A comparison of three methods for nonpalpable breast cancer excision

Krekel, N.M.A.; Zonderhuis, Barbara M; Stockmann, H. B. A. C.; Schreurs, W. H.; Veen, H. van der; Klerk, E.S.M. de Lange de; Meijer, Sybren; Tol, M.P. van den

doi:10.1016/j.ejso.2010.12.006

Cited by 106 publications

(98 citation statements)

References 28 publications

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“…[5,10,12] Still, only one specimen showed surgical margins with DCIS. Therefore, the possible presence of tumour-associated DCIS does not justify excessively large resections to prevent intraductal margin involvement in daily practice, and will therefore not have implications for the use of intra-operative US.…”

Section: Margin Statusmentioning

confidence: 99%

“…If the specimen volume is twice the size of the optimal specimen volume, then the CRR would be 2.0. [5,12] Data analysis All data were analysed by using the Statistical Package for the Social Sciences (SPSS statistical software, Version 15.0; SPSS, Inc., Chicago, IL, USA). Scatterplots were generated from time points versus the excision volume and CRR.…”

Section: The Calculated Resection Ratiomentioning

confidence: 99%

“…[3][4][5][6][7][8] To this end, advances have been made in image-guided breast surgery for nonpalpable breast cancer, and several studies have shown that the use of ultrasonography (US) for intraoperative tumour localisation results in the most accurate surgical excision. [9][10][11][12][13][14] In daily practice, the excision of palpable breast cancer is guided by palpation. The adequacy of this procedure is based on pre-operative imaging techniques and the experience and tactile abilities of the surgeon.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14] The increasingly more important role of breast US in the intra-operative evaluation of breast cancer calls for efforts from surgeons to perform US-guided breast procedures, particularly in settings where dedicated radiologists are not readily available at all times. Although doubts have been addressed regarding the ability of surgeons to perform breast US, previous studies have shown a high accuracy of breast US performed by surgeons.…”

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confidence: 99%

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Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Krekel

Cardozo

Müller³

et al. 2011

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. procedure, all surgeons showed proficiency in performing intra-operative breast US. Conclusion:Surgeons can easily learn the skills needed to perform intra-operative US for palpable breast tumour excision. The technique is non-invasive, simple, safe and effective for obtaining adequate resection margins. Within the first two cases, resections reached optimal volumes, thereby, presumably resulting in improved cosmetic outcomes. In a multicentre, randomised, clinical trial, intra-operative US guidance for palpable breast tumours will be evaluated for oncological ánd cosmetic outcomes. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Synopsis:This study evaluates the performance of surgeons during training for ultrasound-guided excision of palpable T1-T2 invasive breast cancer. Our findings reveal that surgeons can rapidly master intra-operative US, which is non-invasive, simple, safe and effective for obtaining adequate resection margins and excision volumes.

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Section: Margin Statusmentioning

confidence: 99%

Section: The Calculated Resection Ratiomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Krekel

Cardozo

Müller³

et al. 2011

European Journal of Surgical Oncology (EJSO)

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“…Alternative localization methods for nonpalpable breast cancer, such as US-guided and radioguided localization, have been advocated in the past and have come to attention again recently (2,3). In these studies, wire-guided localization (WGL) is reported to be a technically demanding radiological and surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

Should We Abandon Wire-Guided Localization for Nonpalpable Breast Cancer? A Plea for Wire-Guided Localization

2013

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Background and Aims:To evaluate wire-guided localization for nonpalpable breast cancer regarding procedure and surgery-related outcome in a nonteaching community hospital in the Netherlands.Material and Methods: A consecutive series of 117 patients who were treated with breastconserving surgery after wire-guided localization for nonpalpable breast cancer between January 2006 and December 2010 was retrospectively analyzed. The patients' digital records were reviewed for patient, radiological, histological, and surgical characteristics. In order to quantify the excess resected tissue, a calculated resection ratio was determined by dividing the total resection volume by the optimal resection volume. The optimal resection volume was defined as a spherical tumor volume with an added 1.0 cm margin. The total resection volume was defined as the corresponding ellipsoid.Results: There were no procedure-related complications. There were two postoperative hemorrhages. Margins were clear in 92.3% of the cases after the first surgical procedure. Eight (6.8%) patients required two operations and one (0.9%) patient required three operations in order to obtain negative margins. Breast conservation was possible in 113 (96.6%) patients. The median calculated resection ratio was 1.87 (range 0.47-14.92).Conclusions: This study proves that it is possible to obtain excellent results performing breast-conserving surgery for nonpalpable breast cancer regarding margin status, total amount of operations, and the ratio between tumor and resected tissue volume using wireguided localization as a localization tool.

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Magnetic Seed vs Guidewire Breast Cancer Localization With Magnetic Lymph Node Detection

Pantiora,

Jazrawi,

Hersi

et al. 2024

JAMA Surg

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ImportanceGuidewires have been the standard for breast lesion localization but pose operative and logistic challenges. Paramagnetic seeds have shown promising results, but to the authors’ knowledge, no randomized comparison has been performed.ObjectiveTo determine whether the combination of a paramagnetic seed and superparamagnetic iron oxide (SPIO) is equivalent to guidewire and SPIO for breast cancer localization and sentinel lymph node detection (SLND).Design, Setting, and ParticipantsThis was a phase 3, pragmatic, equivalence, 2-arm, open-label, randomized clinical trial conducted at 3 university and/or community hospitals in Sweden from May 2018 to May 2022. Included in the study were patients with early breast cancer planned for breast conservation and SLND. Study data were analyzed July to November 2022.InterventionsParticipants were randomly assigned 1:1 to a paramagnetic seed or a guidewire. All patients underwent SLND with SPIO.Main Outcomes and MeasuresRe-excision rate and resection ratio (defined as actual resection volume / optimal resection volume).ResultsA total of 426 women (median [IQR] age, 65 [56-71] years; median [IQR] tumor size, 11 [8-15] mm) were included in the study. The re-excision rate was 2.90% (95% CI, 1.60%-4.80%), and the median (IQR) resection ratio was 1.96 (1.15-3.44). No differences were found between the guidewire and the seed in re-excisions (6 of 211 [2.84%] vs 6 of 209 [2.87%]; difference, −0.03%; 95% CI, −3.20% to 3.20%; P = .99) or resection ratio (median, 1.93; IQR, 1.18-3.43 vs median, 2.01; IQR, 1.11-3.47; P = .70). Overall SLN detection was 98.6% (95% CI, 97.1%-99.4%) with no differences between arms (203 of 207 [98.1%] vs 204 of 206 [99.0%]; difference, −0.9%; 95% CI, −3.6% to 1.8%; P = .72). More failed localizations occurred with the guidewire (21 of 208 [10.1%] vs 4 of 215 [1.9%]; difference, 8.2%; 95% CI, 3.3%-13.2%; P &lt; .001). Median (IQR) time to specimen excision was shorter for the seed (15 [10-22] minutes vs 18 [12-30] minutes; P = .01), as was the total operative time (69 [56-86] minutes vs 75.5 [59-101] minutes; P = .03). The experience of surgeons, radiologists, and surgical coordinators was better with the seed.Conclusions and RelevanceThe combination of SPIO and a paramagnetic seed performed comparably with SPIO and guidewire for breast cancer conserving surgery and resulted in more successful localizations, shorter operative times, and better experience.Trial RegistrationISRCTN.org Identifier: ISRCTN11914537

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A comparison of three methods for nonpalpable breast cancer excision

Cited by 106 publications

References 28 publications

Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Should We Abandon Wire-Guided Localization for Nonpalpable Breast Cancer? A Plea for Wire-Guided Localization

Magnetic Seed vs Guidewire Breast Cancer Localization With Magnetic Lymph Node Detection

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