Radioguided versus wire-guided localization for non-palpable breast lesions: a meta-analysis

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Objective To compare the therapeutic outcome of radioguided occult lesion localization(ROLL)and radioactive seed localization (RSL)with wire-guided localization (WGL) in patients with non-palpable breast lesions (NPBL). Methods The PubMed, Embase, Cochrane, CNKI, Wanfang and VIP databases were searched for randomized control studies which compared ROLL/RSL with WGL from the earliest available date up to April 2017. Two researchers independently completed literature retrieval and data extraction, and evaluated the quality of the studies based on Cochrane handbook. Risk ratio(RR)and mean difference(MD)with 95% confidence interval(CI)were pooled for dichotomous and continuous variables, respectively. RevMan 5.3 software was adopted for a meta-analysis. Results Fourteen randomized controlled trials(RCT) were eligible, involving a total of 2 311 patients(ROLL: n=562, RSL: n=614, WGL: n=1 135). There was no significant difference in localization-related complication rate (RR=0.53, 95%CI: 0.24-1.18, P=0.120), successful excision rate (RR=1.01, 95%CI: 0.99-1.02, P=0.240), positive margin rate (RR=0.88, 95%CI: 0.68-1.13, P=0.310), intra-operative re-excision rate (RR=1.07, 95%CI: 0.71-1.61, P=0.750), re-operation rate (RR=0.54, 95%CI: 0.23-1.25, P=0.150), postoperative complication rate (RR=0.88, 95%CI: 0.56-1.40, P=0.590) and specimen volume (MD=-2.11, 95%CI: -8.39-4.16, P=0.510)between ROLL group and WGL group. No significant difference was observed in localization-related complication rate (RR=1.02, 95%CI: 0.21-5.08, P=0.980), positive margin rate (RR=0.84, 95%CI: 0.65-1.09, P=0.190), re-operation rate (RR=0.78, 95%CI: 0.55-1.11, P=0.170) and postoperative complication rate (RR=1.34, 95%CI: 0.81-2.22, P=0.260) between RSL group and WGL group. Conclusion With similar effect to WGL, ROLL and RSL are feasible for the localization of non-palpable breast lesions in clinic. Key words: Breast neoplasms; Palpation; Radiosurgery; Radiology; Meta-analysis