Combined LOCalizer™ and Intraoperative Ultrasound Localization: First Experience in Localization of Non-palpable Breast Cancer

Abstract

Background: Wire-guided localization is the gold-standard for the detection of non-palpable breast lesions, although with acknowledged limitations. The aim of this study was to evaluate the combined use of LOCalizerr™ (Hologic, Santa Carla, CA, USA), and intraoperative ultrasound (IOUS) for localization and surgery of nonpalpable breast cancer. Patients and Methods: Patients with non-palpable breast lesions underwent localization procedure with LOCalizer™ and IOUS. After the placement of the marker, eight measures were made to guide the excision. LOCalizerr™ Pencil and IOUS were performed to obtain the distance between the dissection plane and the margins of lesions. Results: The procedure was feasible in the five enrolled patients and associated with clear oncological margins in all cases. Moreover, a high satisfaction according to Likert scale for surgeons, radiologists and patients, performing limited and tailored resections, was reported. Conclusion: Combining LOCalizerr™ and IOUS is an effective method for locating non-palpable breast cancer, guarantying excellent oncological and cosmetic results.Worldwide screening mammography campaigns and the improvement of 3D-tomosynthesis detection has led to an increase in the diagnosis of non-palpable breast lesions (1). It is acknowledged that one-third of breast cancers are occult at first clinical evaluation. The number of patients with nonpalpable breast cancer (NPBC) who are candidates for surgery might rise substantially considering the increasing use of neoadjuvant treatments and downstaging of palpable lesions (2). Therefore, accurate preoperative localization of non-palpable lesions is mandatory for correct surgical excision. In patients with early-stage NPBC, wire-guided localization (WGL) is widely adopted as the method of localization (3), despite being associated with several disadvantages, such as migration, trauma, breakage, patient discomfort, and risk of pneumothorax. Moreover, the placement of wires should be carried out during hospitalization, on the same day of surgery (4).Since the turn of the century, different innovative localizing wireless techniques have been tested and adopted in the search for the ideal system. Radioactive seed localization (RSL) consists of a system using an intraoperative gamma probe capable of identifying a 5-mm I 125 pellet with a titanium shell, the radioactive seed. Similar surgical outcomes after its application are reported, including oncological safety, reoperation rates, minimal invasiveness and cosmesis. The main limit of this technique is patient exposure to radioactivity (5-8).The SCOUT Radar Device (Merit Medical, San Josè, CA, USA) is a non-radioactive, non-wire localization device using infrared light and radar technology, and was approved by the U.S. Food and Drug Administration (FDA) in 2014 for localization of breast lesions. Despite positive results, its main limit is related to the significant cost of the intraoperative probe compared to WGL and RSL (9).The most recently introduced system is the MAGSEED ...

Evaluation of a Wireless Localization System for Nonpalpable Breast Lesions — Feasibility and Cost-effectiveness in Everyday Clinical Routine

“…The size of the study was fairly small, but all of the LOCalizer tags in close proximity to the tumor tissue were visible on specimen radiography, and no clip migration occurred. These results are in line with the literature findings (27,29).…”

“…Observations in the present study showed that wireless localization of nonpalpable breast lesions is feasible and safe in clinical routine work, and this has also been reported in other studies (27)(28)(29). Published data on the use of LOCalizer tags in Germany include only four patients with benign lesions, in whom the RFID tags were placed on the day of surgery, whereas in the present study the tags were placed up to 7 days in advance and also in malignant lesions (28).…”

“…Published data on the use of LOCalizer tags in Germany include only four patients with benign lesions, in whom the RFID tags were placed on the day of surgery, whereas in the present study the tags were placed up to 7 days in advance and also in malignant lesions (28). With regard to the time of placement of the RFID tags, there is potential for the LOCalizer tags, which can remain in breast tissue for more than 30 days, with no upper limit, as specified in the U.S. Food and Drug Administration (FDA) approval (24,27,29). In our experience, use of the LOCalizer system is time-efficient, there are no differences in operating times in comparison with breast-conserving surgery in which the lesion is wire-located, and the system does not create any problems for the histopathological preparation and assessment of the specimen.…”

Breast adenoid cystic carcinoma: a report of seven cases and literature review

“…The dual technique provides not only accurate localization but also better oncology and cosmetic results. Importantly, it also gives effective treatment to patients with non-palpable breast lesions [ 8 ]. As reported, pain in the affected area is another characteristic symptom of this disease, accounting for about 14% of all patients.…”

Radiofrequency Identification—RFID using LOCalizer-Tag in Non-palpable Breast Lump

“…The appropriate and accurate localization is the cornerstone of breast-conserving surgery for NPBL Currently, two localization techniques are the most diffused: WGL, the actual gold standard, and RSL, despite many disadvantages known [5]. LOCalizer™ is a NPBL innovative localization system based on radiofrequency technology, with two interesting features: the exhibition of the exact distance in mm and the attribution of a univocal code for each tag [6,7]. The latter aspect is suitable for multiple NPBLs [8].…”