Comparison of Wire and Non-Wire Localisation Techniques in Breast Cancer Surgery: A Review of the Literature with Pooled Analysis

Abstract

Background and Objectives: Wide local excision is a common procedure in the treatment of breast cancer. Wire-guided localisation (WGL) has been the gold standard for many years; however, several issues have been identified with this technique, and therefore, wire-free techniques have been developed. This scoping review synthesises the available literature comparing wire-guided localisation with the wire-free techniques used in breast-conserving cancer surgery. Materials and Methods: Multiple databases including Pubmed and MEDLINE were used to search articles between 1 January 2000 and 31 December 2022. Terms included “breast neoplasms”, “margins of excision”, and “reoperation”. In total, 34/256 papers were selected for review. Comparisons were made between positive margins and re-excision rates of WGL with wire-free techniques including SAVI SCOUT, Magseed, ROLL, and RSL. Pooled p-values were calculated using chi-square testing to determine statistical significance. Results: Pooled analysis demonstrated statistically significant reductions in positive margins and re-excision rates when SAVI SCOUT, RSL, and ROLL were compared with WGL. When SAVI SCOUT was compared to WGL, there were fewer re-excisions {(8.6% vs. 18.8%; p = 0.0001) and positive margins (10.6% vs. 15.0%; p = 0.0105)}, respectively. This was also the case in the ROLL and RSL groups. When compared to WGL; lower re-excision rates and positive margins were noted {(12.6% vs. 20.8%; p = 0.0007), (17.0% vs. 22.9%; p = 0.0268)} for ROLL and for RSL, respectively {(6.8% vs. 14.9%),(12.36% vs. 21.4%) (p = 0.0001)}. Magseed localisation demonstrated lower rates of re-excision than WGL (13.44% vs. 15.42%; p = 0.0534), but the results were not statistically significant. Conclusions: SAVI SCOUT, Magseed, ROLL, and RSL techniques were reviewed. Pooled analysis indicates wire-free techniques, specifically SAVI SCOUT, ROLL, and RSL, provide statistically significant reductions in re-excision rates and positive margin rates compared to WGL. However, additional studies and systematic analysis are required to ascertain superiority between techniques.

Evolution of localization methods for non-palpable breast lesions: a literature review from a translational medicine perspective

“…In 2006, iodine-125 was established as one of the safe radioactive markers for locating non-palpable breast lesions ( 52 ). When ROLL was compared to RSL, ROLL showed higher patient satisfaction, whilst RSL showed lower proportion of positive margins and lower re-operation rate ( 4 , 5 ).…”

“…It also does not have depth limitations for detectability ( 11 ). Other advantages include reduction in localization and operation time, lower proportion of positive margins, lower re-operation rate and improved patient comfort compared to WGL ( 4 , 5 , 59 ).…”

“…It overcomes most of the disadvantages of WGL with the absence of external components and the possibility of early placement ( 81 ). A recent literature review with pooled analysis showed that SSL has superior outcomes in terms of lower proportion of positive margins and lower re-operation rate compared to WGL, ROLL, RSL, and MSL ( 5 ). Furthermore, this innovation is associated with high patient satisfaction ( 10 ), minimizing patient discomfort and reducing time delay ( 62 , 90 ).…”

Paramagnetic Localization—A Viable Option for Nonpalpable Breast Lesions

“…1 Since then, several other localization techniques have been introduced and tested in clinical trials. 2 Pantiora et al 3 compared paramagnetic seeds vs guidewires for localization of nonpalpable breast cancers in a randomized clinical trial (RCT). 3 Both arms in the trial used superparamagnetic iron oxide (SPIO) for sentinel lymph node localization.…”

“…Guidewire localization has been the primary method used since it was first described in 1965 . Since then, several other localization techniques have been introduced and tested in clinical trials . Pantiora et al compared paramagnetic seeds vs guidewires for localization of nonpalpable breast cancers in a randomized clinical trial (RCT) .…”