Abstract
Simple SummaryA large portion of breast lesions are not palpable and need to be marked before surgery in order to aid complete surgical removal. Currently, this is accomplished by placing a hook in the lesion with radiological guidance, which is in turn attached to a wire through the skin. This is a well-understood technique and is called wire-guided localisation (WGL). It has drawbacks, including being uncomfortable for the patient, and the need for the wire to be placed within less than a day of the surgery. This is why certain wireless techniques have been developed to replace WGL. LOCalizer™ is one such technique, which uses radio-frequency identification tags. In this study, we have systematically reviewed the literature regarding LOCalizer™, and confirmed that it is a valid alternative to WGL. We have also highlighted its limitations and suggested potential technical refinements to improve its clinical performance.Wire-guided localisation (WGL) has been the gold-standard for localising non-palpable breast lesions before excision. Due to its drawbacks, various wireless alternatives have been developed, including LOCalizer™, which is based on radio-frequency identification (RFID) technology. In this systematic review, we consulted EMBASE, Medline and PubMed databases using appropriate search terms regarding the use of RFID technology in the localisation of occult breast lesions. Retrospective and prospective studies were included if they quoted the number of patients, rate of successful placement, retrieval rate, margin positivity rate and the re-excision rate. In addition, studies comparing RFID to WGL were also included and analysed separately. Seven studies were included in this systematic review spanning 1151 patients and 1344 tags. The pooled deployment rate was 99.1% and retrieval rate was 100%. Re-excision rate was 13.9%. One complication was identified. Two studies compared RFID with WGL (128 vs. 282 patients respectively). For both techniques the re-excision rate was 15.6% (20/128 vs. 44/282 respectively, p value is 0.995). Based on our review, LOCalizer™ is safe and non-inferior to WGL in terms of successful localisation and re-excision rates. However, further research is required to assess the cost effectiveness of this approach and its impact on the aesthetic outcome compared with WGL and other wire free technologies to better inform decision making in service planning and provision.
Highlights
Non-palpable lesions form a large plurality of breast cancer cases treated every year
We have recently investigated the clinical performance of currently available radiationfree wireless localisation technologies, SAVI SCOUT (Merit Medical, Alieso Viejo, CA, USA) [9] and Magseed (Endomag Limited, Cambridge, UK) [10]
We present the findings of our systematic review of the literature regarding LOCalizerTM, which shall guide our discussion regarding the merits and issues pertaining to the system, especially in view of the available alternatives
Summary
Non-palpable lesions form a large plurality of breast cancer cases treated every year. The current gold standard, which has been prevalent since the 1970s, is the placement of hooks at the site of the lesion marked by wires protruding from the skin. This is commonly termed as wire-guided localisation (WGL) of the occult breast lesion [4,5,6]. The professional community at large has significant experience and familiarity with this technique, which is not to say that WGL is not without its drawbacks. The most salient reason to find an alternative to WGL is the onerous scheduling requirement imposed on health systems by closely coupling radiological appointments with surgery slots [4,7,8]
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