The Effect of Multiple Wire Localization in Breast Conservation

Fillion, Michelle; Black, Emily; Hudson, Kathleen B.; Morin-Ducote, Garnetta; Bell, John L.; Gray, Keith D.; Lewis, James M.

doi:10.1177/000313481207800530

Cited by 9 publications

(7 citation statements)

References 17 publications

(16 reference statements)

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“…However, we did find that bracketing was the localization modality most likely to correlate with incomplete resection and residual disease. This has been demonstrated elsewhere . This finding supports the use of bracketing in tumors with attributes known to place patients at risk for positive margins: diffuse, multifocal, and large size tumors.…”

Section: Discussionsupporting

confidence: 83%

Identifying Factors and Techniques to Decrease the Positive Margin Rate in Partial Mastectomies: Have We Missed the Mark?

et al. 2016

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Breast conservation therapy (BCT) has a reported incidence of positive margins ranging widely in the literature from 20% to 70%. Efforts have been made to refine standards for partial mastectomy and to predict which patients are at highest risk for incomplete excision. Most have focused on histology and demographics. We sought to further define modifiable risk factors for positive margins and residual disease. A retrospective study was conducted of 567 consecutive partial mastectomies by 21 breast and general surgeons from 2009 to 2012. Four hundred fourteen cases of neoplasm were reviewed for localization, intraoperative assessment, excision technique, rates, and results of re-excision/mastectomy. Histologic margins were positive in 23% of patients, 25% had margins 0.1-0.9 mm, and 7% had tumor within 1-1.9 mm. Residual tumor was identified at-in 61 cases: 38% (disease at margin), 21% (0.1-0.9 mm), and 14% (1-1.9 mm). Ductal carcinoma in situ (DCIS) was present in 85% of residual disease on re-excision and correlated to higher rates of re-excision (p = <0.001), residual disease, and subsequent mastectomy. The use of multiple needles to localize neoplasms was associated with 2-3 times the likelihood for positive margins than when a single needle was required. The removal of additional margins at initial surgery correlated with improved rates of complete excision when DCIS was present. Patients must have careful analysis of specimen margins at the time of surgery and may benefit from additional tissue excision or routine shaving of the cavity of resection. Surgeons should conduct careful patient selection for BCT, in the context of multifocal, and multicentric disease. Patients for whom tumor localization requires bracketing may be at higher risk for positive margins and residual disease and should be counseled accordingly.

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Section: Discussionsupporting

confidence: 83%

Identifying Factors and Techniques to Decrease the Positive Margin Rate in Partial Mastectomies: Have We Missed the Mark?

et al. 2016

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“…Fillion et al, who compared 79 patients treated with BWL to 122 patients treated with WGL, reported more positive margins (39% vs. 18%; P ¼ .039) and re-excisions (44% vs. 25%; P ¼ .004) for BWL. 28 Tumor size in their BWL group (2.9 cm) was larger than in WGL (1.5 cm) (P < .001). This might explain the higher rate of tumor positive margins in BWL as tumor size larger than 2 cm is associated with involved margins.…”

Section: Discussionmentioning

confidence: 86%

“…This might explain the rate of tumor negative resection margins of BWL in this study (77%) being on the high range compared with those of other studies, which range between 44% and 83%. 24,25,[27][28][29] Another explanation for the high rate of negative margins in this study is the use of preoperative magnetic resonance imaging in almost all (82%) patients to get an adequate estimation of the true tumor extent. Fillion et al, who compared 79 patients treated with BWL to 122 patients treated with WGL, reported more positive margins (39% vs. 18%; P ¼ .039) and re-excisions (44% vs. 25%; P ¼ .004) for BWL.…”

Section: Discussionmentioning

confidence: 89%

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Optimization of Wire-guided Technique With Bracketing Reduces Resection Volumes in Breast-conserving Surgery for Early Breast Cancer

Civil

Duvivier

Perin

et al. 2020

Clinical Breast Cancer

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Bracketing wire-guided localization (BWL) to demarcate tumor borders can be used to minimize resection volumes in patients with breast cancer. The sample consisted of 17 patients treated with BWL and 44 patients treated with single wire-guided localization. BWL achieved smaller resection volumes than wire-guided localization without compromising margin status for breast tumors larger than 1.5 cm, which could potentially improve cosmetic outcomes. Background: Wire-guided localization (WGL) of early breast cancer can be facilitated using multiple wires, which is called bracketing wire-guided localization (BWL). The primary aim of this study is to compare BWL and conventional WGL regarding minimization of resection volumes without compromising margin status. Secondly, BWL is evaluated as an alternative method for intraoperative ultrasound (US) guidance in poorly definable breast tumors on US. Patients and Methods: In this retrospective cohort study, patients with preoperatively diagnosed breast cancer undergoing wide local excision between January 2016 and December 2018 were analyzed. Patients with multifocal disease or neoadjuvant treatment were excluded from this study. Optimal resection with minimal healthy breast tissue removal was assessed using the calculated resection ratio (CRR). Results: BWL was performed in 17 (9%) patients, WGL in 44 (22%), and US in 139 (70%). The rate of negative margins was comparable in all 3 groups. The CRR was significantly smaller for BWL (0.6) than WGL (1.3) in tumors larger than 1.5 cm. Additionally, BWL (0.8) led to smaller CRRs than US (1.7). This could be explained by the high number of small tumors ( 1.5 cm) in the US group for which greater CRRs are obtained than for large tumors (> 1.5 cm) (1.9 vs. 1.4; P ¼ .005). Conclusion: For breast tumors larger than 1.5 cm, BWL achieves more optimal resection volumes without compromising margin status compared with WGL. Moreover, BWL seems a suitable alternative to US in patients with poorly ultrasound-visible breast tumors and patients with a small tumor in a (large) breast.

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“…This technique was developed and popularized in the 1970s, and continues to be broadly utilized. With the validation of breast conserving therapy (BCT) for cancer, WL with multiple wires, placed in a bracketed fashion around the lesion of interest, facilitates targeted excision of expansive lesions . Despite its utility, WL has been shown to have several technical disadvantages.…”

Section: Introductionmentioning

confidence: 99%

Bracketed radioactive seed localization vs bracketed wire-localization in breast surgery

et al. 2017

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Multiple localizers placed in a bracketed fashion facilitates excision of radiographically extensive breast lesions. In this study, bracketed radioactive seed localization (bRSL) was compared to bracketed wire localization (bWL). We hypothesized that bRSL would achieve adequate margins and decrease re-operation rates with similar or less specimen volumes (SV) than bWL. Retrospective review identified patients who underwent bracketed breast procedures at an academic medical center. Data collected included patient demographics, tumor features, treatment variables, and surgical outcomes. Wilcoxon rank-sum test and chi-square test were used to compare continuous and categorical data, respectively. A multivariable logistic regression model was used to evaluate the association between re-excision and localization technique after adjusting for clinically relevant variables. Patients who underwent bWL were 3.9 times more likely to undergo re-excision compared to patients in bRSL group (OR=3.9, 95% CI: 2.0-7.4). Initial and total SV did not significantly differ between the two groups (P=.4). Patients were significantly more likely to undergo a mastectomy in the bWL group than in the bRSL group (24% vs 7%; P<.01). For patients undergoing excision of radiologically extensive breast lesions, bRSL serves as an alternative to bWL. In this retrospective study, bRSL was associated with a decreased re-excision rate with similar SV and a lower rate of mastectomy when compared to bWL.

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The Effect of Multiple Wire Localization in Breast Conservation

Cited by 9 publications

References 17 publications

Identifying Factors and Techniques to Decrease the Positive Margin Rate in Partial Mastectomies: Have We Missed the Mark?

Identifying Factors and Techniques to Decrease the Positive Margin Rate in Partial Mastectomies: Have We Missed the Mark?

Optimization of Wire-guided Technique With Bracketing Reduces Resection Volumes in Breast-conserving Surgery for Early Breast Cancer

Bracketed radioactive seed localization vs bracketed wire-localization in breast surgery

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