Does Localization Technique Matter for Non-palpable Breast Cancers?

Abstract

Background There are several techniques for localization of non-palpable breast tumors, but comparisons of these techniques in terms of margin positivity and volume of tissue resected are lacking. Methods Between 2011-2013 and 2016-2018, 2 randomized controlled trials involving 10 centers across the United States accrued 631 patients with stage 0-3 breast cancer, all of whom underwent breast conserving surgery. Of these, 522 had residual non-palpable tumors for which localization was required. The localization technique was left to the discretion of the individual surgeon. We compared margin positivity and volume of tissue resected between various localization techniques. Results The majority of the patients (n = 465; 89.1%) had wire localization (WL), 50 (9.6%) had radioactive seed (RS) localization, and 7 (1.3%) had Savi Scout (SS) localization. On bivariate analysis, there was no difference in terms of margin positivity (37.8% vs. 28.0% vs. 28.6%, P = .339) nor re-excision rates (13.3% vs. 12.0% vs. 14.3%, P = .961) for the WL, RS, and SS groups, respectively. Further, the volume of tissue removed was not significantly different between the 3 groups (71.9 cm3 vs. 55.8 cm3 vs. 86.6 cm3 for the WL, RS, and SS groups, respectively, P = .340). On multivariate analysis, margin status was affected by tumor size (OR = 1.336; 95% CI: 1.148-1.554, P<.001) but not by type of localization ( P = .670). Conclusions While there are a number of methods for tumor localization, choice of technique does not seem to influence volume of tissue resected nor margin status.

Response to Comments Regarding the SHAVE2 Trial

“…With regards to the type of localization, we refer you to our paper recently published on the SHAVE2 data in which we found that there was no difference in terms of positive margin and re-excision rates regardless of type of localization. 3 This has been borne out in several other studies and meta-analyses as well. 4,5…”

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

“…Overall, 43 studies compared RSL and WGL, including 7 randomized controlled trials [30][31][32][33][34][35][36][37], and 32 observational studies [29,. The data synthesis from the 39 studies comprised a population of 19,820 women with nonpalpable breast lesions, with ages ranging from 20 to 92 years old, undergoing conservative surgery with RSL or WGL.…”

“…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).…”

“…Post-operative complication rates were reported by 13 studies [29,31,32,41,42,44,48,51,60,61,[64][65][66], without heterogeneity (I 2 = 0%). The post-operative complications risk after conservative surgery with WGL was lower than with RSL, but this value was not statistically relevant (RR = 1.17, 95% CI = 0.90-1.52; 5525 patients; 13 studies; see Figure 12).…”

Efficacy and Safety of Magnetic Seed Pre-Operative Non-Palpable Breast Lesion Localization: a series of 37 consecutive cases

“…Thanks to widespread screening, the detection of non palpable lesions requiring surgery represents more than half of all breast surgeries, and the challenge of their surgical management lies in accurate preoperative location to allow complete removal, while limiting the sacrifice of healthy glandular tissue for a satisfactory aesthetic result 4 .…”