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

Abstract

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.

Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: A systematic review and meta-analysis

“…However, the most commonly cited drawback for these techniques is the presence of radioactivity in the implanted seed/colloid, with important restrictions for patients and extensive multidisciplinary coordination and regulatory compliance [12]. The use of a radiation-free titanium clip J o u r n a l P r e -p r o o f embedded with a collagen plug positioned after biopsy and visible on the ultrasound has been also proposed [19]. This and other available techniques on preoperative localization have been exhaustively described by Morerira et al [18] and have therefore not been taken into consideration in our analysis.…”