Rapid Implementation of Intraoperative Ultrasonography to Reduce Wire Localization in The Permanente Medical Group

Chang, Sharon B.; Brooke, Magdalene A.; Cureton, Elizabeth L.; Yeh, Alice; Chen, Rhona; Mazzetti-Barros, Nicole; Rahbari, Reza; Butler, Sherry; Hill, Nicole M. Datrice; Shim, Vickie

doi:10.7812/tpp/18-073

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…Utilizing hydrogel-encapsulated biopsy markers for BCS emerges as a secure and viable substitute, mitigating complications associated with the conventional preoperative WGL approach. This cost-efficient method is poised to enhance the patient’s overall experience and streamline surgical procedures ( 43 , 44 ).…”

Section: Localization Methods For Non-palpable Breast Lesionsmentioning

confidence: 99%

“…However, this marker localization technique requires the percutaneous introduction of a foreign body into the breast, which might create potential problems, such as marker extrusion from the skin, challenging placement of marker within a small lesion, and allergic reaction to metallic markers in rare circumstances ( 45 ). Besides, metal markers, especially those from the older generation, may not be easily visible and depend heavily on the expertise of the operating surgeon ( 44 ).…”

Section: Localization Methods For Non-palpable Breast Lesionsmentioning

confidence: 99%

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

Cheung,

Co,

Lui

et al. 2024

Transl Breast Cancer Res

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Background and Objective With an increasing number of non-palpable breast lesions detected due to improved screening, accurate localization of these lesions for surgery is crucial. This literature review explores the evolution of localization methods for non-palpable breast lesions, highlighting the translational journey from concept to clinical practice. Methods A comprehensive search of PubMed, Embase, and Scopus databases until September 2023 was conducted. Key Content and Findings Multiple methods have been developed throughout the past few decades. (I) Wire-guided localization (WGL) introduced in 1966, has become a reliable method for localization. Its simplicity and cost-effectiveness are its key advantages, but challenges include logistical constraints, patient discomfort, and potential wire migration. (II) Intraoperative ultrasound localization (IOUS) has shown promise in ensuring complete lesion removal with higher negative margin rates. However, its utility is limited to lesions visible on ultrasound (US) imaging. (III) Breast biopsy marker localization: the use of markers has improved the precision of localization without the need for wire. However, marker visibility remains a challenge despite improvements in their design. (IV) Radioactive techniques: radio-guided occult lesion localization (ROLL) and radioactive seed localization (RSL) offer flexibility in scheduling and improved patient comfort. However, they require close multidisciplinary collaboration and specific equipment due to radioactive concerns. (V) Other wireless non-radioactive techniques: wireless non-radioactive techniques have been developed in recent three decades to provide flexible and patient-friendly alternatives. It includes magnetic seed localization, radar techniques, and radiofrequency techniques. Their usage has been gaining popularity due to their safety profile and allowance of more flexible scheduling. However, their high cost and need for additional training remain a barrier to a wider adoption. Conclusions The evolution of breast lesion localization methods has progressed to more patient-friendly techniques, each with its unique advantages and limitations. Future research on patient-reported outcomes, cosmetic outcomes, breast biopsy markers and integration of augmented reality with breast lesion localization are needed.

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Section: Localization Methods For Non-palpable Breast Lesionsmentioning

confidence: 99%

Section: Localization Methods For Non-palpable Breast Lesionsmentioning

confidence: 99%

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

Cheung,

Co,

Lui

et al. 2024

Transl Breast Cancer Res

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Intraoperative sonography for nonpalpable breast lesions: Additional indications for a consolidate technique

Famà¹,

Maria

Cicciù

et al. 2020

Breast J

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This prospective study evaluated the intraoperative ultrasound scan (IUSS) for nonpalpable breast lesions’ detection. A total of 108 consecutive female patients underwent surgery using IUSS: Frozen sections demonstrated clear margins in 95.5% of neoplastic patients. Only four (4.5%) patients underwent local re‐excision in the same operation. IUSS demonstrated to be quick, accurate, useful, effective, and safe for the intraoperative management of neoplastic nonpalpable breast lesions when performed by a surgeon who has undergone US training, particularly for people in whom alternative approaches can show some limitations due to contraindications or because of scheduling constraints, costs, and patient discomfort.

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Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective

et al. 2021

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Background Intraoperative ultrasound (IUS) localization for breast cancer is a noninvasive localization technique. In 2015, an IUS program for breast-conserving surgery (BCS) was initiated in a large, integrated health care system. This study evaluated the clinical results of IUS implementation. Methods The study identified breast cancer patients with BCS from 1 January to 31 October 2015 and from 1 January to 31 October 2019. Clinicopathologic characteristics were collected, and localization types were categorized. Clinical outcomes were analyzed, including localization use, surgeon adoption of IUS, day-of-surgery intervals, and re-excision rates. Multivariate logistic regression analysis was performed to evaluate predictors of re-excision. Results The number of BCS procedures increased 23%, from 1815 procedures in 2015 to 2226 procedures in 2019. The IUS rate increased from 4% of lumpectomies (n = 79) in 2015 to 28% of lumpectomies (n = 632) in 2019 (p < 0.001). Surgeons using IUS increased from 6% (5 of 88 surgeons) in 2015 to 70% (42 of 60 surgeons) in 2019. In 2019, 76% of IUS surgeons performed at least 25% of lumpectomies with IUS. The mean time from admission to incision was shorter with IUS or seed localization than with wire localization (202 min with IUS, 201 with seed localization, 262 with wire localization in 2019; p < 0.001). The IUS re-excision rates were lower than for other localization techniques (13.6%, vs 19.6% for seed localization and 24.7% for wire localization in 2019; p = 0.006), and IUS predicted lower re-excision rates in a multivariable model (odds ratio [OR], 0.59). Conclusions In a high-volume integrated health system, IUS was adopted for BCS by a majority of surgeons. The use of IUS decreased the time from admission to incision compared with wire localization, and decreased re-excision rates compared with other localization techniques.

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Rapid Implementation of Intraoperative Ultrasonography to Reduce Wire Localization in The Permanente Medical Group

Cited by 4 publications

References 16 publications

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

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

Intraoperative sonography for nonpalpable breast lesions: Additional indications for a consolidate technique

Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective

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