Localization of nonpalpable breast lesions with sonographically visible clip: optimizing tailored resection and clear margins

Corsi, Fabio; Sorrentino, Luca; Sartani, A.; Bossi, Daniela; Amadori, Rosella; Nebuloni, Manuela; Truffi, Marta; Bonzini, Matteo; Foschi, Diego

doi:10.1016/j.amjsurg.2014.07.010

Cited by 19 publications

(30 citation statements)

References 29 publications

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“…To accurately calculate resection volumes, the three dimensions of the surgical specimen and of the tumor were recorded after surgery. As previously reported, both cancer and specimen were considered as ellipsoids . The optimal resection volume (ORV) was defined as the tumor volume plus 1 cm of macroscopically clear tissue on all margins, by the following formula:

ORV = \frac{4}{3} π true(\frac{italica}{2} + 1 true) true(\frac{italicb}{2} + 1 true) true(\frac{italicc}{2} + 1 true),

where a , b , and c are the three tumor diameters expressed in centimeter.…”

Section: Methodsmentioning

confidence: 99%

“…A mark was placed on the skin overlying the position of TCC. During surgery, a skin incision followed the mark and resection was performed excising breast tissue from skin deep to pectoralis major's fascia . Then, an X‐ray on the specimen was obtained to check the removal of the clip, its centricity into the specimen, and the macroscopic adequacy of margins.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, lesion type may impact the choice of localization technique. We have previously described the usefulness of the preoperative localization of a titanium clip embedded with a collagen plug (TCC), positioned after biopsy and visible on the US, as a stand‐alone technique in nonpalpable breast cancer surgery …”

Section: Introductionmentioning

confidence: 99%

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Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

Corsi

Bossi

Combi

et al. 2019

Journal of Surgical Oncology

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Background and Objectives An accurate localization is mandatory to tailor breast lumpectomy in nonpalpable cancers. The aim of this study was to compare radio‐guided localization (ROLL) vs ultrasound localization of a titanium clip with collagen (TCC) in nonpalpable mass‐like breast cancers. Methods Two hundred seventy‐three consecutive patients were reviewed: 64 patients were localized by TCC and 209 patients by ROLL. Propensity score‐matched analysis was performed. Margin status and reintervention rates were compared. Adequacy of resection was expressed as the calculated resection ratio (CRR) considering lesion size. Loco‐regional and distant recurrence rates were assessed with ROLL vs TCC. Results No differences were found with ROLL vs TCC in clear margins (90.6% vs 89.1%; odds ratio, 0.74; P = 0.64) or reoperations (6.7% vs 1.6%; P = 0.529). ROLL allowed more tailored resections compared with TCC (adjusted CRR, 1.7 vs 2.7; P = 0.0008), particularly in lesions with associated extensive intraductal component (CRR, 3.0 vs 4.5; P = 0.017). Loco‐regional recurrence occurred in 1.9% of ROLL patients vs 3.2% of TCC cases (P = 0.628). Conclusions ROLL and TCC are equally effective to excise nonpalpable mass‐like breast cancers with clear margins, providing similar loco‐regional control. However, ROLL allows more tailored breast resections, particularly in lesions with the associated extensive intraductal component.

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ORV = \frac{4}{3} π true(\frac{italica}{2} + 1 true) true(\frac{italicb}{2} + 1 true) true(\frac{italicc}{2} + 1 true),

where a , b , and c are the three tumor diameters expressed in centimeter.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

Corsi

Bossi

Combi

et al. 2019

Journal of Surgical Oncology

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“…4 Needle-localization is necessary to pinpoint the area to be removed in nonpalpable lesions. 32 Postoperatively this space fills with fluid and restores a rounded contour of the breast. The use of a sports foundation garment is useful to provide support of the surgical breast, prevent hematoma formation, and improve pain control.…”

Section: Prophylactic Mastectomymentioning

confidence: 97%

Local Treatment of Breast Cancer

Lester¹

2015

Seminars in Oncology Nursing

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“…8 If the lesion or hematoma is not visible, then use of USvisible clips, as applied by Rubio et al, can be very useful, especially in the neoadjuvant setting. 9 One can readily see the direct correlation with patient satisfaction and with facilitation of the surgeon's scheduling of operating rooms.…”

Section: Further Use Of Image-guided Us In Both the Operating Room Anmentioning

confidence: 99%

Intraoperative Image-Guided Breast-Conservation Surgery Should be the Gold Standard

Klimberg

2015

Ann Surg Oncol

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The COBALT trial 1 is a small randomized multicenter trial (134 patients) for unicentric palpable breast cancers conducted in the Netherlands primarily to demonstrate the superiority of intraoperative ultrasound (US)-guided breastconservation surgery (BCS) in terms of both cosmesis and patient satisfaction. Indeed, the cosmesis was better for the image-guided surgery than for the palpation-guided surgery, as judged by a three-member panel, a computer program, and self-evaluation (odds ratio, 0.55; p = 0.067). This was primarily due to less volume of excision with US-guided BCS, less reexcision due to positive margins, and improved patient satisfaction. This ultimately led to lower cost, although this datum is not presented in the report. Likewise, Rubio et al. 2 demonstrated utility in the neoadjuvant setting using a USVisible marker placed at the original biopsy. IMPLEMENTATION IN CLINICAL PRACTICEAs described in both reports, the study results would not be difficult to implement in a busy clinical practice. A variety of ultrasound machines are currently available in most operating rooms that could be used for US-guided surgery. This is how I started in my practice more than 20 years ago. I did not charge for such procedures because they were part of my learning curve and because at that time, no certification for surgeons or US courses were available. It made sense that any image-guided procedure was better than what I could feel with my hands.One thing that received no comment in the reports was the use of ex vivo US confirmation of excision completeness immediately on the operating table that could then direct reexcision of a specific margin. How many times has each of us removed a mass only to find that it was not in the center of the lumpectomy specimen. Ultrasound both in vivo and ex vivo help to direct and redirect our efforts, respectively. FURTHER USE OF IMAGE-GUIDED US IN BOTH THE OPERATING ROOM AND THE CLINICThe two studies demonstrate the most rudimentary of uses for surgical US. As proficiency with US is gained by the surgeon, primary lesions and those demonstrated only by US can be removed with the same level of confidence. Many articles attest to the ability to do so. 3 The obvious benefit for the patient is that he or she does not need to undergo a secondary localization procedure. 4 We and others have demonstrated the usefulness of intraoperative US after a positive stereotactic core biopsy that results in the need for BCS therapy. The patients traditionally require needle localization breast biopsy (NLBB), a most barbaric procedure during which 10-20 % of patients faint or vomit due to vasovagal reflex. 5Many procedures have used clips, coils, cryoablation, and radioactive seeds as second procedures to locate nonpalpable lesions, all with results similar to those for NLBB. 6 Our group has demonstrated the usefulness of using the hematoma created in almost all patients after a core biopsy that lasts up to 5 weeks for most patients. We termed this the hematoma-directed ultrasound-guided (HU...

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Localization of nonpalpable breast lesions with sonographically visible clip: optimizing tailored resection and clear margins

Cited by 19 publications

References 29 publications

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

Local Treatment of Breast Cancer

Intraoperative Image-Guided Breast-Conservation Surgery Should be the Gold Standard

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