Radioactive seed vs wire localization for nonpalpable breast lesions: A single institution review

Horwood, Chelsea R.; Grignol, Valerie; Lahey, Samantha; Pemmaraju, Vishnu; Schafer, Andrew; Terando, Alicia M.; Agnese, Doreen M.

doi:10.1111/tbj.13201

Cited by 6 publications

(8 citation statements)

References 14 publications

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“…Similar to our overall findings, Horwood et al, in their single institution analysis, found no difference in the volume of tissue removed between the WL and RS groups ( P = .1353). 5 Langhans et al, in their randomized controlled trial, also found no difference in the total weight of tissue removed, either in the primary excision alone ( P = .32) or when all tissue (including selective margins) were considered ( P = .54). 6 While our subset analysis showed a smaller volume of tissue excised in the RS group, this goes against both the findings of our main analysis and that of previous studies.…”

Section: Discussionmentioning

confidence: 93%

“…This is similar to what others have also reported. 5-7 In a randomized controlled trial of 298 patients, Fung et al found that the positive margin rate was similar between WL and RS groups (12% vs. 10%, respectively, P = .666). 7 Langhans et al also reported similar positive margin rates between the WL and RS groups in their trial of 409 patients (13.3% vs. 11.8%, respectively, P = .65).…”

Section: Discussionmentioning

confidence: 99%

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Does Localization Technique Matter for Non-palpable Breast Cancers?

Chagpar

Garcia-Cantu

Howard-McNatt

et al. 2021

The American Surgeon

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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.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Does Localization Technique Matter for Non-palpable Breast Cancers?

Chagpar

Garcia-Cantu

Howard-McNatt

et al. 2021

The American Surgeon

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“…40 Although many studies do not include surgical complications in their data presented, RSL was reported a 5% complication rate but specific complications were not delineated. 41 Those using RFID have documented hematomas requiring return to the operating room, 42,43 in addition to seromas and wound infections at similar rates. 43 An early experience with MagSeed also reports hematoma formation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the SmartClip™ Nonradioactive Seed, a Novel Wireless Localization Method for the Breast: Initial Clinical Experience and Surgical Outcome

Hefelfinger,

Doherty,

Wahab

et al. 2023

The American Surgeon™

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Introduction Wire localization has been the gold standard for breast localization of non-palpable lesions for decades. This technique remains robust but has disadvantages relative to scheduling, complications of vasovagal reactions in placement, wire migration, or transection. With more modern technologies available, several implantable markers have been developed to allow uncoupling of localization by radiology and the surgical procedure on the same day. This study summarizes our experience with the EnVisio Navigation System™ utilizing SmartClip™ as the implantable tissue localization marker. Methods An IRB-approved retrospective database of benign and malignant breast disease was used to perform a review of 100 consecutive patients who underwent SmartClip™ localized breast and axillary procedures in 2021. Demographic information, localization accuracy, associated surgical procedure(s) with resultant pathology findings, margin status for malignancies, and re-excision rate were collected. Results The localized breast lesion or lymph node was excised and SmartClip™ retrieved in all cases, confirmed by intraoperative specimen radiograph. The distribution of gender and race/ethnicity among the patients who underwent surgery reflects the community population and frequency of breast cancer development among men versus women. 45.1% of the cases involved malignancy, as determined pre-operatively. Positive margins requiring re-excision constituted 18.2% of cases. In twenty-six patients, two or three SmartClips™ were placed per case for either a bracketed lesion, two separate breast lesions, and/or a breast lesion and lymph node. Conclusion Although this study is limited in patient number, it demonstrates safety of this technique and its reliability in guiding the surgeon directly to the lesion(s) of concern.

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“…Studies published that examine resection margin status in using wire‐guided localizations, RSL and SSR, Magseed® and RFID appear to be comparable or slightly improved over wire localization in obtaining negative margins on excision. 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 The technical difficulties in placing these seeds are similar to tissue marker placement, with the risk of seed migration, failure of seed placement, and inadvertent deployment of seed. 29 , 30 , 31 Given similar methods of deployment, it is not surprising that the similar technical difficulties result.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Radioactive seed vs wire localization for nonpalpable breast lesions: A single institution review

Cited by 6 publications

References 14 publications

Does Localization Technique Matter for Non-palpable Breast Cancers?

Does Localization Technique Matter for Non-palpable Breast Cancers?

Evaluation of the SmartClip™ Nonradioactive Seed, a Novel Wireless Localization Method for the Breast: Initial Clinical Experience and Surgical Outcome

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

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