Background/Aim: Wire-guided localisation (WGL) remains the most widely used technique for the localisation of non-palpable breast lesions; however, recent technological advances have resulted in non-wire, non-radioactive alternatives, such as magnetic seeds (Magseeds). The aim of this pooled analysis was to determine whether Magseeds are an effective tool for localising non-palpable breast lesions. Materials and Methods: Various databases were searched for publications which reported data on the localisation and placement rates of Magseed. Data on re-excision rates under use of Magseed and WGL were also collected. Results: Sixteen studies, spanning the insertion of 1,559 Magseeds, were analysed. The pooled analysis showed a successful placement rate of 94.42% and a successful localisation rate of 99.86%. Four studies were analysed in a separate pooled analysis and showed no statistically significant difference between reexcision rates using Magseeds and WGL. Conclusion: The use of Magseeds is an effective, non-inferior alternative to WGL that overcomes many of the limitations of the latter. The pre-operative localisation of non-palpable breast cancer traditionally employs wire-guided localisation (WGL) (1). However, several limitations are associated with WGL. The localisation wire can cause manifold complications, such as diathermy burns, pericardial injury and wire dislocation/ transection (2, 3). Furthermore, wire migration and surgical difficulties in accurately assessing the position of the wire tip intraoperatively can pose significant difficulty for the operating surgeon (4). WGL is performed on the day of surgery, and interdepartmental coordination with radiology for localisation in addition to everyday scheduling difficulties may lead to a prolonged surgical waiting time. An underreported limitation of the flexible wire used in WGL is that it increases the risk of needle-stick injury for the surgeon and the pathologist. Furthermore, it protrudes from the breast and is uncomfortable for the patient. The prospect of an additional procedure on the day of major breast surgery can also be very stressful for patients in whom anxiety level is already high (2). Widespread use of screening methods has led to an increased incidence of non-palpable breast cancer. It is therefore imperative that localisation methods with high patient, radiologist and surgical satisfaction rates are developed. Radioactive seed localisation (RSL) is a feasible alternative to WGL. RSL can occur up to 5 days prior to the surgery and the seeds can be accurately detected with a hand-held gamma probe (5). Furthermore, recent evidence suggests that RSL would be more cost-effective than WGL (6) and would improve the oncological outcomes of imageguided surgery (7). However, handling of radioactive material requires special licensing and is associated with strict regulatory requirements. Hence, the optimal solution would be a non-wire non-radioactive localisation method which contains no energy source. This has led to the emergence of Savi Sco...

Patients presenting with de novo stage IV metastatic breast cancer have a complex disease which is normally treated with palliative intent and systemic therapy. However, there is mounting evidence that resection of the primary tumour and/or localised radiotherapy (locoregional therapy; LRT) could be associated with overall survival improvements. We aimed to conduct a meta-analysis to inform decision making. Using the PubMed, Cochrane and Ovid SP databases, a literature review and meta-analysis were conducted to assess the effect of LRT on overall survival. Studies were analysed for the impact of LRT on survival. All forms of LRT resulted in a significant 31.8% reduction in mortality (N = 42; HR = 0.6823 (95% CI 0.6365; 0.7314)). Surgical resection resulted in a significant 36.2% reduction in mortality (N = 37; HR = 0.6379 (95% CI 0.5974; 0.6811)). The prospective trials reported a 19.23% reduction in mortality which was not statistically significant (N = 3, HR = 0.8077 (95% CI 0.5704; 1.1438). 216 066 patients were included. This is the largest meta-analysis regarding this question to date. Our meta-analysis shows that LRT of the primary tumour seems to improve overall survival in de novo stage IV disease. Therefore, this therapeutic option should be considered in selected patients after a careful multidisciplinary discussion.

Background: Wire-guided localisation (WGL) remains the most widely used technique to guide surgical excision of non-palpable breast lesions worldwide. However, recent technological advances have led to the advent of less invasive radiation-free localisation methods to overcome the limitations of WGL. Patients and Methods: This study prospectively evaluated the role of two radiation-free nonwire localisation methods. Magnetic seeds (n=16) and radiofrequency tags (n=6) were deployed under imaging guidance to guide the surgical excision in 19 consecutive patients. Results: The identification/retrieval and migration rates were 100% and 4.5%, respectively. Twenty-one out of 22 (95.5%) cases had clear surgical margins and no complications were observed. All radiologists and the surgeon rated these methods as being much better than wire localisation. Patient satisfaction data were recorded using a linear visual analogue scale (n=10/19). The mean score was 9.7/10 (range=8-10). Conclusion: Our study provides further evidence that radiation-free wireless breast localisation is an effective alternative to WGL.

Although further work is required to confirm our results and clarify potential mechanisms, our findings suggest that exposure to hair dyes may contribute to an increased breast cancer risk.

Background/Aim: Hypoactive sexual desire disorder (HSDD) is hypothesised to manifest in postmenopausal women at onset of menopause due to decreased oestrogen levels. Transdermal testosterone is a potential treatment option. This systematic review explores the relationship between the incidence of breast cancer and transdermal testosterone use. Materials and Methods: Searches were conducted on the PubMed and Ovid databases. In Ovid, the advanced search function was used: 'transdermal testosterone not male'. In PubMed, the following search terms were used: 'transdermal, testosterone, menopausal, women, breast cancer, women'. Abstracts that fitted our initial criteria were further investigated. Results: A total of 25 publications from PubMed and 192 publications from Ovid were initially assessed. Three randomised control trials were judged to have sufficiently met our inclusion criteria. However, these trials were too heterogeneous for a meta-analysis. A systematic review was deemed the most appropriate analysis of the data available. Conclusion: The publications examined in this systematic review suggest that the use of transdermal testosterone to treat HSDD in postmenopausal women does not increase breast cancer incidence. However, further research in the form of adequately powered randomised controlled trials with breast cancer incidence being the primary end point is required in order to confirm this. Hypoactive sexual desire disorder (HSDD) is likely to be the most common sexual affliction affecting midlife women (1); 6615 This article is freely accessible online.