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Ferreira HHJ, de Souza CD, Pozzo L, Ribeiro MS, Rostelato MECM. Radioactive Seed Localization for Nonpalpable Breast Lesions: Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:441. [PMID: 38396480 PMCID: PMC10887864 DOI: 10.3390/diagnostics14040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND This study is a systematic review with meta-analysis comparing radioactive seed localization (RSL) versus radio-guided occult lesion localization (ROLL) and wire-guided localization (WGL) for patients with impalpable breast cancer undergoing breast-conserving surgery and evaluating efficacy, safety, and logistical outcomes. The protocol is registered in PROSPERO with the number CRD42022299726. METHODS A search was conducted in the Embase, Lilacs, Pubmed, Scielo, Web of Science, and clinicaltrials.gov databases, in addition to a manual search in the reference list of relevant articles, for randomized clinical trials and cohort studies. Studies selected were submitted to their own data extraction forms and risk of bias analysis according to the ROB 2 and ROBINS 1 tools. A meta-analysis was performed, considering the random effect model, calculating the relative risk or the mean difference for dichotomous or continuous data, respectively. The quality of the evidence generated was analyzed by outcome according to the GRADE tool. Overall, 46 articles met the inclusion criteria and were included in this systematic review; of these, 4 studies compared RSL and ROLL with a population of 1550 women, and 43 compared RSL and WGL with a population of 19,820 women. RESULTS The results showed that RSL is a superior method to WGL in terms of surgical efficiency in the impalpable breast lesions' intraoperative localization, and it is at least equivalent to ROLL. Regarding security, RSL obtained results equivalent to the already established technique, the WGL. In addition to presenting promising results, RSL has been proven to be superior to WGL and ROLL technologies.
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Affiliation(s)
| | - Carla Daruich de Souza
- Nuclear and Energy Research Institute (IPEN/CNEN—SP), University of São Paulo (USP), Av. Professor Lineu Prestes 2242, São Paulo 05508-000, SP, Brazil; (H.H.J.F.); (L.P.); (M.S.R.); (M.E.C.M.R.)
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Gabrielova L, Selingerova I, Zatecky J, Zapletal O, Burkon P, Holanek M, Coufal O. Comparison of 3 Different Systems for Non-wire Localization of Lesions in Breast Cancer Surgery. Clin Breast Cancer 2023:S1526-8209(23)00111-8. [PMID: 37301711 DOI: 10.1016/j.clbc.2023.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Localizing breast lesions by marking tumors and their detection using probes during surgery is a common part of clinical practice. Various nonwire localization systems were intended to be compared from different perspectives. METHODS Various measurement experiments were performed. Localization techniques, including radioactive seed (RSLS), magnetically guided (MGLS), or radar (SLS), were compared in signal propagation in water and tissue environments, signal interference by surgical instruments, and the practical experience of surgeons. Individual experiments were thoroughly prospectively planned. RESULTS The RSLS signal was detectable at the largest evaluated distance, ie, 60 mm. The SLS and MGLS signal detection was shorter, up to 25 mm to 45 mm and 30 mm, respectively. The signal intensity and the maximum detection distance in water differed slightly depending on the localization marker orientation to the probe, especially for SLS and MGLS. Signal propagation in the tissue was noted to a depth of 60 mm for RSLS, 50 mm for SLS, and 20 mm for MGLS. Except for the expected signal interferences by approaching surgical instruments from any direction for MGLS, the signal interruption for RSLS and SLS was observed only by inserting instruments directly between the localization marker and probe. Moreover, the SLS signal interference by instrument touch was noted. Based on surgeons' results, individual systems did not differ significantly for most measurement condition settings. CONCLUSION Apparent differences noted among localization systems can help experts choose an appropriate system for a specific situation or reveal small nuances that have not yet been observed in clinical practice.
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Affiliation(s)
- Lucie Gabrielova
- Department of Breast, Skin, and Oncoplastic Surgery, Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Iveta Selingerova
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czech Republic; Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Jan Zatecky
- Department of Breast, Skin, and Oncoplastic Surgery, Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgery, Silesian Hospital in Opava, Opava, Czech Republic; The Institute of Paramedical Health Studies, Faculty of Public Policies, Silesian University, Opava, Czech Republic
| | - Ondrej Zapletal
- Department of Breast, Skin, and Oncoplastic Surgery, Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Burkon
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Milos Holanek
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Oldrich Coufal
- Department of Breast, Skin, and Oncoplastic Surgery, Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Weiser R, Manno GC, Cass SH, Chen L, Kuo YF, He J, Robinson AS, Posleman Monetto F, Silva HC, Klimberg VS. Fluoroscopic Intraoperative Breast Neoplasm and Node Detection. J Am Coll Surg 2023; 236:575-585. [PMID: 36728380 DOI: 10.1097/xcs.0000000000000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Preoperative localization is necessary for nonpalpable breast lesions. A novel procedure, fluoroscopic intraoperative neoplasm and node detection (FIND), obviates the preoperative painful and potentially expensive localization by using intraoperative visualization of the standard clip placed during diagnostic biopsy. We hypothesized FIND would improve negative margin rates. STUDY DESIGN This is an IRB-approved retrospective study (September 2016 to March 2021). Electronic chart review identified breast and axillary node procedures using wire localization (WL) or FIND. Primary outcome was margin status. Secondary outcomes included re-excision rate, specimen weight, surgery time, and axillary node localization rate. RESULTS We identified 459 patients, of whom 116 (25.3%) underwent FIND and 343 (74.7%) WL. Of these, 68.1% of FIND and 72.0% of WL procedures were for malignant lesions. Final margin positivity was 5.1% (4 of 79) for FIND and 16.6% (41 of 247) for WL (p = 0.008). This difference lost statistical significance on multivariable logistic regression (p = 0.652). Re-excision rates were 7.6% and 14.6% for FIND and WL (p = 0.125), with an equivalent mean specimen weight (p = 0.502), and mean surgery time of 177.5 ± 81.7 and 157.1 ± 66.8 minutes, respectively (mean ± SD; p = 0.022). FIND identified all (29 of 29) targeted axillary nodes, and WL identified only 80.1% (21 of 26) (p = 0.019). CONCLUSIONS FIND has lower positive margin rates and a trend towards lower re-excision rates compared with WL, proving its value in localizing nonpalpable breast lesions. It also offers accurate localization of axillary nodes, valuable in the era of targeted axillary dissection. It is a method of visual localization, using a skill and equipment surgeons already have, and saves patients and medical systems an additional schedule-disruptive, painful procedure, especially valuable when using novel localization devices is cost-prohibitive.
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Affiliation(s)
- Roi Weiser
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Gabrielle C Manno
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Samuel H Cass
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Lu Chen
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Jing He
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Angelica S Robinson
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Flavia Posleman Monetto
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - H Colleen Silva
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - V Suzanne Klimberg
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
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Tan L, Chen Z, Wang W, Su Y, Wu Z, Yi L, Zheng Z. Analysis of the Influencing Factors of Tumor Volume, Body Immunity, and Poor Prognosis after 125I Particle Therapy for Differentiated Thyroid Cancer. Mediators Inflamm 2023; 2023:8130422. [PMID: 37181804 PMCID: PMC10171980 DOI: 10.1155/2023/8130422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/30/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Objective To analyze the influencing factors of tumor volume, body immunity, and poor prognosis after 125I particle therapy for differentiated thyroid cancer. Methods A total of 104 patients with differentiated TC who were treated with 125I particles during January 2020 to January 2021 was picked. These subjects were graded as low-dose group (80Gy-110Gy) and high-dose group (110Gy-140Gy) according to the minimum dose received by 90% of the target volume (D90) after surgery. The tumor volume before and after treatment was compared, and fasting venous blood was collected before and after treatment. The content of thyroglobulin (Tg) was detected by electrochemiluminescence immunoassay. The levels of absolute lymphocyte count (ALC), lymphocytes, neutrophils, and monocytes were detected on automatic blood cell analyzer. The lymphocyte to monocyte ratio (LMR), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ration (PLR) were calculated. The changes in the condition of patients were closely observed, and the occurrence of adverse reactions in the two groups were compared. The risk factors influencing the efficacy of 125I particle therapy for differentiated TC were analyzed through multivariate logistic regression analysis. Results The total effective rate of patients in the low- and high-dose groups was 78.85% and 82.69%, respectively (P > 0.05). Compared with the pretreatment period, the tumor volume and Tg level in both groups were much lower (P < 0.05), and the differences in tumor volume and Tg level had no statistically significant difference between the two groups before and after treatment (P > 0.05). At 1 week of the treatment, the total incidence of adverse reactions such as nausea, radiation gastritis, radiation parotitis, and neck discomfort was obviously higher in the high-dose group than in the low-dose group (P < 0.05). At 1 month of treatment, the incidence of adverse reactions such as nausea was markedly higher in the high-dose group than in the low-dose group (P < 0.05). After treatment, serum NLR and PLR contents were memorably elevated and LMR level was sharply decreased in both groups, and serum NLR and PLR contents were higher and LMR content was lower in the high-dose group than in the low-dose group (P < 0.05). Multivariate logistic regression analysis showed that the pathological type of follicular adenocarcinoma, tumor size ≥ 2 cm, clinical stage of III~IV, distant metastasis, and high TSH level before 125I particle treatment were all risk factors related to the efficacy of 125I particle treatment of TC (P < 0.05). Conclusion The efficacy of low-dose and high-dose 125I particles in the treatment of differentiated thyroid cancer is comparable, among which low-dose 125I particles have fewer adverse effects and have less impact on the immunity of the body, which is well tolerated by patients and can be widely used in clinical practice. In addition, the pathological type of follicular adenocarcinoma, tumor size ≥ 2 cm, clinical stage III~IV, distant metastasis, and high TSH level before 125I particle treatment are all risk factors that affect the poor effect of 125I particles on thyroid cancer treatment, and early monitoring of the above index changes can help evaluate the prognosis.
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Affiliation(s)
- Liling Tan
- Department of Nuclear Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Zhijun Chen
- Department of Nuclear Medicine, Jiangxi Tumor Hospital, Nanchang, Jiangxi, China
| | - Wenjun Wang
- Department of Nuclear Medicine, Jiangxi Tumor Hospital, Nanchang, Jiangxi, China
| | - Yu Su
- Department of Nuclear Medicine, Jiangxi Tumor Hospital, Nanchang, Jiangxi, China
| | - Zhen Wu
- Department of Nuclear Medicine, Jiangxi Tumor Hospital, Nanchang, Jiangxi, China
| | - Ling Yi
- Department of Nuclear Medicine, Jiangxi Tumor Hospital, Nanchang, Jiangxi, China
| | - Zhipeng Zheng
- Department of Nuclear Medicine, Jiangxi Tumor Hospital, Nanchang, Jiangxi, China
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Shaughnessy E, Vijapura C, Reyna C, Lewis J, Lewis K, Lee S, Sobel L, Wahab R, Rosen L, Brown A. Exploiting the advantages of a wireless seed localization system that differentiates between the seeds: Breast cancer resection following neoadjuvant chemotherapy. Cancer Rep (Hoboken) 2022; 6:e1690. [PMID: 35940632 PMCID: PMC9875611 DOI: 10.1002/cnr2.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/03/2022] [Accepted: 07/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most wireless localization methods utilize only one means of detection for the surgeon, sufficient to localize a single small breast lesion for excision. Complex cases requiring bracketing of a larger lesion or localization of two or more close lesions can superimpose the signal from separate "seeds" with such methods. The lack of discernment between the localization "seeds" can disorient the surgeon, risking a missed lesion on excision and longer operative times. with the use of neoadjuvant chemotherapy prior to breast surgery, the necessity of localizing both a breast lesion and an axillary lymph node previously biopsied is becoming frequent. CASE A 44 year-old woman underwent neoadjuvant chmotherapy for a breast cancer the did not express estrogen receptor, progesterone receptor, or HER2 receptor. In establishing the extent of disease, a suspicious ipsilateral lymph node was biopsied and found to contain metastatic disease. She had an excellent response to the chemotherapy, with decreased size of the primary tumor and the previously biopsied lymph node. The patient desired breast conservation. The primary tumor and associated calcifications were bracketed using two different Smartclips™, with a third localizing the lymph node biopsied. CONCLUSION This report illustrates how the use of three SmartClips™, within the EnVisioTM system, allowed for separate tracking of each "seed" throughout a complex surgery in a patient following neoadjuvant chemotherapy. This resulted in successful resection of both the tumor and the tagged lymph node.
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Affiliation(s)
- Elizabeth Shaughnessy
- Department of Surgery, Section of Breast Surgery within Division of Surgical OncologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Charmi Vijapura
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Chantal Reyna
- Department of SurgeryCrozer Health SystemSpringfieldPennsylvaniaUSA
| | - Jaime Lewis
- Department of Surgery, Section of Breast Surgery within Division of Surgical OncologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Kyle Lewis
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Su‐Ju Lee
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Lawrence Sobel
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Rifat Wahab
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Lauren Rosen
- Department of Pathology, Section of Surgical Pathology within Division of Anatomic PathologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Ann Brown
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
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Semillas radiactivas y no radiactivas como método de localización quirúrgica de las lesiones mamarias no palpables. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cebrecos I, Sánchez-Izquierdo N, Ganau S, Mensión E, Perissinotti A, Úbeda B, Bargalló X, Alonso I, Vidal-Sicartb S. Radioactive and non-radioactive seeds as surgical localization method of non-palpable breast lesions. Rev Esp Med Nucl Imagen Mol 2022; 41:100-107. [DOI: 10.1016/j.remnie.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
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Guirguis MS, Checka C, Adrada BE, Whitman GJ, Dryden MJ, Sun J, Ding QQ, Le-Petross H, Rauch GM, Clemens M, Moseley T. Bracketing with Multiple Radioactive Seeds to Achieve Negative Margins in Breast Conservation Surgery: Multiple Seeds in Breast Surgery. Clin Breast Cancer 2022; 22:e158-e166. [PMID: 34187752 PMCID: PMC8639835 DOI: 10.1016/j.clbc.2021.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Breast conservation surgery (BCS) is the treatment of choice for unifocal, early-stage breast cancer. The ability to offer BCS to a wider subset of patients, including those with multifocal/multicentric cancer as well as extensive ductal carcinoma in situ, has emerged over time, especially in those undergoing joint oncoplastic reconstruction and those treated with neoadjuvant therapy. However, localization techniques using multiple radioactive seeds for bracketing in this patient subset have not been validated. MATERIALS AND METHODS A single-institution retrospective review was conducted of all patients with breast cancer who underwent BCS, guided by multiple bracketed iodine I 125 radioactive seeds between January 2014 and April 2017. RESULTS Bracketing of breast cancer using 2 or more radioactive seeds was performed in 157 breasts in 156 patients. Negative margins were achieved in 124 of 157 (79%) breasts, including 33 cases (21%) that underwent targeted margin reexcision at the time of surgery after intraoperative, multidisciplinary margin assessment. Thirty-three cases (21%) resulted in close or positive margins, of which 11 (7%) and 10 (6.4%) underwent completion mastectomy or repeat lumpectomy, respectively. Twelve patients (7.6%) did not undergo reexcision. En bloc resection was successful in 134 of 157 (85.4%) lumpectomies. Eighty-nine percent of the procedures were coupled with oncoplastic reconstruction. CONCLUSION Bracketing techniques using multiple radioactive seeds expands the indications for breast conservation therapy in patients who would have traditionally required mastectomy. Intraoperative margin assessment improves surgical and pathologic success. Larger defects created by multifocal resection are optimally managed in concert with oncoplastic reconstruction to minimize asymmetries and aesthetic defects.
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Affiliation(s)
| | - Cristina Checka
- University of Texas MD Anderson Cancer Center, Breast Surgical Oncology
| | | | - Gary J. Whitman
- University of Texas MD Anderson Cancer Center, Breast Imaging
| | - Mark J. Dryden
- University of Texas MD Anderson Cancer Center, Breast Imaging
| | - Jia Sun
- University of Texas MD Anderson Cancer Center, Biostatistics
| | - Qing-Qing Ding
- University of Texas MD Anderson Cancer Center, Anatomical Pathology
| | | | - Gaiane M. Rauch
- University of Texas MD Anderson Cancer Center, Abdominal Imaging
| | - Mark Clemens
- University of Texas MD Anderson Cancer Center, Plastic Surgery
| | - Tanya Moseley
- University of Texas MD Anderson Cancer Center, Breast Imaging
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Tsoumakidou G, Saltiel S, Villard N, Duran R, Meuwly JY, Denys A. Image-guided marking techniques in interventional radiology: A review of current evidence. Diagn Interv Imaging 2021; 102:699-707. [PMID: 34419388 DOI: 10.1016/j.diii.2021.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
Precise marking of lesions using image-guided techniques is essential, as imprecise targeting of a tumor can result in either insufficient excision/treatment with an increased risk of recurrence, or excessive removal of healthy tissue. Most frequent indications include localization of nonpalpable lesions before surgical resection (i.e., hook-wire localization of pulmonary nodules before video-assisted thoracoscopy) and definite marking of liver metastasis before neoadjuvant therapy. Other indications include marking of hepatocellular carcinomas that are not visible on ultrasound and unenhanced computed tomography before thermal ablation, of bone lesions before surgical excision, and of different visceral tumors before stereotactic radiotherapy. This review presents the different existing indications, assesses their usefulness, gives systematic details on the technique and lastly analyzes the current literature with emphasis on results and complications.
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Affiliation(s)
| | - Sarah Saltiel
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
| | - Nicolas Villard
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
| | | | - Alban Denys
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
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Law W, Cao X, Wright FC, Slodkowska E, Look Hong N, Curpen B. Adequacy of invasive and in situ breast carcinoma margins in radioactive seed and wire-guided localization lumpectomies. Breast J 2020; 27:134-140. [PMID: 33270329 DOI: 10.1111/tbj.14115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
Image-guided preoperative localizations help surgeons to completely resect nonpalpable breast cancers. The objective of this study is to compare the adequacy of specimen margins for both invasive breast cancer (IBC) and ductal carcinoma in situ (DCIS) after radioactive seed localization (RSL) vs wire-guided localization (WGL). We retrospectively reviewed 600 cases at a single Canadian academic center from January 2014 to September 2017, comparing surgical margins, re-excisions and reoperations, localization accuracy and major complications (migration, accidental deployment, vasovagal reaction), as well as operative duration between RSL and WGL cases. IBC margins were positive in 7% of RSL and 6% of WGL cases (P = .57). Tumor size (P = .039) and association with DCIS (P = .036) predicted positive margins in invasive carcinoma. DCIS margins were positive in 6% and 8%, and close (≤2 mm) in 37% and 36% of cases (P = .45) for RSL and RSL cases respectively. The presence of extensive intraductal component predicted positive DCIS margins (P < .0001). There was no significant difference between intraoperative re-excisions (P = .54), localization accuracy (P = .34), and operation duration (P = .81). Reoperation for lumpectomies and mastectomies was marginally higher for WGL than RSL (P = .049). There were 11 (4%) WGL and no RSL complications (P = .03). Overall, positive margins for IBC, close or positive margins for DCIS, intraoperative re-excision, localization accuracy, and operation duration were similar between RSL and WGL. The reoperation rate was higher in WGL than RSL, which may reflect practice changes over time. RSL was safer than WGL with lower complication rates.
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Affiliation(s)
- Wyanne Law
- Diagnostic Radiology Resident, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Xingshan Cao
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Frances C Wright
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Elzbieta Slodkowska
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole Look Hong
- Evaluative Clinical Sciences, Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Surgical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Belinda Curpen
- Department of Breast Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Moreira IC, Ventura SR, Ramos I, Fougo JL, Rodrigues PP. Preoperative localisation techniques in breast conservative surgery: A systematic review and meta-analysis. Surg Oncol 2020; 35:351-373. [DOI: 10.1016/j.suronc.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 01/20/2023]
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Retrospective Review of Preoperative Radiofrequency Tag Localization of Breast Lesions in 848 Patients. AJR Am J Roentgenol 2020; 217:605-612. [PMID: 33084384 DOI: 10.2214/ajr.20.24374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND. Advantages of radiofrequency tags for preoperative breast lesion localization include decoupling of tag placement from surgical schedules and improved patient comfort. OBJECTIVE. The purpose of this study was to evaluate the feasibility of a preoperative localization radiofrequency tag system for breast lesions requiring surgical excision. METHODS. The cohort for this retrospective study included consecutive patients who underwent image-guided needle localization with radiofrequency tags before surgical excision from July 12, 2018, to July 31, 2019. Images and medical records were reviewed to evaluate the pathologic diagnoses serving as indications for tag placement, imaging guidance for tag placement, number of tags placed, and target lesion type. Tag placement technical accuracy rate (defined as deployment of the tag within 1 cm of the edge of the target), success (defined as technical accuracy without complication), and surgical margin and reexcision status were evaluated. RESULTS. A total of 1013 tags were placed under imaging guidance in 848 patients (mean age, 60 years; range, 23-96 years) and 847 subsequently underwent surgical excision. Tags were most commonly placed for invasive carcinoma (537/1013, 53.0%), ductal carcinoma in situ (138/1013, 13.6%), and high-risk lesions (289/1013, 28.5%). A total of 673 (66.4%) tags were deployed under mammographic guidance, whereas 340 (33.6%) were placed under sonographic guidance. Two or more tags were placed in 149 of 848 patients (17.6%). Targeted lesion types primarily included masses (448/1013, 44.2%), biopsy clip markers (331/1013, 32.7%), and calcifications (155/1013, 15.3%). Technical accuracy of placement was achieved in 1004 (99.1%) tags. Of the nine inaccurate tag placements, seven (77.8%) required an additional tag or wire placement. Seven (0.7%) biopsy clip markers were displaced within the breast or removed by the tag device during placement. No complications were reported intraoperatively. Therefore, success was achieved in 997 (98.4%) tags. Tags were successfully retrieved in all 847 patients who underwent surgery. Of the 568 patients with a preoperative diagnosis of carcinoma, 86 (15.1%) had positive or close surgical margins requiring surgical reexcision. CONCLUSION. Preoperative image-guided localization with radiofrequency tags is a safe and feasible technique for breast lesions requiring surgery. CLINICAL IMPACT. Radiofrequency tag localization is an acceptable alternative to needle or wire localization, offering the potential for improved patient workflow and experience.
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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.
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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.
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Law W, Look Hong N, Ravi A, Day L, Somani Y, Wright FC, Nofech-Mozes S, Tran WT, Curpen B. Budget Impact Analysis of Preoperative Radioactive Seed Localization. Ann Surg Oncol 2020; 28:1370-1378. [PMID: 32875462 DOI: 10.1245/s10434-020-09071-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study models costs in implementing a radioactive seed localization (RSL) program for nonpalpable breast lesions at a large Canadian tertiary hospital to replace existing wire-guided localization (WGL). METHODS All direct and indirect operating costs of localization per lesion from the hospital's perspective were determined by retrospectively reviewing patient data and costs from January 2014 to December 2016. A budget impact analysis and sensitivity analysis were performed to calculate the mean cost per lesion, the minimum and maximum cost per lesion, operational costs, and initial costs. RESULTS There were 265 WGL lesions in 2014 and 170 RSL lesions in 2016 included in cost calculation. The mean cost per localization was $185 CAD for WGL ($148-$311) and $283 CAD ($245-$517) for RSL using preloaded seeds, adjusted to 2016 Canadian dollars. The annual operational expenditure including all localizations and overhead costs was $49,835 for WGL and $80,803 for RSL. Initial costs for RSL were $22,000, including external training and new equipment purchases. CONCLUSIONS Our budget impact analysis shows that RSL using preloaded radioactive seeds was more expensive than WGL when considering per-lesion localization costs and specific costs related to radiation safety. Manually loading radioactive seed could be a cost-saving alternative to purchasing preloaded seeds. Our breakdown of costs can provide a framework for other centres to determine which localization method best suit their departments.
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Affiliation(s)
- Wyanne Law
- Postgraduate Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
| | - Nicole Look Hong
- Evaluative Clinical Sciences, Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Surgical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Ananth Ravi
- Brachytherapy, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Lisa Day
- Breast Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yasmin Somani
- Nuclear Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frances C Wright
- Division of Surgical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Sharon Nofech-Mozes
- University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - William T Tran
- Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Belinda Curpen
- Breast Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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15
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Lee MK, Sanaiha Y, Kusske AM, Thompson CK, Attai DJ, Baker JL, Fischer CP, DiNome ML. A comparison of two non-radioactive alternatives to wire for the localization of non-palpable breast cancers. Breast Cancer Res Treat 2020; 182:299-303. [PMID: 32451679 DOI: 10.1007/s10549-020-05707-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Multiple wire-free technologies for localization of non-palpable breast cancers have emerged as satisfactory alternatives to wire. However, no study has compared two non-radioactive wire-free approaches to one another. The purpose of this study was to compare outcomes among LOCalizer™ radiofrequency identification (RFID), SAVI Scout® (SAVI), and wire localization (WL). METHODS This was a retrospective, cross-sectional cohort study of patients undergoing lumpectomy for non-palpable breast cancer at a single institution between August 2017 and February 2019. Patients were divided into three cohorts based on localization technique: RFID, SAVI or WL. Operative times and average tumor volumes were compared using one-way analysis of variance. Positive margin and re-excision rates were compared with Fisher's exact test. RESULTS Among 104 patients who underwent lumpectomy for non-palpable breast cancer, 33 patients (31.7%) had RFID, 21 (20.2%) had SAVI, and 50 (48.0%) had WL. Operative times were 79 min for RFID, 81 min for SAVI, and 78 min for WL (p = 0.91). Volume of tissue resected was 36.3 cm3, 31.7 cm3, and 35.3 cm3 for RFID, SAVI, and WL, respectively (p = 0.84). Positive margin rates (RFID 3.0% vs SAVI 9.5% vs WL 8.0%, p = 0.67) and re-excision rates (RFID 6.1% vs SAVI 9.5% vs WL 10.0%, p = 0.82) were similar across groups. CONCLUSIONS Wire-free localization technologies have been compared to WL demonstrating similar efficacy. Our study suggests that RFID and SAVI Scout also perform similarly to one another. Physicians and institutions may consider more nuanced features of each localization system rather than performance alone when choosing a wire-free alternative.
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Affiliation(s)
- Minna K Lee
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Yas Sanaiha
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Amy M Kusske
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Carlie K Thompson
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Deanna J Attai
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Jennifer L Baker
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Cheryce P Fischer
- Department of Radiologic Sciences, University of California Los Angeles, 1260 15th Street, Santa Monica, CA, 90404, USA
| | - Maggie L DiNome
- Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
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Jumaa K, Johani BA, Brackstone M, Kornecki A. A Single-Institute Experience With Radioactive Seed Localization of Breast Lesions-A Retrospective Study. Can Assoc Radiol J 2020; 71:58-62. [PMID: 32062988 DOI: 10.1177/0846537119885682] [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: 10/25/2022] Open
Abstract
OBJECTIVES To assess the benefits associated with radioactive seed localization (RSL) in comparison to conventional wire localization (WL) for nonpalpable breast lesions. METHODS Radioactive seed localization was initiated at our institution in July 2013. Retrospective review of all WL performed between June 2012 and July 2013 (2013) and all RSL performed during June 2015 and July 2016 (2016). Patients who received neoadjuvant therapy or did not undergo their planned surgeries and WL performed in 2016 were excluded. The following data were collected: final pathology, resection margins for malignant lesions, time to surgery, seed migration, and number of localized lumpectomies performed by each surgeon. RESULTS A total of 292 WL procedures (288 women) in 2013 and 194 RSL procedures (186 women) in 2016 were eligible for the study. All WLs were inserted the day of surgery. Mean time from RSL insertion to surgery was 4.0 ± 2.8 days (range: 1-17 days). There was no difference in specimen size for malignant lesions (6.8 ± 2.8 cm for WL and 6.9 ± 2.9 cm for RSL; P = .5). Specimen radiographs were obtained in 233 (80%) of 292 WL compared to 194 (100%) of 194 RSL (P < .001). For malignant lesions, positive margins were present in 34 (17.2%) of 198 with WL compared to 15 (10.3%) of 146 with RSL (P < .001). Close margins (≤1 mm) were present in 31 (15.6%) of 198 with WL compared to 1 (0.6%) of 146 with RSL (P < .001). The seed fell out of the specimen during surgery in 6 (3.1%) of 194. No seed loss was recorded. The surgeons (n = 4) who transitioned to RSL increased the number of surgeries per month from a mean of 4.4 ± 2.6 in 2013 to 6.9 ± 3.5 in 2016, equivalent to a 41% increase (P = .003). CONCLUSIONS The use of RSL, as compared to conventional WL, resulted in a reduction in the number of pathologically involved surgical margins and was associated with an increased number of surgeries. Furthermore, RSL can be performed up to 14 days prior to surgery, which may improve scheduling flexibility in the radiology department.
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Affiliation(s)
- Klaudia Jumaa
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Badria Al Johani
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Anat Kornecki
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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17
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Abstract
OBJECTIVE. The purpose of this article is to review the literature regarding image-guided breast procedures, including helpful tips and tricks to guide the practicing interventional breast radiologist. CONCLUSION. The successful diagnosis and treatment of breast cancer involves coordination of the multidisciplinary breast team. Optimal procedural skills for image-guided biopsy and preoperative lesion localization are paramount to the radiologists' success.
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18
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Singh A, Dillon J, Ravi A. Construction and Characterization of a Novel Single Pixel Beta Detector for Intraoperative Guidance in Breast-Conserving Surgery. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019. [DOI: 10.1109/trpms.2019.2908797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Srour MK, Kim S, Amersi F, Giuliano AE, Chung A. Comparison of wire localization, radioactive seed, and Savi scout ® radar for management of surgical breast disease. Breast J 2019; 26:406-413. [PMID: 31448530 DOI: 10.1111/tbj.13499] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 11/27/2022]
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 To compare three types of localization devices used in breast conserving surgery. METHODS A total of 293 patients had a partial mastectomy (n = 194) or breast biopsy (n = 99) with preoperative image-guided localization of a single nonpalpable lesion between July 2017 to July 2018. Lesions were localized by WL, RSL, or SSR. Although all operations performed were outpatient, due to workflow differences at our institution, operations performed in the hospital operating rooms were defined as "hospital setting." Operations performed at an outpatient surgery facility without the capacity to admit patients were defined as "ambulatory." Delay in operating room start times and total perioperative times in both the hospital and ambulatory setting, localization time, explant of localization device, positive margins, volume of tissue excised, and 30-day complications were evaluated. RESULTS A total of 126 patients (43%) had WL; 59 patients (20%) had RSL; and 108 patients (37%) had SSR localization. SSR localization took longer to perform with an average time of 19 minutes, compared with 15 minutes for WL and 14 minutes for RSL (P = .020). In 93.52% of cases, the first specimen contained both the clip and localization device, which was similar among groups (P = .073). There was no difference in retained biopsy clip among the groups (average 3.4%, P = .173). For operations performed in the hospital, the time from patient arrival to the preoperative area and incision was significantly longer in the WL group with a median of 233 minutes (range 56-486), 130 minutes (range 64-294) in RSL, and 108 minutes (range 59-240) for SSR (P < .001). There was no difference in operative time among the groups with a median of 51 minutes (range 17-122) (P = .108). There was, however, significantly longer perioperative time of 469 minutes (range 210-926) in the WL group compared with 399 minutes (range 240-871) for RSL and 381 minutes (range 232-711) for SSR (P ≤ .001). For the ambulatory setting, although there was no difference in operating time among the groups (median 50 minutes, range 18-127, P = .715), only the RSL showed a decreased perioperative time compared to WL (WL 356 vs RSL 275, P < .001; SSR 279, p = NS). A total of 131 patients (44.7%) had same day localizations. Among operations with delayed start times, there was a longer average delay of 85 minutes (range 1-304) for WL group compared with 69 minutes (range 13-219) in RSL and 53 minutes (range 0-228) in SSR (P < .001). There was no difference among the three groups in positive margin rate, volume of tissue excised, and 30-day complications. CONCLUSION Nonwire localization devices are associated with reduced overall perioperative time compared to wire localization, with few complications.
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Affiliation(s)
- Marissa K Srour
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sungjin Kim
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Armando E Giuliano
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alice Chung
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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20
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Preoperative localization of breast lesions: Current techniques. Clin Imaging 2019; 56:1-8. [DOI: 10.1016/j.clinimag.2019.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/12/2018] [Accepted: 01/15/2019] [Indexed: 11/18/2022]
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21
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Horwood CR, Grignol V, Lahey S, Pemmaraju V, Schafer A, Terando AM, Agnese DM. Radioactive seed vs wire localization for nonpalpable breast lesions: A single institution review. Breast J 2019; 25:282-285. [DOI: 10.1111/tbj.13201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Valerie Grignol
- Division of Surgical Oncology; The Ohio State University; Columbus Ohio
| | - Samantha Lahey
- Division of Surgical Oncology; The Ohio State University; Columbus Ohio
| | - Vishnu Pemmaraju
- Division of Surgical Oncology; The Ohio State University; Columbus Ohio
| | - Andrew Schafer
- Department of Internal Medicine; The Ohio State University; Columbus Ohio
| | - Alicia M. Terando
- Division of Surgical Oncology; The Ohio State University; Columbus Ohio
| | - Doreen M. Agnese
- Division of Surgical Oncology; The Ohio State University; Columbus Ohio
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22
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Microchipping the breast: an effective new technology for localizing non-palpable breast lesions for surgery. Breast Cancer Res Treat 2019; 175:165-170. [DOI: 10.1007/s10549-019-05143-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
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23
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Greenwood HI, Dodelzon K, Katzen JT. Impact of Advancing Technology on Diagnosis and Treatment of Breast Cancer. Surg Clin North Am 2018; 98:703-724. [PMID: 30005769 DOI: 10.1016/j.suc.2018.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
New emerging breast imaging techniques have shown great promise in breast cancer screening, evaluation of extent of disease, and response to neoadjuvant therapy. Tomosynthesis, allows 3-dimensional imaging of the breast, and increases breast cancer detection. Fast abbreviated MRI has reduced time and costs associated with traditional breast MRI while maintaining cancer detection. Diffusion-weighted imaging is a functional MRI technique that does not require contrast and has shown potential in screening, lesion characterization and also evaluation of treatment response. New image-guided preoperative localizations are available that have increased patient satisfaction and decreased operating room delays.
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Affiliation(s)
- Heather I Greenwood
- Department of Radiology, University of California San Francisco, UCSF Medical Center at Mount Zion, 1600 Divisadero Street Room C-250, San Francisco, CA 94115, USA.
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medical Center, New York-Presbyterian, 425 East 61st Street, 9th Floor, New York, NY 10065, USA
| | - Janine T Katzen
- Department of Radiology, Weill Cornell Medical Center, New York-Presbyterian, 425 East 61st Street, 9th Floor, New York, NY 10065, USA
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24
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Jadeja PH, Mango V, Patel S, Friedlander L, Desperito E, Ayala-Bustamante E, Wynn R, Chen-Seetoo M, Taback B, Feldman S, Ha R. Utilization of multiple SAVI SCOUT surgical guidance system reflectors in the same breast: A single-institution feasibility study. Breast J 2017; 24:531-534. [DOI: 10.1111/tbj.12979] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/23/2017] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Priya H. Jadeja
- Columbia University Medical Center; New-York Presbyterian Hospital; New York NY USA
| | - Victoria Mango
- Department of Radiology; Memorial Sloan Kettering Cancer Center; New York NY USA
| | - Sejal Patel
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | - Lauren Friedlander
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | - Elise Desperito
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | | | - Ralph Wynn
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | - Margaret Chen-Seetoo
- Columbia University Medical Center; New-York Presbyterian Hospital; New York NY USA
| | - Bret Taback
- Columbia University Medical Center; New-York Presbyterian Hospital; New York NY USA
| | | | - Richard Ha
- Department of Radiology; Columbia University Medical Center; New York NY USA
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25
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The introduction of radioactive seed localisation improves the oncological outcome of image guided breast conservation surgery. Breast 2017; 36:49-53. [DOI: 10.1016/j.breast.2017.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/01/2017] [Accepted: 09/16/2017] [Indexed: 11/24/2022] Open
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Comparative Evaluation of Iodine-125 Radioactive Seed Localization and Wire Localization for Resection of Breast Lesions. Can Assoc Radiol J 2017; 68:447-455. [DOI: 10.1016/j.carj.2017.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/14/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose Radioactive seed localization (RSL) uses a titanium seed labeled with iodine-125 energy for surgery of nonpalpable breast lesions. RSL facilitates radiology–surgery scheduling and allows for improved oncoplasty compared with wire localization (WL). The purpose of this work was to compare the 2 techniques. Methods We performed a retrospective study of all breast lesions operated with RSL between February 2013 and March 2015 at our university institution, and compared with an equivalent number of surgeries performed with a single WL. Imaging and pathology reports were reviewed for information on guidance mode, accuracy of targeting, nature of excised lesion, size and volume of surgical specimen, status of margins, and reinterventions. Results A total of 254 lesions (247 women) were excised with RSL and compared with 257 lesions (244 women) whose surgery was guided by WL. Both groups were comparable in lesion pathology, guidance mode for RSL or WL positioning, and accuracy of targeting (98% correct). Mean delay between biopsy and surgery was 84 days for RSL versus 103 after WL ( P = .04). No differences were noted after RSL or WL for surgical specimen mean weight, largest diameter, and volume excised. For malignancies, the rate of positive margins was comparable (2.8%-3%), with 5 of 10 women in the RSL group who underwent a second surgery displaying residual malignancy compared with 3 of 9 women in the WL group. Conclusions RSL is safe and accurate, and has comparable surgical endpoints to WL. Because RSL offers flexible scheduling and facilitated oncoplasty, RSL may replace WL for resection of nonpalpable single breast lesions.
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27
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Jeffries DO, Dossett LA, Jorns JM. Localization for Breast Surgery: The Next Generation. Arch Pathol Lab Med 2017; 141:1324-1329. [DOI: 10.5858/arpa.2017-0214-ra] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Preoperative localization of nonpalpable breast lesions using image-guided wire placement has been a standard of breast imaging, diagnosis, and treatment since its development in the 1970s. With this technique, coordinated, same-day wire placement by the radiologist and surgery are required, which can lead to significant inefficiencies in workflow. Other disadvantages of wire localization (WL) include limitations in surgical incision and dissection route and protruding wires that can be both bothersome for the patient and have risk of displacement.
Objective.—
To outline several recently developed techniques that could replace traditional WL and eliminate its disadvantages. The first developed was radioactive seed localization (RSL) using I-125, a technique adopted by many institutions during the last few years. The challenge to this method, however, is the strict nuclear regulatory requirements, which can be a significant burden and limitation. The disadvantages of WL and RSL have provided incentive for the development of other types of preoperative localization procedures. Two of these are recently US Food and Drug Administration–cleared, nonradioactive, non-wire location technologies emerging as alternatives to WL and RSL; SAVI SCOUT (Cianna Medical Inc, Aliso Viejo, California), which uses infrared light and a microimpulse radar reflector, and Magseed (Endomagnetics Inc, Austin, Texas), which uses a magnetic seed for localization.
Data Sources.—
We review the published literature on non-wire location technologies for breast tissue resection.
Conclusions.—
Non-wire location techniques are beneficial, allowing image-guided placement before the day of surgery and resulting in improved workflows. These techniques also eliminate bothersome protruding wires, risk of dislodging, and allow the incision site to be independent from the localization site.
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28
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Gunn J, McLaughlin S. Current Trends in Localization Techniques for Non-palpable Breast Lesions: Making the Invisible Visible. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0244-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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29
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Romanoff A, Schmidt H, McMurray M, Burnett A, Condren A, Port E. Physician preference and patient satisfaction with radioactive seed versus wire localization. J Surg Res 2017; 210:177-180. [PMID: 28457325 DOI: 10.1016/j.jss.2016.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nonpalpable breast lesions require localization before excision. This is most commonly performed with a wire (WL) or a radioactive seed (SL), which is placed into the breast under radiographic guidance. Although there are advantages of each modality, there are no guidelines to address which patients should undergo WL versus SL. We investigated factors influencing the selection of SL versus WL at our institution and assessed patient satisfaction with each procedure. METHODS Patients undergoing preoperative localization of nonpalpable breast lesions from May 2014 through August 2015 were included. Physicians were surveyed on surgical scheduling to evaluate factors influencing the decision to perform SL or WL. Patient satisfaction was evaluated with a survey at the first postoperative visit. Retrospective chart review was performed. RESULTS 341 patients were included: 104 (30%) patients underwent SL and 237 (70%) underwent WL. There was no difference in patient age, benign versus malignant disease, or need for concomitant axillary surgery comparing the SL versus WL groups. Physician survey indicated that 18% of patients were candidates for WL only. Of the patients who were eligible for both, 88 (41%) ultimately underwent SL and 126 (59%) had WL. The most commonly cited reason for selection of one localization method or the other was physician preference, followed by patient preference or avoiding additional visit. There was no significant difference in self-reported preoperative anxiety level, convenience of the localization procedure, pain of the localization procedure, operative experience, postoperative pain level or medication requirement, or overall patient satisfaction comparing patients who underwent SL and WL. CONCLUSIONS SL and WL offer patients similar comfort and satisfaction. Factors influencing selection of one modality over the other include both logistic and clinical considerations.
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Affiliation(s)
- Anya Romanoff
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hank Schmidt
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew McMurray
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annika Burnett
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Audree Condren
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elisa Port
- Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York.
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Mango VL, Wynn RT, Feldman S, Friedlander L, Desperito E, Patel SN, Gomberawalla A, Ha R. Beyond Wires and Seeds: Reflector-guided Breast Lesion Localization and Excision. Radiology 2017; 284:365-371. [PMID: 28430555 DOI: 10.1148/radiol.2017161661] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate outcomes of Savi Scout (Cianna Medical, Aliso Viejo, Calif) reflector-guided localization and excision of breast lesions by analyzing reflector placement, localization, and removal, along with target excision and rates of repeat excision (referred to as re-excision). Materials and Methods A single-institution retrospective review of 100 women who underwent breast lesion localization and excision by using the Savi Scout surgical guidance system from June 2015 to May 2016 was performed. By using image guidance 0-8 days before surgery, 123 nonradioactive, infrared-activated, electromagnetic wave reflectors were percutaneously inserted adjacent to or within 111 breast targets. Twenty patients had two or three reflectors placed for bracketing or for localizing multiple lesions, and when ipsilateral, they were placed as close as 2.6 cm apart. Target and reflector were localized intraoperatively by one of two breast surgeons who used a handpiece that emitted infrared light and electromagnetic waves. Radiographs of the specimen and pathologic analysis helped verify target and reflector removal. Target to reflector distance was measured on the mammogram and radiograph of the specimen, and reflector depth was measured on the mammogram. Pathologic analysis was reviewed. Re-excision rates and complications were recorded. By using statistics software, descriptive statistics were generated with 95% confidence intervals (CIs) calculated. Results By using sonographic (40 of 123; 32.5%; 95% CI: 24.9%, 41.2%) or mammographic (83 of 123; 67.5%; 95% CI: 58.8% 75.1%) guidance, 123 (100%; 95% CI: 96.4%, 100%) reflectors were placed. Mean mammographic target to reflector distance was 0.3 cm. All 123 (100%; 95% CI: 96.4%, 100%) targets and reflectors were excised. Pathologic analysis yielded 54 of 110 malignancies (49.1%; 95% CI: 39.9%, 58.3%; average, 1.0 cm; range, 0.1-5 cm), 32 high-risk lesions (29.1%; 95% CI: 21.4%, 38.2%), and 24 benign lesions (21.8%; 95% CI: 115.1%, 30.4%). Four of 54 malignant cases (7.4%; 95% CI: 2.4%, 18.1%) demonstrated margins positive for cancer that required re-excision. Five of 110 radiographs of the specimen (4.5%; 95% CI: 1.7%, 10.4%) demonstrated increased distance between the target and reflector distance of greater than 1.0 cm (range, 1.1-2.6 cm) compared with postprocedure mammogram the day of placement, three of five were associated with hematomas, two of five migrated without identifiable cause. No related postoperative complications were identified. Conclusion Savi Scout is an accurate, reliable method to localize and excise breast lesions with acceptable margin positivity and re-excision rates. Bracketing is possible with reflectors as close as 2.6 cm. Savi Scout overcomes many limitations of other localization methods, which warrants further study. © RSNA, 2017.
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Affiliation(s)
- Victoria L Mango
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Ralph T Wynn
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Sheldon Feldman
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Lauren Friedlander
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Elise Desperito
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Sejal N Patel
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Ameer Gomberawalla
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Richard Ha
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
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