Localization techniques for guided surgical excision of non-palpable breast lesions

Alfaro²,

2017

ecancer

BackgroundSurgical treatment of non-palpable breast lesions is controversial. At the European Institute of Oncology in Milan, Italy, Prof Umberto Veronesi introduced a new technique called the radioguided occult lesion localisation (ROLL) in 1996 to replace conventional methods and their disadvantages (Zurrida S, Galimberti V, and Monti S et al (1998) Radioguided localization of occult breast lesions Breast 7 11–13 https://doi.org/10.1016/S0960-9776(98)90044-3). Given the success experienced in that institution, the method became the technique of choice for the early diagnosis of breast cancer. In this paper, we will examine the technical aspects of ROLL and the results from a large series of patients treated in our private practice in Costa Rica.MethodsWe analysed the first 816 patients with different non-palpable breast lesions detected by ultrasound or mammography within our private practice in Costa Rica. In 774 patients, technetium 99m labelled with human serum albumin (7–10 MBq) in 0.2 ml of saline solution was injected into the lesion under mammographic or ultrasound guidance. The excisional biopsy was done by means of a gamma-probe and complete excision of the lesion was verified by X-ray on the specimen in lesions that were visible by mammography and ultrasound 4 months after surgery. In the remaining 42 patients, the localisation of the lesion was carried out by wire.ResultsThe tracer was correctly positioned in the first attempt in 772/816 (94.6%) of cases and in the second attempt in two other cases. In 42/816 (5.1%) cases, the localisation of the lesion had to be performed with the traditional method. X-rays showed that the lesion was entirely removed in 770/772 (99.74%) of cases.ConclusionThe ROLL is a simple and excellent option for the removal of hidden breast lesions in clinical practice. It offers the advantage of making resections safer and with tumour-free margins, in addition to reducing the number of reinterventions. Since it makes it possible to specify to the pathologist the exact site where the lesion is located, we can guarantee a better diagnosis. The rate of success with the use of this technique corresponds to the available scientific data, so we conclude that it is a procedure that we can routinely perform in private practice in Costa Rica.

“…However, these two latter techniques have their setbacks, including complications such as incomplete removal of the lesion [15]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radioguided localisation of non-palpable lesions of the breast in Costa Rica: Review of results of our first 800 patients in private practice

Alfaro²,

2017

ecancer

“…Radioguided occult lesion localization (ROLL) and radioactive seed localization also allowed for a similar breast tissue excision volume and similar re-excision interventions when both were compared in the neoadjuvant setting [37]. US guidance requires training and experience, and to date there are no trials comparing US guidance and the ROLL technique in the neoadjuvant setting [37].…”

Section: Lumpectomymentioning

confidence: 99%

Surgical Management of Breast Cancer Treated with Neoadjuvant Therapy

2018

“…Many techniques are used to help surgeons to carry out a complete tumor excision, but needlewired localization (WL), which is named "bracketing" when multiple wires are inserted, is one of the most commonly employed (2). We described our WL technique, which helps surgeons by marking the limits of the resection, inserting some wires 1 cm distance to radiological lesion limits, and by warning them of conflictive points which could compromise surgical technique (3).…”

Section: Introductionmentioning

confidence: 99%

Oncoplastic breast conserving surgery with tailored needle-guided excision

et al. 2017

Background: Breast conserving surgery (BCS) administered with oncoplastic approach (OBCS), when it is required, is currently the gold standard for the treatment of early breast cancer. Wire-guided localization (WL) is the most popular technique used to help surgeon in breast cancer excision. Currently, a universal and undeniable goal is to minimize the rate of positive margins and re-excision operation after BCS improving cosmetic outcome and decreasing health care costs. This study is aimed to report our experience combining OBCS and tailored WL as surgical approach for early breast cancers.Methods: We performed a retrospective study on 148 breast cancer patients who were treated with OBCS and tailored WL, which consists in individualization of the number and location of wires depending on patient particularities, in our Breast Unit from March 2013 to December 2015. A multivariate analysis was used to determine the association between clinic-pathologic variables, which can be known preoperatively, and margin status.Results: The rate of affected margins was 13.5% and 10.8% patients underwent re-interventions for oncologic reasons. Multifocality was strongly associated with involved margins [odds ratio (OR) 4.67].Conclusions: OBCS together with tailored WL obtains an acceptable rate of positive margins and high rate of final BCS.