Bracketed radioactive seed localization vs bracketed wire-localization in breast surgery

Silva, Monica Da; Porembka, Jessica H.; Mokdad, Ali H.; Seiler, Stephen; Huth, James; Rivers, Aeisha; Wooldridge, Rachel; Chu, Amanda; Brown, E. Sherwood; Bao, Jean; Farr, Deborah; Hansen, Meghan; Unzeitig-Barron, Alison; Leitch, Marilyn; Rao, Roshni

doi:10.1111/tbj.12854

Cited by 12 publications

(9 citation statements)

References 20 publications

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“…Bracketing is possible with radioactive seeds, and has been shown to be superior with seeds than wire. A retrospective study showed a decrease in re excision rate with similar specimen volumes and lower rate of mastectomy for bracketed seed localization when compared with wire localization (38).…”

Section: Updatementioning

confidence: 99%

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic

et al. 2018

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In 2015, the American Society of Breast Surgeons (ASBrS) convened a multidisciplinary consensus conference, the Collaborative Attempt to Lower Lumpectomy Reoperation Rates (CALLER). The CALLER conference endorsed a "toolbox" of multiple processes of care for which there was evidence that they were associated with fewer reoperations. We present an update of the toolbox taking into consideration the latest advances in decreasing re excision rates. In this review, we performed a comprehensive review of the literature from 2015-2018 using search terms for each tool. The original ten tools were updated with the latest evidence from the literature and our strength of recommendation. We added an additional section looking at new tools and techniques that may provide more accurate intraoperative assessment of margins.The updates on the CALLER Toolbox for lumpectomy will help guide surgeons to various resources to aid in the removal of breast cancer, while being aware of cosmesis and decreasing re excision rates.

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Section: Updatementioning

confidence: 99%

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic

et al. 2018

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“…9 Our study demonstrated negative margins in 68 per cent of cases for bRSL. In a study by Da Silva et al 6 published in 2018, patients were significantly more likely to undergo a mastectomy in the bWL group than in the bRSL group (24% vs 7%; P < 0.01). Our study supports that conclusion with only one patient converted to mastectomy (4%).…”

Section: Discussionmentioning

confidence: 93%

“…Lesions requiring bracketed localization include radiologically evident, nonpalpable lesions or lesions that extend beyond the palpable area on imaging. In a study by Da Silva et al, 6 patients with bWL are 3.9 times more likely to undergo reoperation than patients with bRSL, including increased rate of conversion to mastectomy.…”

mentioning

confidence: 97%

Bracketed Radioactive Seed Localization for Breast Conservation Surgery

Dixon¹,

Jasra

Ankola³

et al. 2020

The American Surgeon

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We aimed to evaluate the surgical margin outcomes and re-excision rates in patients undergoing bracketed seed localization of biopsy-proven breast cancer detected on screening mammogram. After approval by our Institutional Review Board, we retrospectively identified patients who had undergone iodine-125 seed localized lumpectomy at our institution from January 2010 to June 2017 by one of two fellowship-trained breast surgeons. Of those patients, a subset of 25 patients were identified who had undergone bracketed seed localization, defined as two or more seeds used to delineate the radiographic borders of the area of concern. All patients had originally presented with calcifications identified on screening mammogram that were subsequently diagnosed as ductal carcinoma in situ and/or invasive ductal carcinoma by image-guided biopsy performed at our institution. Eight patients had one positive margin on final surgical pathology and required re-excision (32%). One patient was converted to mastectomy. Of the patients requiring re-excision, the average maximum linear extent of calcifications was 3.4 cm (SD 0.97), whereas it was 3.1 cm (SD 1.2) in patients with negative surgical margins ( P = 0.5). Bracketing calcifications with radioactive seeds can potentially allow more patients to undergo breast conservation surgery.

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“…WGL has been the historical gold standard for non-palpable tumour localization. WGL is effective regarding lesion localization, but reoperation rates range from 2.8 to 53 per cent, as a result of tumour-positive resection margins 33 , 34 . Also, WGL is associated with logistical challenges, wire dislocation, kinking or fracturing, and patient discomfort 3 .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours: systematic review

Jansen,

Bargon,

Huibers

et al. 2023

BJS Open

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Background Accurate tumour localization is crucial for precise surgical targeting and complete tumour removal. Indocyanine green fluorescence, an increasingly used technique in oncological surgery, has shown promise in localizing non-palpable breast tumours. The aim of this systematic review was to describe the efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours. Methods A systematic literature search was performed in PubMed, Embase, and the Cochrane Library, including studies from 2012 to 2023. Studies reporting the proportion of breast tumours identified using indocyanine green fluorescence were included. The quality of the studies and their risk of bias were appraised using the Methodological Index for Non-Randomized Studies (‘MINORS’) tool. The following outcomes were collected: identification rate, clear resection margins, specimen volume, operative time, re-operation rate, adverse events, and complications. Results In total, 2061 articles were screened for eligibility, resulting in 11 studies, with 366 patients included: two RCTs, three non-randomized comparative studies, four single-arm studies, and two case reports. All studies achieved a 100 per cent tumour identification rate with indocyanine green fluorescence, except for one study, with an identification rate of 87 per cent (13/15). Clear resection margins were found in 88–100 per cent of all patients. Reoperation rates ranged from 0.0 to 5.4 per cent and no complications or adverse events related to indocyanine green occurred. Conclusion Indocyanine green fluorescence has substantial theoretical advantages compared with current routine localization methods. Although a limited number of studies were available, the current literature suggests that indocyanine green fluorescence is a useful, accurate, and safe technique for the intraoperative localization of non-palpable breast tumours, with equivalent efficacy compared with other localization techniques, potentially reducing tumour-positive margins.

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Bracketed radioactive seed localization vs bracketed wire-localization in breast surgery

Cited by 12 publications

References 20 publications

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic

Bracketed Radioactive Seed Localization for Breast Conservation Surgery

Efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours: systematic review

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