Adequacy of invasive and in situ breast carcinoma margins in radioactive seed and wire‐guided localization lumpectomies

Abstract

Image‐guided preoperative localizations help surgeons to completely resect nonpalpable breast cancers. The objective of this study is to compare the adequacy of specimen margins for both invasive breast cancer (IBC) and ductal carcinoma in situ (DCIS) after radioactive seed localization (RSL) vs wire‐guided localization (WGL). We retrospectively reviewed 600 cases at a single Canadian academic center from January 2014 to September 2017, comparing surgical margins, re‐excisions and reoperations, localization accuracy and major complications (migration, accidental deployment, vasovagal reaction), as well as operative duration between RSL and WGL cases. IBC margins were positive in 7% of RSL and 6% of WGL cases (P = .57). Tumor size (P = .039) and association with DCIS (P = .036) predicted positive margins in invasive carcinoma. DCIS margins were positive in 6% and 8%, and close (≤2 mm) in 37% and 36% of cases (P = .45) for RSL and RSL cases respectively. The presence of extensive intraductal component predicted positive DCIS margins (P < .0001). There was no significant difference between intraoperative re‐excisions (P = .54), localization accuracy (P = .34), and operation duration (P = .81). Reoperation for lumpectomies and mastectomies was marginally higher for WGL than RSL (P = .049). There were 11 (4%) WGL and no RSL complications (P = .03). Overall, positive margins for IBC, close or positive margins for DCIS, intraoperative re‐excision, localization accuracy, and operation duration were similar between RSL and WGL. The reoperation rate was higher in WGL than RSL, which may reflect practice changes over time. RSL was safer than WGL with lower complication rates.

Retrospective Cohort Study of Practical Applications of Paramagnetic Seed Localisation in Breast Carcinoma and Other Malignancies

“…( p = 0.043) Similar to this finding, the size of DCIS in the postoperative specimen was associated with positive section margins ( p < 0.001). This is comparable to the findings for WGL or radioactive seed localisation [ 19 , 20 , 21 , 22 ]. The determining component for section margins is not solely DCIS, as in 60% of the cases with positive section margins this was due to the invasive component.…”

Early Breast Cancer: Could Combined LOCalizerTM and Ultrasound Localization Replace the Metallic Wire? A Multicentric Study

“…Perhaps the use of US and the evaluation of distances from the margins can improve surgeons’ orientation. Law et al reported a re-operation rate of 6% in their study, assessing the adequacy of invasive and in situ breast carcinoma margins in radioactive seed- and wire-guided localization lumpectomies [ 21 ]. Regarding the radiofrequency system, different rates of R0 surgery have been described.…”

Radioactive Seed Localization for Nonpalpable Breast Lesions: Systematic Review and Meta-Analysis

“…Intraoperative re-excision rates were reported by 15 studies [31,34,35,40,43,45,50,[62][63][64][65][66]69,70], with a high heterogeneity (I 2 = 95%). The intraoperative re-excision risk in conservative surgery with RSL was higher than with WGL, but this value was not statistically relevant (RR = 1.02, 95% CI = 0.75-1.38; 5623 patients; 15 studies; analysis Figure 7).…”

“…Reoperation rates were reported by 27 studies [29,35,[38][39][40][41][42][44][45][46][47][48][49][50][51][52][53][54][55][56][57][60][61][62][63][64][65][66][67]69,70], with a relevant heterogeneity (I 2 = 61%). The reoperation risk after conservative surgery with RSL was lower than with WGL (RR = 0.71, 95% CI = 0.61-0.84; 13884 patients; 27 studies; see Figure 8).…”