No abstract

Breast conserving surgery has become the standard of care and is more commonly performed than mastectomy for early stage breast cancer, with recent studies showing equivalent survival and lower morbidity. Accurate preoperative lesion localization is mandatory to obtain adequate oncological and cosmetic results. Image guidance assures the precision requested for this purpose. This review provides a summary of all techniques currently available, ranging from the classic wire positioning to the newer magnetic seed localization. We describe the procedures and equipment necessary for each method, outlining the advantages and disadvantages, with a focus on the cost-effective preoperative skin tattoo technique performed at our centre. Breast surgeons and radiologists have to consider ongoing technological developments in order to assess the best localization method for each individual patient and clinical setting.

Objective: The aim of this study was to externally validate the feasibility and robustness of a risk-stratification score for B3 lesions based on clinical, pathological, and radiological data for improved clinical decision making. Methods: 129 consecutive histologically confirmed B3 lesions diagnosed at ultrasound-guided biopsy at our institution were included in this retrospective study. Patient- and lesion-related variables were independently assessed by two blinded breast radiologists (R1, R2), by assigning each feature a score from 0 to 2 (maximum sum-score of 5). Sensitivity, specificity, positive and negative predictive values were calculated at two different thresholds (≥1 and 2). Categorical variables were compared using Chi-squared and Fisher exact tests. The diagnostic accuracy of the score to distinguish benign from malignant B3 lesions was assessed by receiver operating characteristic (ROC) analysis. Results: Surgery was performed on 117/129 (90.6%) lesions and 11 of these 117 (9.4%) lesions were malignant. No cancers were found at follow-up of at least 24 months. Area under the ROC-curve was 0.736 (R1) to 0.747 (R2), with no significant difference between the two readers (p = 0.5015). Using a threshold of ≥1, a sensitivity, specificity, PPV, and NPV of 90%/90% (R1/R2), 39%/38% (R1/R2), 11%/12% (R1/R2) and 97%/98% (R1/R2) were identified. Both readers classified 47 lesions with a score ≤1 (low risk of associated malignancy). Of these, only one malignant lesion was underdiagnosed (Ductal carcinoma in situ-G1). Conclusions: In our external validation, the score showed a high negative predictive value and has the potential to reduce unnecessary surgeries or re-biopsies for ultrasound-detected B3-lesions by up to 39%.