patient feedback was highly positive. Both radiologists and surgeons rated the LOCalizer™ technique as better than WGL. CONCLUSION Our study demonstrates that wireless localisation using RFID is an effective and time-efficient alternative to WGL, with low margin positivity and re-operation rates, and high patient, radiologist and surgeon acceptance.
Collapse
Affiliation(s)
- Umar Wazir
- The London Breast Institute, Princess Grace Hospital, London, U.K.,Department of General Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Salim Tayeh
- The London Breast Institute, Princess Grace Hospital, London, U.K
| | - Nicholas Perry
- The London Breast Institute, Princess Grace Hospital, London, U.K
| | - Michael Michell
- The London Breast Institute, Princess Grace Hospital, London, U.K
| | - Anmol Malhotra
- The London Breast Institute, Princess Grace Hospital, London, U.K
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, U.K.
| |
Collapse
|
46
|
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.
Collapse
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.
| |
Collapse
|
47
|
Lindenberg M, van Beek A, Retèl V, van Duijnhoven F, van Harten W. Early budget impact analysis on magnetic seed localization for non-palpable breast cancer surgery. PLoS One 2020; 15:e0232690. [PMID: 32401779 PMCID: PMC7219736 DOI: 10.1371/journal.pone.0232690] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/19/2020] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Current localization techniques used in breast conserving surgery for non-palpable tumors show several disadvantages. Magnetic Seed Localization (MSL) is an innovative localization technique aiming to overcome these disadvantages. This study evaluated the expected budget impact of adopting MSL compared to standard of care. METHODS Standard of care with Wire-Guided Localization (WGL) and Radioactive Seed Localization (RSL) use was compared with a future situation gradually adopting MSL next to RSL or WGL from a Dutch national perspective over 5 years (2017-2022). The intervention costs for WGL, RSL and MSL and the implementation costs for RSL and MSL were evaluated using activity-based costing in eight Dutch hospitals. Based on available list prices the price of the magnetic seed was ranged €100-€500. RESULTS The intervention costs for WGL, RSL and MSL were respectively: €2,617, €2,834 and €2,662 per patient and implementation costs were €2,974 and €26,826 for MSL and RSL respectively. For standard of care the budget impact increased from €14.7m to €16.9m. Inclusion of MSL with a seed price of €100 showed a budget impact of €16.7m. Above a price of €178 the budget impact increased for adoption of MSL, rising to €17.6m when priced at €500. CONCLUSION MSL could be a cost-efficient localization technique in resecting non-palpable tumors in the Netherlands. The online calculation model can inform adoption decisions internationally. When determining retail price of the magnetic seed, cost-effectiveness should be considered.
Collapse
Affiliation(s)
- Melanie Lindenberg
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Health Technology and Services research, University of Twente, Enschede, The Netherlands
| | - Anne van Beek
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Valesca Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Health Technology and Services research, University of Twente, Enschede, The Netherlands
| | - Frederieke van Duijnhoven
- Division of Surgical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Wim van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Health Technology and Services research, University of Twente, Enschede, The Netherlands
- * E-mail:
| |
Collapse
|
48
|
The problem of axillary staging in breast cancer after neoadjuvant chemotherapy. Role of targeted axillary dissection and types of lymph node markers. Cir Esp 2020; 98:510-515. [PMID: 32386728 DOI: 10.1016/j.ciresp.2020.03.012] [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: 01/11/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 11/20/2022]
Abstract
Targeted axillary dissection (TAD) consists of a new axillary staging technique that combines sentinel lymph node biopsy (SLNB) and clipped lymph node biopsy (CLNB) in the same surgery, in order to re-stage patients with breast cancer and positive axillary lymph nodes undergoing neoadjuvant chemotherapy (NAQT). Prior to the NAQT, the affected lymph node is punctured and a solid marker is left inside echo-guided, in order to biopsy it in the subsequent surgery. There are numerous types of markers: metallic (steel, titanium or polyglycolic acid clips), radioiodine or ferromagnetic seeds, which differ in the method of location (wire, gamma-detection or magnetic probe). The aim of this study is to perform a systematic review about the current status of the TAD, as well as to explain the different techniques and types of axillary marking, based on the current available evidence.
Collapse
|
49
|
Saphier N, Kondraciuk J, Morris E, Bernard-Davila B, Mango V. Preoperative Localization of Breast MRI Lesions: MRI-guided Marker Placement With Radioactive Seed Localization as an Alternative to MRI-guided Wire Localization. JOURNAL OF BREAST IMAGING 2020; 2:250-258. [PMID: 33554114 DOI: 10.1093/jbi/wbaa012] [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: 08/07/2019] [Indexed: 11/14/2022]
Abstract
Objective Preoperative MRI-guided wire localization (MWL) presents challenges to both the physician and patient. In this study, we examined the efficiency and outcome of MRI-guided marker placement followed by mammographic-guided radioactive seed localization (MMP/RSL) as an alternative localization method. The primary outcome parameter was pathology upon excision. The secondary outcome parameters were total procedure time and clinical indication for localization. Methods A retrospective review of a large tertiary cancer center's breast imaging database was performed. Records of 21 patients with MMP/RSL (24 markers) from August 2013 to January 2019 were compared with 34 patients receiving MWL (48 wires) from January 2016 to January 2019. Multiple factors, including age, prelocalization pathology, postsurgical pathology, concordance, re-excision rates, and total procedure time required for each technique, were compared. Univariate and descriptive statistical analyses were performed. Results Mean patient age in years (MMP/RSL = 54.1 ± 13.1, MWL = 55.1 ± 10.8, P = 0.389), time in MR scanner in minutes (MMP/RSL = 31.7 ± 12.0, MWL = 35.8 ± 13.1, P = 0.678), and postsurgical pathology malignancy rates (MMP/RSL = 71.4%, MWL = 65.7%, P = 0.7715) were similar without statistically significant differences. As expected, the mean total procedure time was slightly longer without a statistically significant difference (47.3 ± 19.8 min versus 35.8 ± 13.1 min, P = 0.922) for the MMP/RSL group. All patients in both groups underwent successful localization with 100% radiologic-pathology concordance. Re-excision rates were lower for the MMP/RSL group (9.5%) versus the MWL group (16.7%); however, they were not found to be statistically significant (P = 0.7104). Conclusion MMP/RSL is a feasible alternative to MWL and may alleviate many challenges presented by MWL. Further studies are needed.
Collapse
Affiliation(s)
- Nicole Saphier
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Jessica Kondraciuk
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Elizabeth Morris
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | | | - Victoria Mango
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| |
Collapse
|
50
|
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.
Collapse
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
| |
Collapse
|