Clip and wire localization of locally advanced malignant breast masses in patients undergoing neoadjuvant chemotherapy and breast conservation therapy

Shalaby, Lamiaa Adel Salah El Din; Khallaf, Emad; Moussa, Mohamed

doi:10.1186/s43055-019-0066-z

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…According to the BIRADS score, 67.6% were graded as 5, indicating they were highly suggestive of malignancy, while 29.4% were graded as 6, signifying known biopsy-proven malignancy. These results align closely with the study by Shalaby et al [19], where all 20 patients studied had pathologically proven malignancies (i.e., BI-RADS VI) and were diagnosed with locally advanced breast carcinoma (stages IIB, IIIA, and IIIB).…”

Section: Discussionsupporting

confidence: 91%

“…In the study by Shalaby et al [19], tumor response was assessed by comparing image findings after two cycles of chemotherapy, facilitated by clip placement. Wire localization was performed on radiopaque clips at the end of NACT in patients with non-palpable lesions, providing an accurate and straightforward approach for the surgeon to the tumor bed.…”

Section: Discussionmentioning

confidence: 99%

“…The study conducted by Shalaby et al [19] examined the accuracy of localizing breast malignant masses in patients who underwent neoadjuvant chemotherapy and conservative breast surgery, using clip and wire markers. Based on the findings of this study, a minimum sample size of 24 patients was determined, with a 0.5% margin of error and a 5% level of significance.…”

Section: Sample Sizementioning

confidence: 99%

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Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Carcinoma Using Image-Guided Clip Placement

Pandurangappa,

Paruthy,

Jamwal

et al. 2023

Cureus

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BackgroundThe present study aims to evaluate the response of locally advanced breast carcinoma (LABC) to neoadjuvant chemotherapy (NACT) using image-guided clip placement based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. MethodsThirty-four patients with LABC were included in the study. Consent for three-dimensional titanium clip placement (400/300/200 mm Liga clips) under local anesthesia with USG guidance was obtained. Serial sonographic/X-ray evaluations of tumor bed size were conducted before every cycle of NACT. All data were recorded in millimeters of concentric tumor regression/non-regression. Tumor regression in a concentric or Swiss cheese pattern and non-responders were evaluated. Assessment of the response to NACT was performed using RECIST criteria, dividing it into four categories. Tumor response was confirmed with computerized tomography (CT) conducted before and after the completion of NACT. Patients underwent surgical management, mostly modified radical mastectomy (MRM), as they had locally advanced breast carcinoma. Following MRM, the clips in the specimen guided the original site of the tumor for histopathological evaluation and response to chemotherapy. ResultsTumor response was classified into four types: complete response (CR), partial response (PR), progressive disease (PD), and stable disease. RECIST 1.1 criteria were elaborated and defined. Data for all patients were entered into an Excel sheet (Microsoft Corporation, Redmond, Washington) to prepare a master chart, and the following observations were made and analyzed using SPSS software. The duration of chemotherapy for the study population ranged from 32 to 206 days, with a mean (±SD) of 111.82 (± 52.64) days and a median (IQR) of 81 (63, 158) days. The mean period between clip insertion and completion of NACT was 111.82 days. The baseline sum diameters and post-NACT diameters of the tumors were 70.50 (±13.60) mm before NACT and 17.75 (±17.20) mm after NACT. Hence, the mean size of the lump was statistically significantly lower after NACT, with a mean difference of 52.75 (p<0.05). The mean rate of reduction in tumor diameter was found to be 74.32% (±23.44%) based on RECIST 1.1 criteria. Pathological response was observed in all patients except for 8.8% of the patients. Clinical complete response was seen in 35.29% of patients, and partial response was observed in 52.92% of the patients based on RECIST 1.1 criteria. The study thus demonstrates the effectiveness of NACT in LABC, with a mean reduction in tumor diameter of 74.32%, assessed with the help of RECIST 1.1 criteria. ConclusionNACT for patients with LABC has shown a significant reduction in tumor size. NACT should be the initial mode of management for patients with LABC. RECIST 1.1 criteria are effective and can be used to assess tumor response to NACT. This has aided in the stratification of the response of NACT for further management through systemic therapy (adjuvant chemotherapy) after the surgical excision of the tumor.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

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Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Carcinoma Using Image-Guided Clip Placement

Pandurangappa,

Paruthy,

Jamwal

et al. 2023

Cureus

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“…Once a complete tumor response is achieved through NACT, radiological and pathological examinations of the former tumor region post-treatment are necessary. To accurately pinpoint the location of the tumor, marker clips (MCs) are commonly used, which are implanted through either ultrasound (US) or mammographic imaging 6 , 7 . However, US often falters in identifying the MC following NACT, especially in cases of total clinical response, prompting the need for mammography and incurring added radiation exposure 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Photoacoustic/ultrasound dual-modality imaging for marker clip localization in neoadjuvant chemotherapy of breast cancer

Deng,

Bai,

Xiang

et al. 2024

J. Biomed. Opt.

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. Significance To ensure precise tumor localization and subsequent pathological examination, a metal marker clip (MC) is placed within the tumor or lymph node prior to neoadjuvant chemotherapy for breast cancer. However, as tumors decrease in size following treatment, detecting the MC using ultrasound imaging becomes challenging in some patients. Consequently, a mammogram is often required to pinpoint the MC, resulting in additional radiation exposure, time expenditure, and increased costs. Dual-modality imaging, combining photoacoustic (PA) and ultrasound (US), offers a promising solution to this issue. Aim Our objective is to localize the MC without radiation exposure using PA/US dual-modality imaging. Approach A PA/US dual-modality imaging system was developed. Utilizing this system, both phantom and clinical experiments were conducted to demonstrate that PA/US dual-modality imaging can effectively localize the MC. Results The PA/US dual-modality imaging can identify and localize the MC. In clinical trials encompassing four patients and five MCs, the recognition rate was . Three experiments to verify the accuracy of marker position recognition were successful. Conclusions We effectively localized the MC in real time using PA/US dual-modality imaging. Unlike other techniques, the new method enables surgeons to pinpoint nodules both preoperatively and intraoperatively. In addition, it boasts non-radioactivity and is comparatively cost-effective.

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“…Radiologic complete response is the presence of a marking clip overlying a normal breast parenchyma or an architectural distortion pattern in sonomammography (clip sign) [7]. It has been documented that pathologic complete response is a prognostic marker for breast ca ncer patients after NAC, however, clinical, and radiologic complete response complicates the surgery because it is difficult to locate the original site of the primary tumor [8]. The gold standard of good pathological assessment is the identification of the area that best correlates with clinical and radiological findings in the NAC-BCS patients [9].…”

Section: Introductionmentioning

confidence: 99%

Impact of margin width on local recurrence after breast conservative surgery following neoadjuvant chemotherapy

Akmal¹,

Youssef²,

Tahoun³

et al. 2022

Journal of Pharmaceutical Negative Results

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Background: The main goal of BCS after NAC is complete excision of the tumor with clear margin, however, no clear definition of what constitutes a clear margin has been proposed. An additional challenge for surgeons is the extent of resection especially in good responders to NAC. The aim of this study was to determine the impact of margin width on local recurrence after breast conservative surgery for patients who responded to neoadjuvant chemotherapy. Patients and Methods: This study is a prospective observational cohort study conducted at the National Cancer Institute, Cairo university, Egypt. The study included 75 Egyptian female breast cancer patients who responded to NAC and then assigned to BCS in the period from October 2019 till October 2020. Patients were assessed with regular appointments at the outpatient clinics up to 2 years follow up after surgery.Results: The mean age was 43.8±9.5 years and 65.3 % of patients were in the premenopausal status. All patients (75 cases) had either cT2 or cT3 disease. Clinical nodal disease (cN1-3) was found in 68 patients (90.7%). Radiologic complete response was seen in 31 patients (41.3%). Most patients (85.3%) had a least circumferential margin of more than 2 mm. Positive nodal involvement was confirmed in 22 patients (29.3%). Over 70% of patients had ypT stage 1c or 2 and over 60 % of patients had ypN stage 0. By the end of follow up, four patients developed local recurrence. The unadjusted local recurrence rate was 5.3% and cumulative local recurrence free survival of the whole studied group at 36 months was 94.6%. The least circumferential resection margin (2mm) had no impact on local recurrence free survival.Conclusion: Margin after NAC and BCS is safe according to ‘‘no ink on tumor’’ guideline and we emphasize the resection of the clipped area in cases of cCR and/or rCR, however, further studies with larger sample size and longer duration of follow up are required to mitigate the local recurrence after BCS following NAC.

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Clip and wire localization of locally advanced malignant breast masses in patients undergoing neoadjuvant chemotherapy and breast conservation therapy

Cited by 5 publications

References 20 publications

Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Carcinoma Using Image-Guided Clip Placement

Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Carcinoma Using Image-Guided Clip Placement

Photoacoustic/ultrasound dual-modality imaging for marker clip localization in neoadjuvant chemotherapy of breast cancer

Impact of margin width on local recurrence after breast conservative surgery following neoadjuvant chemotherapy

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