Magnetically Guided Localization Using a Guiding-Marker System® and a Handheld Magnetic Probe for Nonpalpable Breast Lesions: A Multicenter Feasibility Study in Japan.

Tomoko Kurita,Hiroyuki Takei,Meishi Hankyo,Moriaki Kusakabe,Yoko Kanada,Kanae Taruno,Takashi Sakatani,Akihiro Kuwahata,Kentaro Sakamaki,Masaki Sekino,Takashi Kuwayama,Katsutoshi Enokido,Keiko Yanagihara,Sadako Akashi-Tanaka,Misaki Matsuyanagi,Seigo Nakamura

doi:10.3390/cancers13122923

Abstract

Simple SummaryIn this multicenter feasibility study, non-palpable breast lesions in 89 patients were localized using a handheld cordless magnetic probe (TAKUMI) and a magnetic marker (Guiding-Marker System®). Additionally, a dye was injected subcutaneously under ultrasound guidance to indicate the extent of the tumor. Consequently, a magnetic marker was detected in all resected specimens, and the initial surgical margin was positive only in five (6.1%) of 82 patients. Thus, the magnetic guiding localization system with ultrasound guidance is useful for the detection and excision of non-palpable breast lesions.Accurate pre-operative localization of nonpalpable lesions plays a pivotal role in guiding breast-conserving surgery (BCS). In this multicenter feasibility study, nonpalpable breast lesions were localized using a handheld magnetic probe (TAKUMI) and a magnetic marker (Guiding-Marker System®). The magnetic marker was preoperatively placed within the target lesion under ultrasound or stereo-guidance. Additionally, a dye was injected subcutaneously to indicate the extent of the tumor excision. Surgeons checked for the marker within the lesion using a magnetic probe. The magnetic probe could detect the guiding marker and accurately localize the target lesion intraoperatively. All patients with breast cancer underwent wide excision with a safety margin of ≥5 mm. The presence of the guiding-marker within the resected specimen was the primary outcome and the pathological margin status and re-excision rate were the secondary outcomes. Eighty-seven patients with nonpalpable lesions who underwent BCS, from January to March of 2019 and from January to July of 2020, were recruited. The magnetic marker was detected in all resected specimens. The surgical margin was positive only in 5/82 (6.1%) patients; these patients underwent re-excision. This feasibility study demonstrated that the magnetic guiding localization system is useful for the detection and excision of nonpalpable breast lesions.

Highlights

The introduction of mammographic screening programs has led to the identification of an increased number of nonpalpable breast lesions
Localization markers inkplaced margin the formalin-fixed were for masses (71on patients) under sonographic guidance and forparaffin-e calcification
64 patients had invasive tus, in carcinoma, and most 23 had ductal carcinoma in situ (DCIS).cases, was determined on initia sified based on consensus guidelines [21,22]

Summary

Introduction

The introduction of mammographic screening programs has led to the identification of an increased number of nonpalpable breast lesions. Due to the development of neoadjuvant chemotherapy, there has been an increase in the number of patients in whom a complete response was obtained [3]. These lesions are often difficult to identify preoperatively and intraoperatively. Several techniques have been developed for the localization of nonpalpable breast cancers [1,4,5,6,7]. The two most established techniques for pre-operative localization of nonpalpable breast lesions are wire-guided localization (WGL) and radioactive seed localization (RSL). RSL involves implanting a small radioactive seed to identify the lesion and/or its borders. RSL overcomes many of the disadvantages of WGL, but it requires a strict nuclear regimen, which is its main limitation for applicability at hospitals

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Discussion

Conclusion