Exploiting the advantages of a wireless seed localization system that differentiates between the seeds: Breast cancer resection following neoadjuvant chemotherapy

Abstract

Background Most wireless localization methods utilize only one means of detection for the surgeon, sufficient to localize a single small breast lesion for excision. Complex cases requiring bracketing of a larger lesion or localization of two or more close lesions can superimpose the signal from separate “seeds” with such methods. The lack of discernment between the localization “seeds” can disorient the surgeon, risking a missed lesion on excision and longer operative times. with the use of neoadjuvant chemotherapy prior to breast surgery, the necessity of localizing both a breast lesion and an axillary lymph node previously biopsied is becoming frequent. Case A 44 year‐old woman underwent neoadjuvant chmotherapy for a breast cancer the did not express estrogen receptor, progesterone receptor, or HER2 receptor. In establishing the extent of disease, a suspicious ipsilateral lymph node was biopsied and found to contain metastatic disease. She had an excellent response to the chemotherapy, with decreased size of the primary tumor and the previously biopsied lymph node. The patient desired breast conservation. The primary tumor and associated calcifications were bracketed using two different Smartclips™, with a third localizing the lymph node biopsied. Conclusion This report illustrates how the use of three SmartClips™, within the EnVisioTM system, allowed for separate tracking of each “seed” throughout a complex surgery in a patient following neoadjuvant chemotherapy. This resulted in successful resection of both the tumor and the tagged lymph node.

Resection Ratios and Tumor Eccentricity in Breast-Conserving Surgery Specimens for Surgical Accuracy Assessment

“…The value of this outcome measure becomes even more apparent in light of the increasing number of technologies that are currently being investigated for the purpose of breast tumor localization. These techniques include magnetic and paramagnetic localization (Magseed [28][29][30][31], Sirius Pintuition [32,33], MOLLI [34], TAKUMI [35]), radiofrequency reflector-based localization (SAVI SCOUT [36][37][38]), radiofrequency identification tags (LO-Calizer [39][40][41]), EnVisio [42]), and stereotactic marking using a carbon suspension [43][44][45]. Due to the lack of solid evidence with regard to clinical effectiveness, none of these investigated techniques have widespread adoption [46].…”