Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: A systematic review and meta-analysis

Garzotto, Francesco; Comoretto, Rosanna Irene; Michieletto, Silvia; Franzoso, Gianpaolo; Mele, Marcello; Gregori, Darío; Bonavina, Maria Giuseppina; Bozza, Fernando A.; Caumo, Francesca; Saibene, Tania

doi:10.1016/j.breast.2021.04.007

Cited by 24 publications

(23 citation statements)

References 83 publications

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“…With respect to RSL, results from our analysis suggests RSL trends towards significance when compared to WGL for both margin positivity (OR: 0.677, 95% CI: 0.397–1.110) and reoperation rates (OR: 0.685, 95% CI: 0.341–1.260), when only RCTs are included. Garzotto et al recently performed a meta-analysis illustrating the role of non-wired, non-ionizing techniques in enhancing surgical outcomes such as margin positivity and reoperation rates, however this analysis was limited to non-randomized studies [ 5 ]. Therefore, this NMA of RCTs holds the highest level of evidence assessing current strategies of breast tumour localization, compared to conventional WGL.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate localization of the lesion is crucial to ensure tumour margins are clear of disease, to minimise the requirement for reoperation, and to facilitate successful BCS. Unfortunately, WGL of non-palpable cancers have been reported to have positive margin rates as high as 17.0%, often requiring reoperation, and conferring an increased risk of local recurrence [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials

et al. 2022

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Mammographic screening programmes have increased detection rates of non-palpable breast cancers. In these cases, wire-guided localization (WGL) is the most common approach used to guide breast conserving surgery (BCS). Several RCTs have compared WGL to a range of novel localization techniques. We aimed to perform a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing methods of nonpalpable breast cancer localization. Methods: A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. Results: 24 RCTs assessing 9 tumour localization methods in 4236 breasts were included. Margin positivity and reoperation rates were 16.9% (714/4236) and 14.3% (409/2870) respectively. Cryo-assisted localization had the highest margin positivity (28.2%, 58/206) and reoperation (18.9%, 39/206) rates. Compared to WGL (n = 2045 from 24 RCTs) only ultrasound guided localization (USGL) (n = 316 from 3 RCTs) significantly lowered margin positivity (odds ratio (OR): 0.192, 95% confidence interval (CI): 0.079-0.450) and reoperation rates (OR: 0.182, 95%CI: 0.069-0.434). Anchor-guided localization (n = 52, 1 RCT) significantly lowered margin positivity (OR: 0.229, 95%CI: 0.050-0.938) and magnetic-marker localization improved patient satisfaction (OR: 0.021, 95%CI: 0.001-0.548). There was no difference in operation duration, overall complications, haematoma, seroma, surgical site infection rates, or specimen size/vol/wt between methods. Conclusion: USGL and AGL are non-inferior to WGL for the localization of non-palpable breast cancers. The reported data suggests that these techniques confer reduced margin positivity rates and requirement for reoperation. However, caution when interpreting results relating to RCTs with small sample sizes and further validation is required in larger prospective, randomized studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials

et al. 2022

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“…Our experience suggests that success rates for ultrasound Magseed localisation and re-excision are comparable to existing studies of lesions with heterogeneous characteristics, including for lesion sizes >1 cm. 13,14 Insertion of Magseed and localisation of lesions with the Sentimag detector was relatively simple in these cases, even when two masses were close together (3 cm apart) and in the same breast. Most Magseed insertions were performed >1 week before surgery and were easily located without clinically consequent displacement, as evidenced by resection pathology results.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies, including one in Hong Kong and a systematic review, have demonstrated the efficacy of Magseed in localisation of non-palpable masses. [11][12][13][14] However, the proportion of ultrasound-guided Magseed localisation of papillary or subcentimetre lesions was low. To the best of our knowledge, performance and efficacy in this group of lesions has not been established.…”

Section: Introductionmentioning

confidence: 99%

Magseed Localisation of Non-palpable Papillary Lesions: a Pictorial Essay

Law

Lai

et al. 2022

Hong Kong Journal of Radiology

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“…The seed is localized during surgery with a handheld gamma detection probe. Patient satisfaction and successful removal of target lesions was reported to be equivalent or better than wire localization, but regulatory restrictions for ordering, transport, storage, and recovery of radioactive devices along with the attendant infrastructure required to implement this program is considerable, especially in the face of other alternatives (9).…”

Section: Tumor Localizationmentioning

confidence: 99%

Current Surgical Innovations in the Treatment of Breast Cancer

Crystal¹,

Mella-Catinchi²,

Xu³

et al. 2022

Breast Cancer

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Surgery is an essential component in the management of treatable breast cancer. With the use of standardized staging and data collection, evidence-based management of breast cancer has evolved to limit treatments to what is necessary but sufficient to allow tissue preservation and control of treatment-specific morbidity. As more tumors are discovered by pretreatment imaging and are not identifiable on physical exam, intraoperative tumor localization techniques have become increasingly sophisticated and reliable. Techniques for localization of "sentinel" nodes has become increasingly accurate and technically less complicated. Surgical treatment may occur Note to the reader: This chapter is part of the book Breast Cancer (ISBN: 978-0-6453320-3-2), scheduled for publication in July 2022. The book is being published by Exon Publications,

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Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: A systematic review and meta-analysis

Abstract: Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: a systematic review and meta-analysis, The Breast,

Cited by 24 publications

References 83 publications

Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials

Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials

Magseed Localisation of Non-palpable Papillary Lesions: a Pictorial Essay

Current Surgical Innovations in the Treatment of Breast Cancer

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