Abstract
BackgroundWire-guided localization (WGL) of early breast cancer can be facilitated using multiple wires, which is called bracketing wire-guided localization (BWL). The primary aim of this study is to compare BWL and conventional WGL regarding minimization of resection volumes without compromising margin status. Secondly, BWL is evaluated as an alternative method for intraoperative ultrasound (US) guidance in poorly definable breast tumors on US. Patients and MethodsIn this retrospective cohort study, patients with preoperatively diagnosed breast cancer undergoing wide local excision between January 2016 and December 2018 were analyzed. Patients with multifocal disease or neoadjuvant treatment were excluded from this study. Optimal resection with minimal healthy breast tissue removal was assessed using the calculated resection ratio (CRR). ResultsBWL was performed in 17 (9%) patients, WGL in 44 (22%), and US in 139 (70%). The rate of negative margins was comparable in all 3 groups. The CRR was significantly smaller for BWL (0.6) than WGL (1.3) in tumors larger than 1.5 cm. Additionally, BWL (0.8) led to smaller CRRs than US (1.7). This could be explained by the high number of small tumors (≤ 1.5 cm) in the US group for which greater CRRs are obtained than for large tumors (> 1.5 cm) (1.9 vs. 1.4; P = .005). ConclusionFor breast tumors larger than 1.5 cm, BWL achieves more optimal resection volumes without compromising margin status compared with WGL. Moreover, BWL seems a suitable alternative to US in patients with poorly ultrasound-visible breast tumors and patients with a small tumor in a (large) breast.
Highlights
Recent developments in imaging and diagnostic tools and the establishment of mammographic screening programs have led to breast cancer being diagnosed at an earlier stage.[1,2] As a result of Submitted: Mar 17, 2020; Accepted: Apr 26, 2020; Epub: May 5, 2020To achieve optimal tumor resection, the precision of the tumor localization technique is essential
Of the 61 patients treated with wire localization, 46 (75%) patients had a non-palpable tumor, and most tumors consisted of ductal carcinoma in situ (DCIS) (49%) or invasive ductal carcinoma (41%)
The results of this study show that bracketing wire-guided localization (BWL) leads to resection of less healthy breast tissue without compromising margin status in patients with breast tumors larger than 1.5 cm compared with WGL
Summary
Recent developments in imaging and diagnostic tools and the establishment of mammographic screening programs have led to breast cancer being diagnosed at an earlier stage.[1,2] As a result of Submitted: Mar 17, 2020; Accepted: Apr 26, 2020; Epub: May 5, 2020To achieve optimal tumor resection, the precision of the tumor localization technique is essential. - Clinical Breast Cancer December 2020 e749. If the tumor is not visible on ultrasound, wire-guided-localization (WGL) is used.[14,15,16] WGL is associated with increased margin involvement compared with US.[14,17,18,19,20,21,22] This higher rate of positive margins could be explained by the use of a single wire, by which the 3 dimensions of the tumor cannot be outlined. With a single wire, it is more difficult to specify which tissue has to be excised to achieve complete resection
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