Radio‐guided and clip‐guided preoperative localization for malignant microcalcifications offer similar performances in breast‐conserving surgery

Abstract

Obtaining a tailored breast resection is challenging in microcalcifications detected on screening mammography, and an accurate localization is required. The aim of this study was to compare the efficacy of radio‐guided localization (ROLL) versus ultrasound localization of a titanium clip with collagen (TCC) in terms of clear margins, re‐intervention rates, excess of resected breast tissue, and operative times in pure malignant microcalcifications detected on screening mammography. Two hundred and twenty‐one consecutive patients with malignant microcalcifications detected on screening mammography from a tertiary breast unit were reviewed: 177 patients were localized by TCC and 44 patients by stereotactic ROLL. A propensity score‐matched analysis was performed, followed by a logistic regression model, to avoid selection bias. Adequacy of resection was expressed as the calculated resection ratio considering lesion size. No differences were found in clear margins with ROLL versus TCC (77.3% vs 81.8%, adjusted OR 2, P = 0.27). Re‐operation rates were similar, being 11.3% with ROLL and 7.4% with TCC (P = 0.627). Mean resection volume was 46.2 cm3 with ROLL versus 54.2 cm3 with TCC (P = 0.222). Adjusted mean calculated resection ratio was 1.8 with ROLL and 2.1 with TCC (P = 0.38). Surgery time was longer with TCC compared to ROLL (69.6 vs 52.7 minutes, P < 0.0001). ROLL and TCC are equally effective to excise malignant microcalcifications with clear margins, providing similar re‐intervention rates and resection volumes.

Breast-conserving surgery with 3D-printed surgical guide: a single-center, prospective clinical study

“…However, these techniques are limited by radiation exposure, poor initial seed placement, seed displacement, depth limitation, and high cost. Additionally, there is a limitation related to the difficulty of marking the extent of breast tumors, as depicted by imaging 10,[13][14][15][16][17][18][19][20][21][22][23][24] (Table 4). MRI defines the tumor extent more accurately than other imaging modalities, and it is known to accurately detect multifocal or multicentric cancers 25 .…”

Clinical practice guidelines for visualized percutaneous breast tissue clips: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021

“…US-guided clip placement has been reported to be more accurate than X-ray-guided placement. [ 3 , 12 ] The expert panel preferred US-guided clip placement, with X-ray-guided placement as an optional method. Regarding the number of clips to be placed, which should balance localization accuracy and medical cost, [ 10 , 11 ] the expert panel recommended one clip for each primary breast lesion or metastatic axillary LN.…”

“…US-guided clip placement has been reported to be more accurate than X-ray-guided placement [3,12] . The expert panel preferred US-guided clip placement, with X-ray-guided placement as an optional method.…”

“…Imaging-guided approaches for clip placement 3.2.1 Ultrasound-guided placement [11][12][13] I A 3.2.2 X-ray-guided placement [12] I A…”

“…Preoperative clip localization methods 3.3.1 Guide wire [9,14] I A 3.3.2 Dye [15] I A 3.3.3 Isotopic tracer [12] I A 3.4…”