Localization Of Non-palpable Breast Cancer Research Articles

SP6.3 - Comparison of three new wireless non-radiation techniques for localization of non-palpable breast cancer - an updated systematic review and pooled meta-analysis

Abstract The method for finding non-palpable breast cancers has evolved due to technological advancements. New wire-free techniques have made implantation and retrieval easier with improved oncological outcomes. Although some evidences are available as to reduced requirement for re-operation with wireless techniques when compared to wire, in current clinical practice, the choice of selection amongst wireless technique depends on clinician preference and there is a lack of consensus. The objective of current systematic review and meta-analysis is to assess the clinical effectiveness between three new wireless non radiation localisation techniques, such as Magseed (Magnetic seed), Radiofrequency identification tag (RFID) and Savi-scout reflector localization from published literature over the last 3 years. Literature search as per PRISMA guidelines revealed twenty-six studies from 2020 to 2022 involving 6275 innovative agents analysing the 3 groups were identified. Statistical analysis using Medcalc software showed a pooled positive margin rate of 12.28% (95% CI, 10 -15%) and a re-excision rate of 11.29% (95%CI, 9 -14%) for all 3 innovative technique combined whereas studies that compare innovative techniques with wire, showed higher positive margin rate of 14.87% (95% CI, 12-18%) and re-excision rate of 16.23% (95% CI, 14-18%) for wire localization, along with considerable heterogeneity. In sub group analysis with Kruskal-Wallis test, there were no statistical significance for margin (p 0.797) and re-operation (p 0.464) rates between each group. Consolidated insertion and retrieval success for innovative group were 98.13% and 99.13% respectively. To establish the best localization approach, future RCT's will be required to assess quantitative cost-effective analyses.

Advanced Localization Technique for Non-Palpable Breast Cancer: Radiofrequency alone VS Combined Technique with Ultrasound.

Breast conservative surgery is the primary therapeutic choice for non-aggressive early breast cancers, and a minimally-invasive approach is strongly recommended. The breast localization represents a modern challenge for surgery. Wire-guided localization is still the gold standard technique, but new wireless systems have been proposed, such as radiofrequency identification with LOCalizerTM (Hologic, Santa Carla, CA, USA), which reports encouraging results. The current study aimed to evaluate the accuracy and efficacy of the combined use of LOCalizerTM and ultrasound compared with the results obtained using LOCalizerTM alone for the detection of non-palpable breast cancer. Ninety-six patients who were candidates for breast localization were enrolled. Group A received a combined localization with LOCalizerTM and US, while group B underwent only LOCalizerTM identification. Oncological radicality was reached in 100% of the patients in Group A and in 89.2% of the patients in Group B, with p = 0.006. The mean specimens' volume was 13.2 ± 0.6 cm3 for Group A and 16.1 ± 1.4 cm3 for Group B, while mean specimen weights were 21.8 ± 2.2 and 24.4 ± 1.8 g, respectively (p = 0.003 and p = 0.004, respectively). LOCalizerTM with ultrasound, in the current series, has resulted in the preferred option for the localization of non-palpable breast cancer, allowing limited resection (in weight and volume), guaranteeing excellent oncological outcomes, and great satisfaction for patients and physicians.

Radiofrequency localization of nonpalpable breast cancer in a multicentre prospective cohort study: feasibility, clinical acceptability, and safety

PurposeIn breast conserving surgery, accurate lesion localization is essential for obtaining adequate surgical margins. Preoperative wire localization (WL) and radioactive seed localization (RSL) are widely accepted methods to guide surgical excision of nonpalpable breast lesions but are limited by logistical challenges, migration issues, and legislative complexities. Radiofrequency identification (RFID) technology may offer a viable alternative. The purpose of this study was to evaluate the feasibility, clinical acceptability, and safety of RFID surgical guidance for localization of nonpalpable breast cancer.MethodsIn a prospective multicentre cohort study, the first 100 RFID localization procedures were included. The primary outcome was the percentage of clear resection margins and re-excision rate. Secondary outcomes included procedure details, user experience, learningcurve, and adverse events.ResultsBetween April 2019 and May 2021, 100 women underwent RFID guided breast conserving surgery. Clear resection margins were obtained in 89 out of 96 included patients (92.7%), re-excision was indicated in three patients (3.1%). Radiologists reported difficulties with the placement of the RFID tag, partially related to the relatively large needle-applicator (12-gauge). This led to the premature termination of the study in the hospital using RSL as regular care. The radiologist experience was improved after a manufacturer modification of the needle-applicator. Surgical localization involved a low learning curve. Adverse events (n = 33) included dislocation of the marker during insertion (8%) and hematomas (9%). The majority of adverse events (85%) occurred using the first-generation needle-applicator.ConclusionRFID technology is a potential alternative for non-radioactive and non-wire localization of nonpalpable breast lesions.

Optimal localization strategies for non-palpable breast cancers -A network meta-analysis of randomized controlled trials.

PurposeMammographic screening programmes have increased detection rates of non-palpable breast cancers. In these cases, wire-guided localization (WGL) is the most common approach used to guide breast conserving surgery (BCS). Several RCTs have compared WGL to a range of novel localization techniques. We aimed to perform a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing methods of non-palpable breast cancer localization.MethodsA NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny.Results24 RCTs assessing 9 tumour localization methods in 4236 breasts were included. Margin positivity and reoperation rates were 16.9% (714/4236) and 14.3% (409/2870) respectively. Cryo-assisted localization had the highest margin positivity (28.2%, 58/206) and reoperation (18.9%, 39/206) rates. Compared to WGL (n = 2045 from 24 RCTs) only ultrasound guided localization (USGL) (n = 316 from 3 RCTs) significantly lowered margin positivity (odds ratio (OR): 0.192, 95% confidence interval (CI): 0.079–0.450) and reoperation rates (OR: 0.182, 95%CI: 0.069–0.434). Anchor-guided localization (n = 52, 1 RCT) significantly lowered margin positivity (OR: 0.229, 95%CI: 0.050–0.938) and magnetic-marker localization improved patient satisfaction (OR: 0.021, 95%CI: 0.001–0.548). There was no difference in operation duration, overall complications, haematoma, seroma, surgical site infection rates, or specimen size/vol/wt between methods.ConclusionUSGL and AGL are non-inferior to WGL for the localization of non-palpable breast cancers. The reported data suggests that these techniques confer reduced margin positivity rates and requirement for re-operation. However, caution when interpreting results relating to RCTs with small sample sizes and further validation is required in larger prospective, randomized studies.

Nationwide registry study on trends in localization techniques and reoperation rates in non-palpable ductal carcinoma in situ and invasive breast cancer.

There is a transition from wire-guided localization (WGL) of non-palpable breast cancer to other localization techniques. Multiple prospective studies have sought to establish superior clinical outcomes for radioactive-seed localization (RSL), but consistent and congruent evidence is missing. In this study, female patients with breast cancer operated with breast-conserving surgery after tumour localization of a non-palpable breast cancer or ductal carcinoma in situ (DCIS) were included. The cohort was identified from the nationwide Netherlands Breast Cancer Audit conducted between 2013 and 2018. Trends in localization techniques were analysed. Univariable and multivariable analyses were performed to assess the association between the localization technique and the probability of a reoperation. A total of 28 370 patients were included in the study cohort. The use of RSL increased from 15.7 to 61.1 per cent during the study years, while WGL decreased from 75.4 to 31.6 per cent. The localization technique used (RSL versus WGL) was not significantly associated with the odds of a reoperation, regardless of whether the lesion was DCIS (odds ratio 0.96 (95 per cent c.i. 0.89 to 1.03; P = 0.281)) or invasive breast cancer (OR 1.02 (95 per cent c.i. 0.96 to 1.10; P = 0.518)). RSL is rapidly replacing WGL as the preoperative localization technique in breast surgery. This large nationwide registry study found no association between the type of localization technique and the odds of having a reoperation, thus confirming the results of previous prospective cohort studies.

Combined LOCalizer™ and Intraoperative Ultrasound Localization: First Experience in Localization of Non-palpable Breast Cancer.

Wire-guided localization is the gold-standard for the detection of non-palpable breast lesions, although with acknowledged limitations. The aim of this study was to evaluate the combined use of LOCalizerr™ (Hologic, Santa Carla, CA, USA), and intraoperative ultrasound (IOUS) for localization and surgery of non-palpable breast cancer. Patients with non-palpable breast lesions underwent localization procedure with LOCalizer™ and IOUS. After the placement of the marker, eight measures were made to guide the excision. LOCalizerr™ Pencil and IOUS were performed to obtain the distance between the dissection plane and the margins of lesions. The procedure was feasible in the five enrolled patients and associated with clear oncological margins in all cases. Moreover, a high satisfaction according to Likert scale for surgeons, radiologists and patients, performing limited and tailored resections, was reported. Combining LOCalizerr™ and IOUS is an effective method for locating non-palpable breast cancer, guarantying excellent oncological and cosmetic results.

Abstract P3-13-10: A comparison of the micro-impulse radar SAVI SCOUT to the radioactive I125 seed in localization of non-palpable breast cancer for breast conserving therapy

Abstract Breast conservation and primary radiation (BCT) is a widely used treatment for early stage breast cancer patients. Studies report a 20-40 percent re-excision rate to obtain clear margins. Current localization practices include needle, radioactive seed and intraoperative U/S. Seed localization has been found to decrease tissue volume excision and improve patient satisfaction. However, radioactive seed programs are difficult to implement due to cumbersome regulations by the Nuclear Regulatory Commission (NRC). SAVI SCOUT® is a new technology cleared by the FDA for tumor localization. This device utilizes non-radioactive, micro-impulse radar (radar) to provide surgical guidance. The aim of this study was to evaluate the SCOUT® and determine its equivalence to seed localization by comparing re-excision rates and specimen volume. 70 patients with clinical stage 0, I, or II breast cancer who were treated with BCT were included in this IRB approved review. 35 patients were compared using the SCOUT radar localization technique with 35 patients using the radioactive iodine 125 seed localization technique. All patients received a wide segmental resection. The tissue was oriented and assessed clinically (visualization and palpation) and radiographically (Kubtec's XPERT 40 Digital Specimen Radiography System) in the operating room. Additional margins were excised if deemed to be suspicious by the surgeon (unless the anterior margin was skin or the posterior margin was the pectoral muscle fascia). Final margin status for both groups was compared. A positive margin was any margin with tumor on ink. The total volume of the excised specimen plus additional margins was recorded by the pathologist. In all 70 patients, the targeted lesions, seed and/or reflectors were successfully removed. There were 420 margins assessed (6 for each specimen), using the additional margins excised as the final margin for evaluation of tumor on ink. Of the 210 final margins in the specimens excised using the seed, 5 margins (2.38%) in 4 patients were positive. 5 margins (2.38%) were also positive in 4 patients using the SCOUT. Nine patients in total returned to the operating room for re-excision. [One re-excision was performed as physician preference for close (<2mm) margins for DCIS.] 5/9 patients requiring re-excision were found to have residual disease. A total of 119 additional margins were excised from 51 patients at the initial operation. 68 margins from 26 patients (SCOUT) and 51 margins from 25 patients (seed). Of the 119, 5 margins were found to be positive. 3 margins 4.41% (3/68) in the SCOUT group and 2 margins 3.92% (2/51) in the seed group. The average volume resected from the SCOUT averaged 81.28 cm3 while the volume of the seed averaged 100.39 cm3 (p-value 0.209). The use of SCOUT for non-palpable tumor localization was equivalent to seed localization when comparing margin re-excision rate and tissue volumes. We conclude that SCOUT is an excellent alternative in breast cancer localization and can be easily implemented in most hospitals for breast conservation therapy. Citation Format: Nolano SE, Thalhiemer LO, Yu E, Grujic E, Carter WB, Frazier TG. A comparison of the micro-impulse radar SAVI SCOUT to the radioactive I125 seed in localization of non-palpable breast cancer for breast conserving therapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-10.

Heading toward radioactive seed localization in non-palpable breast cancer surgery? A meta-analysis.

Wire-guided localization is the most commonly used technique for intraoperative localization of non-palpable breast cancer. Radioactive seed localization (RSL) is becoming more popular and seems to be a reliable alternative for intraoperative lesion localization. The purpose of the present meta-analysis was to evaluate the use of RSL. Primary study outcomes were irradicality and re-excision rates. In total 3168 patients were included. The clinical adaptation shows growing confidence in RSL and further growth is expected.

Preclinical studies of the role of iron oxide magnetic nanoparticles for nonpalpable lesion localization in breast cancer

BackgroundOne-third of all breast cancers are present as clinically nonpalpable lesions. The current gold standard treatment is surgical excision by wire-guided localization. This technique has patient, technical, and scheduling drawbacks. Alternatives exist but depend on radioisotopes with their legislative and waste management issues. Magnetic nanoparticles (MNPs) have already been successfully used for sentinel lymph node biopsy in breast cancer. We therefore aimed to determine the feasibility of using iron oxide MNPs and a handheld magnetometer for the localization of nonpalpable breast cancers using a preclinical model. MethodsWe constructed phantom models to assess the relationship between the handheld magnetometer peak readings and the variation in volume of iron oxide MNPs and their depth of injection in a series of porcine and avian tissue models. We also radiolabeled the MNPs with 99mTc and alendronate to create the conjugate 99mTc-dipicolylamine–alendronate–MNP and used nano–single-photon emission computed tomography–computed tomography to perform imaging to demonstrate localization properties. ResultsThe handheld magnetometer readings follow a linear relationship with variations in volume of magnetic tracer and a logarithmic relationship with variations in depth of injection of the magnetic tracer at a fixed volume. The application of derived quadratic equations from the R2 curves of handheld magnetometer signal versus depth allowed calculation of the depth of injection of iron oxide MNPs from the handheld magnetometer readings and demonstrated the predictable behavior of the iron oxide MNPs and the handheld magnetometer. Satisfactory localization characteristics were confirmed in the phantoms and imaged using nano–single-photon emission computed tomography and computed tomography. ConclusionsIron oxide MNPs demonstrate positive localization characteristics in phantom models with predictable behavior patterns. We suggest that the use of MNPs provides a potential technique for the localization of nonpalpable breast lesions and deserves further exploration in animal and human feasibility studies.

Radioactive seed localization for non-palpable breast cancer

Radioactive seed localization (RSL) is an alternative to wire localization for guiding surgical excision of non-palpable breast cancer. This review provides an overview of the available evidence on the accuracy of RSL in patients undergoing breast-conserving surgery. PubMed, Embase and the Cochrane Library were searched systematically in January 2012 for studies that addressed localization of non-palpable breast cancer using an iodine-125-labelled seed. Studies were deemed eligible if they reported on the proportion of patients with tumour-positive margins after RSL, the proportion of patients needing re-excision after RSL, and procedural complications. Six studies reported data on RSL in 1611 patients with non-palpable breast lesions. Overall complete resection rates ranged from 73 to 96.7 per cent. Three studies included over 300 patients, and complete resection rates in these studies varied between 89.5 and 96.7 per cent. The risk of seed migration and failure of seed placement ranged from 0 to 0.6 per cent and 0 to 7.2 per cent respectively. Available scientific evidence suggests that RSL is a safe and accurate technique for localization of non-palpable breast lesions.

Cost-Effectiveness of Radioguided Occult Lesion Localization (ROLL) Versus Wire-Guided Localization (WGL) in Breast Conserving Surgery for Nonpalpable Breast Cancer: Results from a Randomized Controlled Multicenter Trial

Accurate preoperative localization of nonpalpable breast cancer is essential to achieve complete resection. Radioguided occult lesion localization (ROLL) has been introduced as an alternative for wire-guided localization (WGL). Although efficacy of ROLL has been established in a randomized controlled trial, cost-effectiveness of ROLL compared with WGL is not yet known. The objective of this study was to determine whether ROLL has acceptable cost-effectiveness compared with WGL. An economic evaluation was performed along with a randomized controlled trial (ClinicalTrials.gov, No. NCT00539474). Women (>18 years) with histologically proven nonpalpable breast cancer and eligible for breast conserving treatment with sentinel node procedure were randomized to ROLL (n = 162) or WGL (n = 152). Empirical data on direct medical costs were collected, and changes in quality of life were measured over a 6-month period. Bootstrapping was used to assess uncertainty in cost-effectiveness estimates, and sensitivity of the results to the missing data approach was investigated. In total, 314 patients with 316 invasive breast cancers were enrolled. On average ROLL required the same time as WGL for the surgical procedure (119 vs 118 min), resulted in a 7 % higher reinterventions risk, and 13 % more complications. Quality of life effects were similar (difference 0.00 QALYs 95 % CI (-0.04-0.05). Total costs were also similar for ROLL and WGL (+<euro>26 per patient 95 % CI <euro>-250-311). ROLL is comparable to WGL with respect to both costs and quality of life effects as measured with the EQ5D and will therefore not lead to more cost-effective medical care.

Intraoperative ultrasound localization of nonpalpable breast cancers: A valuable aid during breast-conserving surgery

ObjectiveTo evaluate the usefulness of intra-operative ultrasonography (US) for localization of nonpalpable breast cancer that could be visualized with preoperative US. Patients and methodsWe prospectively assessed 57 nonpalpable sonographically detected and biopsy-proved breast cancers in 57 patients. US localization of breast cancers was performed in the OR by the radiologist immediately before definitive surgery using either injection of blue dye or placement of a guide wire after marking of the skin overlying the lesion with a marking pen. Tumor identification, the correlation with tumor diameter on preoperative US, analysis of resection margins, and the need to perform surgical re-excision were analyzed. ResultsUS correctly localized all lesions at surgery. Re-excision due to positive resection margins was necessary in four patients (7%) including three patients with ductal carcinoma-in situ (DCIS) and one patient with invasive disease at the surgical margin. Mastectomy was necessary in one patient (1.7%) due to multifocal invasive carcinoma. Thus, the re-excision rate was 8.7% (5 of 57). ConclusionUS in the operating room is an attractive alternative guiding tool of localizing nonpalpable breast cancers that have been seen on preoperative US improving the process of image-guided surgery.

Abstract P4-14-08: Intraoperative ultrasound guidance for excision of non-palpable breast cancer

Abstract Background: The effectiveness of intraoperative ultrasound (IOUS) for preoperative localization of non-palpable breast cancers within the operation theatre has not been studied extensively. In this prospective cohort study, we compared margin status, re-excision rate and excised volume of IOUS to guidewire localization (GWL). Methods: A total of 258 consecutive patients with non-palpable invasive breast cancer underwent breast conserving surgery between 1999–2010. GWL was performed in 138 (54%) and IOUS in 120 (46%) patients. Tumour dimensions, resection volume, margin status and re-excision rates were compared by means of multivariate regression analysis. Calculated resection ratios, i.e. indicating the amount of excess tissue resection, were calculated by dividing the total resection volume by the optimal resection volume (the tumor diameter plus a 1.0 cm margin) and compared between the groups. Results: The groups were similar in terms of age, histological subtype and presence of DCIS. Lesions in the IOUS group were larger (1.24 vs. 0.98 cm), while lesions in the GWL group consisted more often of microcalcifications only (19% vs. 3%). Tumour free resection margins were obtained in more than 93% of patients (93.5% with GWL vs. 93.3% with IOUS, P = .958) and re-excision was performed in 11.0% of patients undergoing GWL and 12.5% of patients undergoing IOUS (P = .684). In both groups, resection volumes were similar, but IOUS led to more optimal tissue resection (calculated resection ratio 4.33 vs 3.30, P = .018). After adjustment for tumor diameter, radiological findings and presence of DCIS, the difference in calculated resection volumes was no longer significant. Conclusion: For localization of non-palpable breast cancer, IOUS is a reliable alternative to GWL, as it achieves similar results in terms of complete tumour removal, re-excision rate and excised volume. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-14-08.

Abstract P5-15-03: Cost-effectiveness of ‘radioguided occult lesion localization’ (ROLL) versus ‘wire-guided localization’ (WGL) in breast conserving surgery for non-palpable breast cancer: results from a randomized controlled multicentre trial

Abstract Background: Accurate pre-operative localization of non-palpable breast cancer is essential to achieve complete resection. Radio-guided occult lesion localization (ROLL) has been introduced as an alternative for wire-guided localization (WGL). Although efficacy of ROLL has been established in a RCT, cost-effectiveness of ROLL compared with WGL is not yet known. Objective. To determine whether ROLL has acceptable cost-effectiveness compared with WGL. Methods. An economic evaluation was performed alongside a randomized controlled trial (ClinicalTrials.gov, number NCT00539474). Women (&amp;gt;18 years) with histologically proven non-palpable breast cancer and eligible for breast conserving treatment with sentinel node procedure were randomized to ROLL(n = 162) or WGL (n = 152). Empirical data on direct medical costs was collected, and changes in quality of life were measured over a 6 months period. Bootstrapping was used to assess uncertainty in cost-effectiveness estimates, and sensitivity of the results to the missing data approach was investigated. Results. In total, 314 patients with 316 invasive breast cancers were enrolled. On average ROLL required the same time as WGL for the initial procedure (119 vs. 118 min.), resulted in a 7% higher re-interventions risk (27% vs. 20%, p = 0.163), a 13% higher complication risk (30% vs. 17%, p = 0.006) but showed similar health effects (difference 0.00 QALYs 95%CI (−0.04 to 0.05). Total costs were also similar for ROLL and WGL (+ €26 per patient 95% CI-250 to 311). Conclusion. ROLL is comparable to WGL with respect to both costs and quality of life, and will therefore not lead to more cost-effective medical care. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-15-03.

Intraoperative ultrasound guidance for excision of non-palpable invasive breast cancer: a hospital-based series and an overview of the literature

Intraoperative ultrasound (IOUS) can be used in the operation theatre for localization of non-palpable breast cancers. In this prospective cohort study, we compared the yield of IOUS to guidewire localization (GWL). A total of 258 consecutive patients with non-palpable invasive breast cancer underwent breast conserving surgery between 1999 and 2010. GWL was performed in 138 (54 %) and IOUS in 120 (46 %) patients. Tumor dimensions, resection volume, margin status and re-excision rates were compared by means of multivariate regression analysis. The groups were similar in terms of age, histological subtype and presence of DCIS. Lesions in the IOUS group were larger (1.24 vs. 0.98 cm, P < 0.001), while microcalcifications were more common in the GWL group (19 vs. 3 %, P < 0.001). Even after stratification for tumor diameter, presence of DCIS and findings on mammography, resection volumes were similar in both groups. Tumor-free resection margins were obtained in >93 % of patients (93.5 % with GWL vs. 93.3 % with IOUS, P = 0.958) and re-excision was performed in 11 % of patients undergoing GWL and 12.5 % of patients undergoing IOUS (P = 0.684). For localization of non-palpable breast cancer, IOUS is a reliable alternative to GWL, as it achieves similar results in terms of complete tumor removal, re-excision rate and excised volume.

Intraoperative Ultrasound Localization of Nonpalpable Breast Cancers

Preoperative localization of nonpalpable breast cancers requires good coordination between imaging and surgery departments, and insertion of a guide wire can be traumatic for the patient. This study was designed to evaluate the efficacy of intraoperative ultrasound localization of nonpalpable breast cancers directly by the surgeon. This prospective study was conducted from June 2006 to October 2006 in 70 patients who underwent surgery for nonpalpable invasive breast cancer. Ultrasound was performed in the operating room by the surgeon with the patient in the operative position. Tumor identification, the correlation with tumor diameter on preoperative ultrasound, analysis of resection margins, and the need to perform surgical re-excision were analyzed. Intraoperative ultrasound identified the target in 67 (95.7%) of 70 patients. Two of the three lesions not detected by intraoperative ultrasound were < or =5 mm in diameter in patients with a body mass index of > or =25 (normal range, 19-24). The correlation with diagnostic ultrasound for tumor dimensions was satisfactory (correlation coefficient r = .80). Resection margins free of invasive lesions were obtained in 66 cases (94.3%). Three patients (4.3%) required surgical re-excision, one mastectomy due to multifocal cancer, and two lumpectomy due to positive resection margins. Intraoperative ultrasound localization of nonpalpable breast cancers is feasible and effective, with a sensitivity of 98.3% for tumors >5 mm. It spares the patient the discomfort of a radiological and/or supplementary examination with insertion of a guide wire. It also saves time and money for hospital teams.

非触知乳癌におけるVATSマーカーを用いたエコーガイド下マーキングの有用性

非触知乳癌におけるVATSマーカーを用いたエコーガイド下マーキングの有用性

Specimen radiography and preoperative localization of nonpalpable breast cancer.

Specimen radiography with or without needle localization should become standard procedure when breast biopsy is performed solely on the basis of mammographic findings. Without these techniques, surgery may prove useless. Over a five-year period from 1974 through 1978, a series of 423 specimen radiographs were done at Memorial Sloan-Kettering Cancer Center for questionable mammographic calcifications or, in a few instances, nonpalpable masses. One hundred and twenty-six proved to be carcinoma, but they represent only 4% of the total number of cancers treated during this period of time. Most breast cancers are still being detected by palpation or palpation combined with mammography. The cancers needing specimen radiography or needle localization are the truly minimal lesions with the best prognosis. With present day techniques, radiation dosage from mammography is extremely low. Its continued use should be encouraged if mammography is to have any impact on breast cancer survival rates. High quality mammograms, interpretation by experienced radiologists, and close coordination of the efforts of the radiologists, surgeon, and pathologist can make possible the detection of increasing numbers of these minimal cancers.