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1
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Qiu ZX, Xie LY, Li YZ, Zhang ZC, Chen HL, Zhan WL, Huang Q, Huang JH, Wu ZY, Qiu SQ. L-ICG as an optical agent to improve intraoperative margin detection in breast-conserving surgery: a prospective study. Breast Cancer Res Treat 2025; 210:709-718. [PMID: 39832050 DOI: 10.1007/s10549-025-07609-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 01/02/2025] [Indexed: 01/22/2025]
Abstract
PURPOSE Precise tumor excision is important in breast-conserving surgery (BCS). This study explores the safety and accuracy of fluorescence image-guided BCS (FIGS) using a lidocaine mucilage-ICG compound (L-ICG). METHODS 54 patients who underwent BCS from August 2020 to September 2023 were enrolled. L-ICG was locally injected 0.5 cm from the tumor border. FIGS was performed to guide the tumor excision. Frozen sectioning of surgical field biopsies was used to assess the intraoperative margin status. The primary outcome measures were margin width and positive margin rates. Cosmetic outcome was evaluated by the modified version of Breast-QTM Breast-Conserving Therapy Module (Postoperative) and breast cosmetic outcome assessment criteria. RESULTS The median cranial, caudal, medial, and lateral margin widths were 8 mm (interquartile range [IQR], 3-14), 5.5 mm (IQR, 2-15), 6 mm (IQR, 3-15), and 8 mm (IQR, 3-15), respectively. Five out of 54 (9.3%) patients had an intraoperative positive margin. Intraoperatively extended resection was performed for four patients and mastectomy for the remaining one. This further reduced the positive margin rate to 1.9% at final histopathology. 50 patients received cosmetic outcome evaluation, 100% of them were "somewhat satisfied" or "very satisfied" with the appearance of the operated breast when clothed and 98% of them were scaled as "Good" or "Excellent" in their appearance of the operated breast. No serious adverse events were observed. With a median follow-up of 12.8 months, no events for tumor relapse were observed. CONCLUSION L-ICG-based FIGS is a promising technique to guide precise tumor excision in BCS.
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Affiliation(s)
- Zi-Xuan Qiu
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Li-Yun Xie
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China
| | - Ying-Zi Li
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China
| | - Ze-Chun Zhang
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China
| | - Hai-Lu Chen
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China
| | - Wan-Lin Zhan
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China
| | - Qin Huang
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China
| | - Jian-Hao Huang
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China
| | - Zhi-Yong Wu
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China.
| | - Si-Qi Qiu
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China.
- Clinical Research Center, Shantou Central Hospital, Shantou, 515041, China.
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Baysal H, Eren T, Erdem G, Karatas C, Baysal B, Alimoglu O. Foreign Body in the Breast: A Case Report. Cureus 2024; 16:e73162. [PMID: 39650956 PMCID: PMC11623980 DOI: 10.7759/cureus.73162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2024] [Indexed: 12/11/2024] Open
Abstract
Foreign bodies in the breast are rarely encountered and may infrequently lead to complications such as persistent breast pain, abscess, and/or granuloma formation, pneumothorax, or cardiac tamponade. We aimed to present a case with a foreign body in her right breast, which was diagnostically missed in previous screenings. A 44-year-old asymptomatic woman, who was included in the national breast cancer screening program, was found to have a 2 cm-sized metallic foreign body in the upper-outer quadrant of her right breast via mammographic imaging. Retrospective clinical evaluations revealed that the foreign body had been present in her breast for at least five years. She was successfully treated via wire-assisted surgery. Although they may remain asymptomatic for long periods, foreign bodies detected in the breast are suggested to be surgically removed due to the possibility of considerable subsequent local or thoracic complications.
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Affiliation(s)
- Hakan Baysal
- General Surgery, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi, Istanbul, TUR
| | - Tunc Eren
- General Surgery, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi, Istanbul, TUR
| | - Gulnur Erdem
- Radiology, Istanbul Medeniyet University, Istanbul, TUR
| | - Celal Karatas
- General Surgery, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi, Istanbul, TUR
| | | | - Orhan Alimoglu
- General Surgery, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi, Istanbul, TUR
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Bresciani D, Tsai J. Retained Foreign Body in the Breast Following a Motor Vehicle Collision: A Case Report. Case Rep Surg 2024; 2024:5262600. [PMID: 39410953 PMCID: PMC11479772 DOI: 10.1155/2024/5262600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/22/2024] [Indexed: 10/19/2024] Open
Abstract
Background: Unintentionally retained foreign bodies in the breast are a rare phenomenon. Most reported cases are iatrogenically derived from surgeries and procedures. Only a handful of reported cases refer to noniatrogenic causes, including bullets, a sewing needle, and a headscarf pin. However, there are no reports to date that describe a retained foreign body in the breast after a motor vehicle collision or a similar traumatic event or from a decorative steering wheel emblem decal. Case Description: We report the case of a 25-year-old female who was involved in a motor vehicle collision with airbag deployment that led to a left breast retained foreign body, a steering wheel emblem decal. On presentation to the emergency room, she reported left chest pain associated with a puncture wound lateral to the left nipple. Imaging at that time was consistent with a metallic object embedded in the subcutaneous tissue of the left breast. Four months after the accident, the patient continued having daily burning pain in the associated area. As such, surgical excision was recommended, and wire-localized excision of the foreign body was subsequently performed. Grossly, the foreign body appeared as a metallic object with rhinestones, which the patient confirmed was a decorative emblem decal that was on her steering wheel. The postoperative course was uncomplicated, and follow-up examinations revealed resolution of the left breast pain. Conclusions: This case underscores a unique presentation after a common accident-a retained foreign body in the breast after a motor vehicle collision-and its successful surgical intervention leading to a favorable postoperative course. Notably, the National Highway Traffic Safety Administration recently advised drivers against adding decorative emblem decals to their steering wheels for this reason. The case therefore highlights safety precautions that should be taken regarding the addition of this type of accessory.
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Affiliation(s)
- Daniela Bresciani
- Breast Surgical Oncology, Department of General Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jacqueline Tsai
- Breast Surgical Oncology, Department of General Surgery, Stanford University School of Medicine, Stanford, California, USA
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Rho S, Stillwell RA, Yan K, de Almeida Barreto AFB, Smith JR, Fay P, Police AM, O'Sullivan TD. Wirelessly Powered Visible Light-Emitting Implant for Surgical Guidance during Lumpectomy. SENSORS (BASEL, SWITZERLAND) 2024; 24:5639. [PMID: 39275550 PMCID: PMC11398236 DOI: 10.3390/s24175639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/24/2024] [Accepted: 08/28/2024] [Indexed: 09/16/2024]
Abstract
Achieving negative surgical margins, defined as no tumor found on the edges of the resected tissue, during lumpectomy for breast cancer is critical for mitigating the risk of local recurrence. To identify nonpalpable tumors that cannot be felt, pre-operative placements of wire and wire-free localization devices are typically employed. Wire-free localization approaches have significant practical advantages over wired techniques. In this study, we introduce an innovative localization system comprising a light-emitting diode (LED)-based implantable device and handheld system. The device, which is needle injectable and wire free, utilizes multiple wirelessly powered LEDs to provide direct visual guidance for lumpectomy. Two distinct colors, red and blue, provide a clear indication of tissue depth: blue light is absorbed strongly in tissue, visible within a close range of <1 cm, while red light remains visible through several centimeters of tissue. The LEDs, integrated with an impedance-matching circuit and receiver coil, are encapsulated in biocompatible epoxy for injection with a 12 G needle. Our findings demonstrate that the implant exhibits clearly perceivable depth-dependent color changes and remains visible through >2 cm of ex vivo chicken breast and bovine muscle tissue using less than 4 W of transmitted power from a handheld antenna. These miniaturized needle-injectable localization devices show promise for improving surgical guidance of nonpalpable breast tumors.
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Affiliation(s)
- Sunghoon Rho
- Department of Electrical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Roy A Stillwell
- Department of Electrical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Kedi Yan
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA 98195, USA
| | | | - Joshua R Smith
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA 98195, USA
- Allen School of Computer Science and Engineering, University of Washington, Seattle, WA 98195, USA
| | - Patrick Fay
- Department of Electrical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Alice M Police
- Monument Health Cancer Care Institute, 353 Fairmont Boulevard Rapid City, Rapid City, SD 57701, USA
| | - Thomas D O'Sullivan
- Department of Electrical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
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Lee M, Woo J, Peak SH, Kim HG, Lim WS, Chung J, Lee JE, Kim JH, Park S, Kim JM, Lee JW. An exploratory clinical trial of preoperative non-invasive localization before breast-conserving surgery using augmented reality technology. Breast Cancer Res Treat 2024; 206:31-44. [PMID: 38743175 PMCID: PMC11182803 DOI: 10.1007/s10549-024-07272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/24/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE This single-center, randomized, prospective, exploratory clinical trial was conducted to assess the clinical efficacy of an augmented reality (AR)-based breast cancer localization imaging solution for patients with breast cancer. METHODS This clinical trial enrolled 20 women who were diagnosed with invasive breast cancer between the ages of 19 and 80, had a single lesion with a diameter ≥ 5 mm but ≤ 30 mm, had no metastases to other organs, and had not received prior chemotherapy. All patients underwent mammography, ultrasound, computed tomography, and magnetic resonance imaging for preoperative assessment. Patients were randomly assigned to ultrasound-guided skin marking localization (USL) and AR-based localization (ARL) groups (n = 10 in each group). Statistical comparisons between USL and ARL groups were made based on demographics, radiologic features, pathological outcomes, and surgical outcomes using chi-square and Student t-tests. RESULTS Two surgeons performed breast-conserving surgery on 20 patients. Histopathologic evaluation of all patients confirmed negative margins. Two independent pathologists evaluated the marginal distances, and there were no intergroup differences in the readers' estimates (R1, 6.20 ± 4.37 vs. 5.04 ± 3.47, P = 0.519; R2, 5.10 ± 4.31 vs. 4.10 ± 2.38, P = 0.970) or the readers' average values (5.65 ± 4.19 vs. 4.57 ± 2.84, P = 0.509). In comparing the tumor plane area ratio, there was no statistically significant difference between the two groups in terms of either reader's mean values (R1, 15.90 ± 9.52 vs. 19.38 ± 14.05, P = 0.525; R2, 15.32 ± 9.48 vs. 20.83 ± 12.85, P = 0.290) or the overall mean values of two readers combined (15.56 ± 9.11 vs. 20.09 ± 13.38, P = 0.388). Convenience, safety, satisfaction, and reusability were all superior in the AR localization group (P < 0.001) based on the two surgeons' responses. CONCLUSION AR localization is an acceptable alternative to ultrasound-guided skin marking with no significant differences in surgical outcomes.
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Affiliation(s)
- Minah Lee
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Joohyun Woo
- Division of Breast Surgery, Department of Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Se Hyun Peak
- Division of Breast Surgery, Department of Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Hyun Goo Kim
- Division of Breast Surgery, Department of Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Woo Sung Lim
- Division of Breast Surgery, Department of Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jin Chung
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jee Eun Lee
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jeoung Hyun Kim
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sanghui Park
- Department of Pathology, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Ji Min Kim
- Department of Pathology, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jun Woo Lee
- Division of Breast Surgery, Department of Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea.
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Choi YJ. Migration of the localization wire to the back in patient with nonpalpable breast carcinoma: A case report. World J Clin Cases 2021; 9:7863-7869. [PMID: 34621839 PMCID: PMC8462241 DOI: 10.12998/wjcc.v9.i26.7863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/19/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Due to the increasing number of diagnosed nonpalpable breast cancer cases, wire localization has been commonly performed for surgical guidance to remove nonpalpable breast lesions. This report presents a rare case of localized wire migration to a subcutaneous lesion of the upper back in a breast cancer patient undergoing breast-conserving surgery.
CASE SUMMARY A 48-year-old female was scheduled for breast-conserving surgery for left breast cancer. Ultrasonography guided wire localization was performed intraoperatively by surgeon to localize the nonpalpable breast cancer. After axilla sentinel lymph node biopsy, we realized that the wire was not visualized. The wire was not found in the operation field, including the breast and axilla. Breast-conserving surgery was performed after wire re-localization. Intraoperative chest posteroanterior view revealed that the wire was located on the level of midaxillary line. Two days after the operation, a serial simple X-ray revealed that the wire was located on the subcutaneous lesion of the back. The wire tip was palpable under the skin of the upper back, and the wire was removed under local anesthesia.
CONCLUSION Hooked wire misplacement can lead to fatal complications. Surgeons must consider the possibility of wire migration during breast cancer surgery.
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Affiliation(s)
- Young Jin Choi
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
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7
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Iatrogenic Breast Foreign Body Seen on a Screening Mammogram. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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8
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Martaindale S, Scoggins M, Bassett RL, Whitman G. Retained Localization Wire Fragments in the Breast: Long-term Follow-up. Curr Probl Diagn Radiol 2021; 51:313-316. [PMID: 34006396 DOI: 10.1067/j.cpradiol.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Historically, wire localization was the most widely utilized procedure for preoperative breast lesion localization. Occasionally a portion of the wire is retained in the breast. When recognized intraoperatively, the fragment can be removed immediately, but some cases are identified during post-surgical mammographic follow-up. There is little research detailing long-term stability of retained wire fragments, associated complications, or management options for cases requiring removal. We aimed to determine how often retained wire fragments remained stable, the frequency with which intervention was required, and methods available for fragment removal. METHODS Following IRB approval, we conducted a retrospective review of patients with a retained wire localization fragment identified by EMR search seen at our institution between January 1990 and July 2019. Mammograms, localization images, specimen radiographs, and relevant clinical notes were reviewed. Information collected included breast tissue density, patient age, associated pathology, length of time the fragment was retained, presence and/or absence of fragment migration or other complications, and management of removed fragments. RESULTS Eighteen eligible patients were identified with 19 retained wire fragments. Fragments ranged in length from 1 mm -33 mm. Twelve wire fragments had mammograms available to evaluate stability. All twelve fragments were stable mammographically for an average of 96.9 months. Seven wire fragments had no follow-up mammograms available. Eight wire fragments were surgically excised. None were excised due to migration. CONCLUSION Localization wire fragments retained in the breast are at low risk for clinically significant migration and can be safely followed mammographically rather than undergoing immediate surgical excision or imaging-guided percutaneous removal.
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Affiliation(s)
- Sarah Martaindale
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Marion Scoggins
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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9
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Ultrasound-Guided Hook-Wire Localization for Surgical Excision of Non-Palpable Superficial Inguinal Lymph Nodes in Dogs: A Pilot Study. Animals (Basel) 2020; 10:ani10122314. [PMID: 33297352 PMCID: PMC7762221 DOI: 10.3390/ani10122314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022] Open
Abstract
The evaluation of loco-regional lymph nodes (LN) plays an important prognostic role and assists the clinical decision making in canine cancer patients. Excision of non-palpable LN can be challenging. The aim of the study was to evaluate surgical time, successful excision rate and surgical complications associated with the use of an ultrasound-guided hook-wire (UGHW) LN localization method for non-palpable superficial inguinal LN (SILN) in dogs. Dogs that presented for excision of non-palpable SILN, performed with the aid of an UGHW placement, were enrolled. Information including signalment, SILN width, UGHW placement and surgical procedure time, hook-wire position, successful excision and intra- and post-operative complications were reviewed. Seventeen dogs were enrolled. Median LN width was 3 mm (range 2-11). Median time of preoperative UGHW placement and surgical LN excision was 8 min and 15 min, respectively. Successful SILN excision was achieved in all cases. Two minor intra-operative (hook migration and wire fragmentation) and one minor post-operative complications (seroma) were observed. No major intraoperative or post-operative complications occurred. The UGHW LN localization method is safe and effective and may allow a high rate of successful SILN excisions in dogs. This method has the potential to facilitate LN excision for other superficial LN locations.
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10
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Micha AE, Sinnett V, Downey K, Allen S, Bishop B, Hector LR, Patrick EP, Edmonds R, Barry PA, Krupa KDC, Rusby JE. Patient and clinician satisfaction and clinical outcomes of Magseed compared with wire-guided localisation for impalpable breast lesions. Breast Cancer 2020; 28:196-205. [PMID: 32974810 PMCID: PMC7796883 DOI: 10.1007/s12282-020-01149-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023]
Abstract
Background Guide-wire localisation remains the most commonly used technique for localisation of impalpable breast lesions in the UK. One alternative is magnetic seed localisation. We aimed to investigate patient and clinician satisfaction in two consecutive cohorts, describe re-excision and positive margin rates, and explore reasons for positive margins and the implications for localisation techniques. Methods A single-institution prospective service evaluation of two cohorts of consecutive cases of wire and then Magseed localisation was carried out. Data were collected on patient and clinician satisfaction, clinico-pathological findings, and causes of involved margins. T tests were used to compare continuous variables and Chi-squared test for satisfaction outcomes. Results 168 consecutive cases used wire-guided localisation (WGL) and 128 subsequent cases used Magseeds. Patients reported less anxiety between localisation and surgery in the Magseed group, and clinicians reported greater ease of use of Magseeds. There were no differences in lesion size, surgical complexity, or re-excision rate between the groups. In a subset of patients receiving standard wide local excision (i.e., excluding mammoplasties), the impact on margin involvement was investigated. There was no significant difference in radiological under-sizing or accuracy of localisation. However, specimen weight and eccentricity of the lesion were statistically significantly lower in the Magseed group. Despite this, re-excision rates were not significantly different (p = 0.4). Conclusions This is the first large study of satisfaction with localisation and showed clinician preference for Magseed and a reduction in patient anxiety. It also demonstrated similar positive margin rates despite smaller specimen weights in the Magseed group. Magnetic seed localisation offers an acceptable clinical alternative to guide wire localisation. The impact on local service provision should also be considered.
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Affiliation(s)
- Aikaterini E Micha
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Victoria Sinnett
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Kate Downey
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Steve Allen
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Briony Bishop
- Royal Marsden NHS Foundation Trust, London, UK
- Bedfordshire Hospitals NHS Trust, South Wing, Kempston Rd, Bedford, MK42 9DJ, UK
| | - Lauren R Hector
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Elaine P Patrick
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | | | - Peter A Barry
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Institute for Cancer Research, Sutton, UK
| | - Katherine D C Krupa
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Jennifer E Rusby
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK.
- Institute for Cancer Research, Sutton, UK.
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11
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Sanders LM, Morgan D, Polini N, Mehta A. Preoperative Wire Localization of the Breast on the Day Before Surgery. JOURNAL OF BREAST IMAGING 2020; 2:240-249. [PMID: 38424980 DOI: 10.1093/jbi/wbaa015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To assess the feasibility and accuracy of preoperative wire localization performed one day prior to surgery and the relationship between the time interval following wire placement with migration distance within the time-window examined. METHODS Two trials were performed with next-day mammography to assess migration. Trial 1 used a standard hooked wire (50 patients, 61 wires). Trial 2 employed a looped wire (50 patients, 59 wires). A third trial was subsequently performed (16 patients, 18 wires) using the looped wire without repeat mammograms. Complications were recorded. Comparative statistical analyses were performed between patients in Trial 1 and Trial 2. RESULTS In Trials 1 and 2, no wires required readjustment on the day of surgery. Mean and maximum migration were less with the looped wire (range: 0-7 mm) compared to the hooked wire (range: 0-18 mm), allowing for the elimination of next-day mammograms in Trial 3. A Mann-Whitney U test showed no significant difference between the migration distances for the first two trials (P = 0.11). A Chi-square test showed no significant difference in the direction of the migration between the two trials (P = 0.15). There was no correlation between the time interval of localization and needle migration in the first two trials (r = -0.16, P = 0.22 and -0.12, P = 0.36). Specimen radiographs demonstrated the lesion/biopsy marker clip in all cases in all three trials. No infections or bleeding occurred. Two patients developed an allergic reaction to adhesive. CONCLUSION Wire localization performed on the day before surgery is feasible, inexpensive, did not compromise accuracy, and successfully unlinked the radiologic and surgical procedures.
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Affiliation(s)
| | - Dina Morgan
- Ambulatory Care Breast Center, Livingston, NJ
| | | | - Avani Mehta
- Ambulatory Care Breast Center, Livingston, NJ
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12
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Winter AM, Bennett DL, Schwartz T. Sewing needles in the breasts localized intraoperatively with sentimag probe. Breast J 2019; 26:833-834. [PMID: 31513722 DOI: 10.1111/tbj.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea M Winter
- Saint Louis University School of Medicine, St. Louis, Missouri
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13
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Evaluation of a Nonradioactive Magnetic Marker Wireless Localization Program. AJR Am J Roentgenol 2018; 211:940-945. [DOI: 10.2214/ajr.18.19637] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Cheang E, Ha R, Thornton CM, Mango VL. Innovations in image-guided preoperative breast lesion localization. Br J Radiol 2018; 91:20170740. [PMID: 29271240 DOI: 10.1259/bjr.20170740] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Screening mammography increases detection of non-palpable breast lesions requiring image-guided localization prior to surgery. Accurate preoperative localization is crucial for successful surgical outcomes. Wire-guided localization is currently the most widely used localization method for non-palpable breast lesions; however, this technique has multiple disadvantages including patient discomfort, possible wire transection and migration, suboptimal surgical incision placement due to wire location and limited scheduling flexibility decreasing operating room efficiency. As a result, promising new techniques including radioactive seed localization, non-radioactive radar localization and magnetic seed localization have been developed as alternatives. In this article, we provide an overview of these techniques and discuss their advantages, drawbacks and currently available outcome data.
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Affiliation(s)
- Ellen Cheang
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, Breast and Imaging Center , New York, NY , USA
| | - Richard Ha
- 2 Department of Radiology, Columbia University Medical Center , New York, NY , USA
| | - Cynthia M Thornton
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, Breast and Imaging Center , New York, NY , USA
| | - Victoria L Mango
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, Breast and Imaging Center , New York, NY , USA
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15
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Jadeja PH, Mango V, Patel S, Friedlander L, Desperito E, Ayala-Bustamante E, Wynn R, Chen-Seetoo M, Taback B, Feldman S, Ha R. Utilization of multiple SAVI SCOUT surgical guidance system reflectors in the same breast: A single-institution feasibility study. Breast J 2017; 24:531-534. [DOI: 10.1111/tbj.12979] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/23/2017] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Priya H. Jadeja
- Columbia University Medical Center; New-York Presbyterian Hospital; New York NY USA
| | - Victoria Mango
- Department of Radiology; Memorial Sloan Kettering Cancer Center; New York NY USA
| | - Sejal Patel
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | - Lauren Friedlander
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | - Elise Desperito
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | | | - Ralph Wynn
- Department of Radiology; Columbia University Medical Center; New York NY USA
| | - Margaret Chen-Seetoo
- Columbia University Medical Center; New-York Presbyterian Hospital; New York NY USA
| | - Bret Taback
- Columbia University Medical Center; New-York Presbyterian Hospital; New York NY USA
| | | | - Richard Ha
- Department of Radiology; Columbia University Medical Center; New York NY USA
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16
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Milligan R, Pieri A, Critchley A, Peace R, Lennard T, O'Donoghue JM, Howitt R, Nicholson S, Cain H, Petrides G, Sibal N. Radioactive seed localization compared with wire-guided localization of non-palpable breast carcinoma in breast conservation surgery- the first experience in the United Kingdom. Br J Radiol 2017; 91:20170268. [PMID: 29076748 DOI: 10.1259/bjr.20170268] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In the UK, guidewires have traditionally been used for localization of non-palpable breast lesions in patients undergoing breast conservation surgery (BCS). Radioactive seed localization (RSL) using Iodine-125 seeds is an alternative localization method and involves inserting a titanium capsule, containing radioactive Iodine-125, into the breast lesion. We aim to demonstrate feasibility of RSL compared with guidewire-localization (GWL) for BCS in the UK. METHODS Data were collected on 100 patients with non-palpable unifocal invasive carcinoma of the breast undergoing GWL WLE prior to the introduction of RSL and the first 100 patients treated with RSL WLE. Statistical comparisons were made using Χ2-squared analysis or unpaired two-sample t-test. Significance was determined to be at p ≤ 0.05. RESULTS Mean total tumour size was 19.44 mm (range: 5-55) in the GWL group and 18.61 mm (range: 3.8-59) in the RSL group (p = 0.548), while mean total specimen excision weight was significantly lower in the RSL group; 31.55 g (range: 4.5-112) vs 37.42 g (range: 7.8-157.1) (p = 0.018). Although 15 patients had inadequate surgical resection margins in the GWL group compared the 13 in the RSL group (15 vs 13%, respectively, p = 0.684), 10 of the patients in the GWL group had invasive carcinoma present resulting in at least one positive margin compared with only 3 patients in the RSL group (10 vs 3%, respectively, p = 0.045). CONCLUSION In this study, RSL is shown to be non-inferior to the use of GWL for non-palpable carcinoma in patients undergoing BCS and we suggest that it could be introduced successfully in other breast units. Advances in knowledge: Here we have demonstrated the use of RSL localization results in significant lower weight resection specimens of breast carcinoma when compared with a matched group using GWL, without any significant differences in oncological outcome between the groups.
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Affiliation(s)
- Robert Milligan
- 1 Department of Cellular Pathology,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - Andrew Pieri
- 1 Department of Cellular Pathology,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - Adam Critchley
- 1 Department of Cellular Pathology,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - Richard Peace
- 2 Department of Breast Surgery,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - Tom Lennard
- 1 Department of Cellular Pathology,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - J M O'Donoghue
- 1 Department of Cellular Pathology,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - Rachel Howitt
- 3 Directorate of Radiology,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - Stewart Nicholson
- 1 Department of Cellular Pathology,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - Henry Cain
- 1 Department of Cellular Pathology,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - George Petrides
- 2 Department of Breast Surgery,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
| | - Nidhi Sibal
- 2 Department of Breast Surgery,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK
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17
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Comparative Evaluation of Iodine-125 Radioactive Seed Localization and Wire Localization for Resection of Breast Lesions. Can Assoc Radiol J 2017; 68:447-455. [DOI: 10.1016/j.carj.2017.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/14/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose Radioactive seed localization (RSL) uses a titanium seed labeled with iodine-125 energy for surgery of nonpalpable breast lesions. RSL facilitates radiology–surgery scheduling and allows for improved oncoplasty compared with wire localization (WL). The purpose of this work was to compare the 2 techniques. Methods We performed a retrospective study of all breast lesions operated with RSL between February 2013 and March 2015 at our university institution, and compared with an equivalent number of surgeries performed with a single WL. Imaging and pathology reports were reviewed for information on guidance mode, accuracy of targeting, nature of excised lesion, size and volume of surgical specimen, status of margins, and reinterventions. Results A total of 254 lesions (247 women) were excised with RSL and compared with 257 lesions (244 women) whose surgery was guided by WL. Both groups were comparable in lesion pathology, guidance mode for RSL or WL positioning, and accuracy of targeting (98% correct). Mean delay between biopsy and surgery was 84 days for RSL versus 103 after WL ( P = .04). No differences were noted after RSL or WL for surgical specimen mean weight, largest diameter, and volume excised. For malignancies, the rate of positive margins was comparable (2.8%-3%), with 5 of 10 women in the RSL group who underwent a second surgery displaying residual malignancy compared with 3 of 9 women in the WL group. Conclusions RSL is safe and accurate, and has comparable surgical endpoints to WL. Because RSL offers flexible scheduling and facilitated oncoplasty, RSL may replace WL for resection of nonpalpable single breast lesions.
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Dal F, Ökmen H, Yılmaz MK, Sarı S, Nazlı MA, Arslan E. Extraction of a Foreign Body from the Breast Using Radio-guided Occult Lesion Localization (ROLL): Metallic Foreign Body in the Breast. Eur J Breast Health 2017; 13:159-160. [PMID: 28894857 DOI: 10.5152/ejbh.2017.3428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/16/2017] [Indexed: 11/22/2022]
Abstract
The most common clinical causes of metallic foreign body in the breast are surgical clips, pieces of guide-wire and gunshot wounds. Metallic foreign bodies can lead to local breast pain, abscesses, pneumothorax after granulomas or migration, and cardiac tamponade. Mammotome biopsy, fluoroscopy, guide-wire biopsy and radio-guided occult lesion localization (ROLL) are the standard techniques applied for surgical excision of non-palpable breast lesions. This article presents the second case in the literature undergoing the ROLL technique for the removal of a metallic foreign body from the breast.
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Affiliation(s)
- Fatih Dal
- Department of General Surgery, Health Sciences University Turkish Ministry of Health, Istanbul Research and Training Hospital, İstanbul, Turkey
| | - Hasan Ökmen
- Department of General Surgery, Health Sciences University Turkish Ministry of Health, Istanbul Research and Training Hospital, İstanbul, Turkey
| | - Meltem Küçük Yılmaz
- Department of General Surgery, Health Sciences University Turkish Ministry of Health, Istanbul Research and Training Hospital, İstanbul, Turkey
| | - Serkan Sarı
- Department of General Surgery, Health Sciences University Turkish Ministry of Health, Istanbul Research and Training Hospital, İstanbul, Turkey
| | - Mehmet Ali Nazlı
- Department of Radyology, Health Sciences University Turkish Ministry of Health, Istanbul Research and Training Hospital, İstanbul, Turkey
| | - Esra Arslan
- Department of Nuclear Medicine, Health Sciences University Turkish Ministry of Health, Istanbul Research and Training Hospital, İstanbul, Turkey
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19
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Mango VL, Wynn RT, Feldman S, Friedlander L, Desperito E, Patel SN, Gomberawalla A, Ha R. Beyond Wires and Seeds: Reflector-guided Breast Lesion Localization and Excision. Radiology 2017; 284:365-371. [PMID: 28430555 DOI: 10.1148/radiol.2017161661] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate outcomes of Savi Scout (Cianna Medical, Aliso Viejo, Calif) reflector-guided localization and excision of breast lesions by analyzing reflector placement, localization, and removal, along with target excision and rates of repeat excision (referred to as re-excision). Materials and Methods A single-institution retrospective review of 100 women who underwent breast lesion localization and excision by using the Savi Scout surgical guidance system from June 2015 to May 2016 was performed. By using image guidance 0-8 days before surgery, 123 nonradioactive, infrared-activated, electromagnetic wave reflectors were percutaneously inserted adjacent to or within 111 breast targets. Twenty patients had two or three reflectors placed for bracketing or for localizing multiple lesions, and when ipsilateral, they were placed as close as 2.6 cm apart. Target and reflector were localized intraoperatively by one of two breast surgeons who used a handpiece that emitted infrared light and electromagnetic waves. Radiographs of the specimen and pathologic analysis helped verify target and reflector removal. Target to reflector distance was measured on the mammogram and radiograph of the specimen, and reflector depth was measured on the mammogram. Pathologic analysis was reviewed. Re-excision rates and complications were recorded. By using statistics software, descriptive statistics were generated with 95% confidence intervals (CIs) calculated. Results By using sonographic (40 of 123; 32.5%; 95% CI: 24.9%, 41.2%) or mammographic (83 of 123; 67.5%; 95% CI: 58.8% 75.1%) guidance, 123 (100%; 95% CI: 96.4%, 100%) reflectors were placed. Mean mammographic target to reflector distance was 0.3 cm. All 123 (100%; 95% CI: 96.4%, 100%) targets and reflectors were excised. Pathologic analysis yielded 54 of 110 malignancies (49.1%; 95% CI: 39.9%, 58.3%; average, 1.0 cm; range, 0.1-5 cm), 32 high-risk lesions (29.1%; 95% CI: 21.4%, 38.2%), and 24 benign lesions (21.8%; 95% CI: 115.1%, 30.4%). Four of 54 malignant cases (7.4%; 95% CI: 2.4%, 18.1%) demonstrated margins positive for cancer that required re-excision. Five of 110 radiographs of the specimen (4.5%; 95% CI: 1.7%, 10.4%) demonstrated increased distance between the target and reflector distance of greater than 1.0 cm (range, 1.1-2.6 cm) compared with postprocedure mammogram the day of placement, three of five were associated with hematomas, two of five migrated without identifiable cause. No related postoperative complications were identified. Conclusion Savi Scout is an accurate, reliable method to localize and excise breast lesions with acceptable margin positivity and re-excision rates. Bracketing is possible with reflectors as close as 2.6 cm. Savi Scout overcomes many limitations of other localization methods, which warrants further study. © RSNA, 2017.
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Affiliation(s)
- Victoria L Mango
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Ralph T Wynn
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Sheldon Feldman
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Lauren Friedlander
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Elise Desperito
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Sejal N Patel
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Ameer Gomberawalla
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
| | - Richard Ha
- From the Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Floor, New York, NY 10032
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20
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Li X, Oprea-Ilies GM, Krishnamurti U. New Developments in Breast Cancer and Their Impact on Daily Practice in Pathology. Arch Pathol Lab Med 2017; 141:490-498. [DOI: 10.5858/arpa.2016-0288-sa] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Advances in research have transformed our understanding of breast cancers and have altered the daily practice of pathology. Theranostic evaluations performed by pathologists are now critical in triaging the patients into appropriate treatment groups, as are new guidelines that were recently established for the evaluation of HER2/neu gene amplification. Emerging molecular classifications of breast cancers bring novel perspectives to the assessment of individual cases, and opportunities for better treatments. Molecular studies have particularly shed light on distinct biological subsets of triple-negative breast cancers, for which new targeted therapies are being developed. The prognostic and therapeutic utility of new histopathologic parameters, such as tumor-infiltrating lymphocytes, are also being elucidated, and new protocols have been devised for the pathologic evaluation of breast specimens that have undergone neoadjuvant treatment. Novel clinical practices, such as radioactive seed localization, also affect the way breast specimens are processed and evaluated. In this brief review, we highlight the developments that are most relevant to pathology and are changing or could potentially impact our daily practice.
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Affiliation(s)
| | | | - Uma Krishnamurti
- From the Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Gerogia
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21
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Evaluation of the SAVI SCOUT Surgical Guidance System for Localization and Excision of Nonpalpable Breast Lesions: A Feasibility Study. AJR Am J Roentgenol 2016; 207:W69-W72. [DOI: 10.2214/ajr.15.15962] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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22
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Corsi F, Sorrentino L, Sartani A, Bossi D, Amadori R, Nebuloni M, Truffi M, Bonzini M, Foschi D. Localization of nonpalpable breast lesions with sonographically visible clip: optimizing tailored resection and clear margins. Am J Surg 2015; 209:950-958. [DOI: 10.1016/j.amjsurg.2014.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/03/2014] [Accepted: 07/16/2014] [Indexed: 12/14/2022]
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23
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Dauer LT, Thornton C, Miodownik D, Boylan D, Holahan B, King V, Brogi E, Morrow M, Morris EA, St Germain J. Radioactive seed localization with 125I for nonpalpable lesions prior to breast lumpectomy and/or excisional biopsy: methodology, safety, and experience of initial year. HEALTH PHYSICS 2013; 105:356-365. [PMID: 23982612 DOI: 10.1097/hp.0b013e31829c03e1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of radioactive seed localization (RSL) as an alternative to wire localizations (WL) for nonpalpable breast lesions is rapidly gaining acceptance because of its advantages for both the patient and the surgical staff. This paper examines the initial experience with over 1,200 patients seen at a comprehensive cancer center. Radiation safety procedures for radiology, surgery, and pathology were implemented, and radioactive material inventory control was maintained using an intranet-based program. Surgical probes allowed for discrimination between 125I seed photon energies from 99mTc administered for sentinel node testing. A total of 1,127 patients (median age of 57.2 y) underwent RSL procedures with 1,223 seeds implanted. Implanted seed depth ranged from 10.3-107.8 mm. The median length of time from RSL implant to surgical excision was 2 d. The median 125I activity at time of implant was 3.1 MBq (1.9 to 4.6). The median dose rate from patients with a single seed was 9.5 µSv h-1 and 0.5 µSv h-1 at contact and 1 m, respectively. The maximum contact dose rate was 187 µSv h-1 from a superficially placed seed. RSL performed greater than 1 d before surgery is a viable alternative to WL, allowing flexibility in scheduling, minimizing day of surgery procedures, and improving workflow in breast imaging and surgery. RSL has been shown to be a safe and effective procedure for preoperative localization under mammographic and ultrasound guidance, which can be managed with the use of customized radiation protection controls.
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Affiliation(s)
- Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan-Kettering CancerCenter, New York, NY 10021, USA.
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24
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Safety and efficacy of radioactive seed localization with I-125 prior to lumpectomy and/or excisional biopsy. Eur J Radiol 2013; 82:1453-7. [DOI: 10.1016/j.ejrad.2013.04.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/18/2013] [Indexed: 11/22/2022]
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25
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Barentsz MW, van den Bosch MAAJ, Veldhuis WB, van Diest PJ, Pijnappel RM, Witkamp AJ, Verkooijen HM. Radioactive seed localization for non-palpable breast cancer. Br J Surg 2013; 100:582-8. [PMID: 23456627 DOI: 10.1002/bjs.9068] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Radioactive seed localization (RSL) is an alternative to wire localization for guiding surgical excision of non-palpable breast cancer. This review provides an overview of the available evidence on the accuracy of RSL in patients undergoing breast-conserving surgery. METHODS PubMed, Embase and the Cochrane Library were searched systematically in January 2012 for studies that addressed localization of non-palpable breast cancer using an iodine-125-labelled seed. Studies were deemed eligible if they reported on the proportion of patients with tumour-positive margins after RSL, the proportion of patients needing re-excision after RSL, and procedural complications. RESULTS Six studies reported data on RSL in 1611 patients with non-palpable breast lesions. Overall complete resection rates ranged from 73 to 96.7 per cent. Three studies included over 300 patients, and complete resection rates in these studies varied between 89.5 and 96.7 per cent. The risk of seed migration and failure of seed placement ranged from 0 to 0.6 per cent and 0 to 7.2 per cent respectively. CONCLUSION Available scientific evidence suggests that RSL is a safe and accurate technique for localization of non-palpable breast lesions.
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Affiliation(s)
- M W Barentsz
- Centre of Interventional Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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26
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Fusco R, Petrillo A, Catalano O, Sansone M, Granata V, Filice S, D'Aiuto M, Pankhurst Q, Douek M. Procedures for location of non-palpable breast lesions: a systematic review for the radiologist. Breast Cancer 2012; 21:522-31. [PMID: 23115016 DOI: 10.1007/s12282-012-0427-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
Abstract
Accurate location of small breast lesions is mandatory for proper surgical management. The purpose of this article is systematically review procedures used to locate non-palpable breast lesions, including a description of the current status, advantages, and disadvantages for each technique. A total of 47 articles were finally included: 7 articles for the wire location technique, 5 articles for the radioguided location technique, 13 articles that compare wire location with radioguided location, 3 articles for the carbon location technique, 2 articles that compare wire location with carbon location, and 17 articles for the clip location technique. The success of location and the clear margin are reported for each location technique and for the separate articles included; clip migration shift, also, is reported for the clip location technique. Odds ratio with related 95 % confidence intervals were also calculated for successful location. Comparative analysis or meta-analysis for all the different breast lesion location techniques is missing. Prospective investigations and randomized investigations for homogeneous populations are still needed to determine which is the most cost-effective modality among those used to date.
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Affiliation(s)
- Roberta Fusco
- Department of Diagnostic Unit, National Cancer Institute, Pascale Foundation, via M. Semmola, 80131, Naples, Italy
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27
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Larrieux G, Cupp JA, Liao J, Scott-Conner CEH, Weigel RJ. Effect of introducing hematoma ultrasound-guided lumpectomy in a surgical practice. J Am Coll Surg 2012; 215:237-43. [PMID: 22632911 DOI: 10.1016/j.jamcollsurg.2012.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/27/2012] [Accepted: 04/11/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preoperative needle localization (NL) is the gold standard for lumpectomy of nonpalpable breast cancer. Hematoma ultrasound-guided (HUG) lumpectomy can offer several advantages. The purpose of this study was to compare the use of HUG with NL lumpectomy in a single surgical practice. STUDY DESIGN Patients with nonpalpable lesions who underwent NL or HUG lumpectomy from January 2007 to December 2009 by a single surgeon were identified from a breast surgery database. Ease of scheduling, volume excised, re-excision rates, operating room time, and health care charges were the main outcomes variables. Univariate and multivariate analyses were performed to compare the 2 groups. RESULTS Lumpectomy was performed in 110 patients, 55 underwent HUG and 55 underwent NL. Hematoma ultrasound-guided lumpectomy was associated with a nearly 3-fold increase in the odds ratio of additional tissue being submitted to pathology (p = 0.039), but neither the total amount of breast tissue removed, nor the need for second procedure were statistically different between the 2 groups. Duration of the surgical procedure did not vary between the 2 groups; however, the time from biopsy to surgery was shorter for HUG by an expected 9.7 days (p = 0.019), implying greater ease of scheduling. Mean charges averaged $250 less for HUG than for NL, but this difference was not statistically significant. CONCLUSIONS Hematoma ultrasound-guided is equivalent to NL with regard to volume of tissue excised, need for operative re-excision, and operating room time. Adoption of HUG in our practice allowed for more timely surgical care.
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Affiliation(s)
- Gregory Larrieux
- Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
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28
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McGhan LJ, McKeever SC, Pockaj BA, Wasif N, Giurescu ME, Walton HA, Gray RJ. Radioactive Seed Localization for Nonpalpable Breast Lesions: Review of 1,000 Consecutive Procedures at a Single Institution. Ann Surg Oncol 2011; 18:3096-101. [DOI: 10.1245/s10434-011-1910-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Indexed: 01/11/2023]
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29
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Aydogan F, Atasoy D, Olgun DC, Dikici AS, Aliyev A, Gazioglu E. Extraction of a foreign body from the breast parenchyma using radioguided occult lesion localisation (ROLL) technique: a new approach. Br J Radiol 2010; 83:e147-9. [PMID: 20603400 DOI: 10.1259/bjr/92618371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The radioguided occult lesion localisation (ROLL) technique is used for the excision of non-palpable breast lesions. This technique has not been described previously for the extraction of foreign bodies from the breast parenchyma. We report here a female patient who was admitted to our hospital with a foreign body in her right breast. The ROLL technique was used for the extraction of the foreign body.
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Affiliation(s)
- F Aydogan
- Department of General Surgery, Istanbul University Istanbul, Turkey
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30
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van Riet YEA, Jansen FH, van Beek M, van de Velde CJH, Rutten HJT, Nieuwenhuijzen GAP. Localization of non-palpable breast cancer using a radiolabelled titanium seed. Br J Surg 2010; 97:1240-5. [DOI: 10.1002/bjs.7097] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Resection guided by a radiologically placed hookwire is the most common surgical technique for non-palpable breast cancer. This technique has several well described disadvantages such as incidental migration, kinking or fracture of the wire, and difficult logistics between the radiology, surgical and nuclear medicine departments. Use of an iodine-125-radiolabelled (I-125) seed for localization of non-palpable breast tumours could potentially prevent these problems.
Methods
Data on use of the I-125 seed localization technique in 325 consecutive women were collected prospectively between October 2003 and June 2009. All patients with screen-detected, histologically proven malignancy were included. Patients with a preoperative core biopsy showing either ductal carcinoma in situ or unclear pathology were excluded from this study.
Results
The mean(s.d.) age of the women was 59·5(11·9) years. Localization was guided ultrasonographically in 275 procedures, stereotactically in 45 and by both techniques in five. The I-125 seed was removed by surgery after a mean of 4(5) days. The mean duration of operation was 62·9(21·2) min. Complete tumour removal was achieved in 310 procedures (95·4 per cent).
Conclusion
Localization of impalpable breast cancer using a I-125 seed was safe and led to a high proportion of radical lumpectomies.
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Affiliation(s)
- Y E A van Riet
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - F H Jansen
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - M van Beek
- Institute of Pathology, Eindhoven, The Netherlands
| | | | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Jakub JW, Gray RJ, Degnim AC, Boughey JC, Gardner M, Cox CE. Current status of radioactive seed for localization of non palpable breast lesions. Am J Surg 2010; 199:522-8. [DOI: 10.1016/j.amjsurg.2009.05.019] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/26/2009] [Accepted: 05/26/2009] [Indexed: 11/16/2022]
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Migration of guidewire after surgical breast biopsy: an unusual case report. Cardiovasc Intervent Radiol 2009; 32:1087-90. [PMID: 19506948 DOI: 10.1007/s00270-009-9620-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Revised: 01/26/2009] [Accepted: 05/19/2009] [Indexed: 12/18/2022]
Abstract
Needle localization of breast lesions is commonly performed for surgical guidance when excising nonpalpable lesions. A few reports have specifically addressed complications associated with needle-localized surgical breast biopsy. We present the first reported case of delayed cardiac injury resulting from migration of a guidewire from a needle-localized breast biopsy that occurred 2 years after the procedure. The patient presented with chest pain and cardiac tamponade. It was found that a hook-wire had penetrated the pericardium and left ventricular myocardium through the aortic valve into the ascending aorta. The diagnosis was made by echocardiogram and computed axial tomography scan and subsequent surgical removal was undertaken successfully.
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López-Olmos J. Cuerpo extraño perineal: aguja retenida tras el parto más de 25 años. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2007. [DOI: 10.1016/s0210-573x(07)74488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Burnside ES, Sohlich RE, Sickles EA. Movement of a biopsy-site marker clip after completion of stereotactic directional vacuum-assisted breast biopsy: case report. Radiology 2001; 221:504-7. [PMID: 11687696 DOI: 10.1148/radiol.2212010565] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 51-year-old woman underwent stereotactic core biopsy of suspicious microcalcifications in the upper outer left breast with subsequent metallic clip deployment. Postprocedure mammograms demonstrated accurate placement of the clip. However, mammography 10 months later revealed movement of the clip 4 cm medially in the breast.
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Affiliation(s)
- E S Burnside
- Department of Radiology, University of California School of Medicine, San Francisco, CA, USA.
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CORRESPONDENCE. Breast 2000. [DOI: 10.1054/brst.2000.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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