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

Abstract

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.

Innovations and Challenges in Breast Cancer Care: A Review

“…Increasing use of breast conservation surgery, especially after downstaging following neoadjuvant chemotherapy (NACT), has led to an increase in the use of novel techniques such as Magseed ® , Radiofrequency Iodine seed (RFID) localization, Savi Scout ® , and Pintuition ® to assist in precisely excising tissue of interest in theatre; this coupled with the use of 3D intraoperative X-rays have greatly helped to reduce breast margin re-excision rates and improved cosmetic outcomes, leading to better patient satisfaction and reduced readmission rates. A significant advantage is the ease of inserting these localizers under local anaesthesia in outpatient settings under ultrasound guidance, and this can be kept in the breast for six months, which can help in surgical scheduling and resource optimization [ 10 , 11 , 12 , 13 ].…”

Patient Satisfaction with Radio-Frequency Identification (RFID) Tag Localization Compared with Wire Localization for Nonpalpable Breast Lesions: the RFID Trial

“…Margin positivity and re-excision rates have been reported for completeness, although this study did not have enough power to detect a difference for these variables. For WL, Davey et al reported a positive margin rate of 20.1% and a surgical re-excision rate of 17.3% in a meta-analysis involving 24 randomized controlled trials [21]. In a review by Tayeh et al, the surgical re-excision rate for RFID localization was 13.9% [22].…”

Radio-Guided Occult Lesion Localization With 99mTc for the Localization of Nonpalpable Melanoma and Soft Tissue Sarcoma Lesions: A Feasibility Study

“…Several large meta-analyses regarding the best localization technique for nonpalpable breast lesions included only a few of the techniques each time, 19,20 but so far, there is no conclusive superior localization technique that has been proven. A new prospective multicenter cohort study called the MELODY study (methods for localization of different types of breast lesions; NCT05559411) has therefore been initiated and is hopefully going to provide a better overview in the advantages and disadvantages of all available localization techniques for breast cancer, including 99m Tc ROLL 21 .…”