Background/Aim: Wire-guided localisation (WGL) remains the most widely used technique for the localisation of non-palpable breast lesions; however, recent technological advances have resulted in non-wire, non-radioactive alternatives, such as magnetic seeds (Magseeds). The aim of this pooled analysis was to determine whether Magseeds are an effective tool for localising non-palpable breast lesions. Materials and Methods: Various databases were searched for publications which reported data on the localisation and placement rates of Magseed. Data on re-excision rates under use of Magseed and WGL were also collected. Results: Sixteen studies, spanning the insertion of 1,559 Magseeds, were analysed. The pooled analysis showed a successful placement rate of 94.42% and a successful localisation rate of 99.86%. Four studies were analysed in a separate pooled analysis and showed no statistically significant difference between reexcision rates using Magseeds and WGL. Conclusion: The use of Magseeds is an effective, non-inferior alternative to WGL that overcomes many of the limitations of the latter. The pre-operative localisation of non-palpable breast cancer traditionally employs wire-guided localisation (WGL) (1). However, several limitations are associated with WGL. The localisation wire can cause manifold complications, such as diathermy burns, pericardial injury and wire dislocation/ transection (2, 3). Furthermore, wire migration and surgical difficulties in accurately assessing the position of the wire tip intraoperatively can pose significant difficulty for the operating surgeon (4). WGL is performed on the day of surgery, and interdepartmental coordination with radiology for localisation in addition to everyday scheduling difficulties may lead to a prolonged surgical waiting time. An underreported limitation of the flexible wire used in WGL is that it increases the risk of needle-stick injury for the surgeon and the pathologist. Furthermore, it protrudes from the breast and is uncomfortable for the patient. The prospect of an additional procedure on the day of major breast surgery can also be very stressful for patients in whom anxiety level is already high (2). Widespread use of screening methods has led to an increased incidence of non-palpable breast cancer. It is therefore imperative that localisation methods with high patient, radiologist and surgical satisfaction rates are developed. Radioactive seed localisation (RSL) is a feasible alternative to WGL. RSL can occur up to 5 days prior to the surgery and the seeds can be accurately detected with a hand-held gamma probe (5). Furthermore, recent evidence suggests that RSL would be more cost-effective than WGL (6) and would improve the oncological outcomes of imageguided surgery (7). However, handling of radioactive material requires special licensing and is associated with strict regulatory requirements. Hence, the optimal solution would be a non-wire non-radioactive localisation method which contains no energy source. This has led to the emergence of Savi Sco...

Dear editor, Our experiments in 160 breast carcinoma cases, survival analyses established that RACK1 is an independent prognostic factor for poor outcome (P < 0.001) [1].Furthermore, in breast carcinoma cell lines stably-transfected with RACK1, as well as nude mouse models, showed that RACK1 promotes breast carcinoma proliferation, migration and invasion/metastasis in vitro and in vivo [2, 3]. Our results are consistent with the finding of Wang et al in oral squamous cell carcinoma [4,5].We strongly suggest that the authors should consider experiments in breast cancer cell lines to verify the findings in vivo.Should you have any question please do not hesitate to contacting with me.Preference:

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We have read with great interest the recent article by Mamidipudi and Cartwright (2009), in which the authors showed that RACK1 induced apoptosis of human colon cells by inhibiting the expression of antiapoptotic pathways and Src activity, thus leading to death of colon cancer cells.We have recently conducted an analysis of RACK1 messenger RNA (mRNA) expression in 127 human breast cancer and 33 non-cancerous breast tissue specimens. The study was carried out using reverse transcriptase-polymerase chain reaction following RNA extraction from frozen samples. The mRNA copy numbers for RACK1 were normalized against the epithelial marker CK19 as previously described (Al Sarakbi et al., 2009) in order to adjust for epithelial cellularity in the specimens examined. We observed that RACK1 expression levels were higher in the normal breast tissue compared with the cancer specimens (mean levels were 136 vs 32 in paired samples, P ¼ 0.44). Furthermore, RACK1 mRNA levels were significantly lower in TNM3 tumours compared with TNM1 tumours (0.08 vs 33, P ¼ 0.04). After a median followup of 10 years, high levels of RACK1 mRNA expression were associated with a good clinical outcome. The mean level of expression in patients who remained disease-free was 36 compared with 2.4 in those who had systemic relapse (P ¼ 0.042) or those who had local recurrence (mean ¼ 3.86, P ¼ 0.05).Our results are consistent with the authors' observation that RACK1 has a novel pre-apoptotic function in human malignancy. However, our results contradict a recent study that looked at the protein expression of RACK1 in human breast cancer and showed that high levels were predictive of a poor clinical outcome (Cao et al., 2009). Further research is required in order to establish the role of RACK1 as an independent prognostic indicator in human cancer.

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