Nonpalpable Breast Cancer Research Articles

Preoperative Ultrasound-Guided Marking, Mammogram, and Peroperative Use of Image Intensifier: A Cost-Effective Technique in Clipped Non-Palpable Breast Cancer Lesions to Achieve Adequate Surgical Margins.

To measure the effectiveness of localisation and removal of impalpable target lesions without compromising patient safety in a resource-limited setup using preoperative ultrasound and mammography with peroperative use of C-arm image intensifier. Descriptive study. Place and Duration of the Study: Department of Breast Surgery, Ittefaq Hospital (Trust), Lahore, Pakistan, from 25th October 2011 to 17th February 2023. All the breast cancer patients who achieved complete clinical response after neoadjuvant systemic treatment and underwent breast conservation surgery during the study period were included. Tumour / clip localisation was done using preoperative ultrasound or image-guided marking, a 2-view mammogram in all cases and the use of an image intensifier to confirm the presence of clips in the excised specimen. The primary outcome was the accurate localisation and removal of the index lesion, while the secondary outcome included the reoperation rate for positive margins and early local recurrence. Data from 144 patients were reviewed. Successful localisation was done in all the patients; only one patient had a positive margin for ductal carcinoma-in situ (DCIS), achieving a 99.3% clear margin rate. Local recurrence within two years after primary operation was seen in one patient only. Conclusion: By a combined approach of preoperative ultrasound-guided marking, a 2-view mammogram, and the use of image intensifier, successful localisation of an impalpable breast lesion is possible without compromising oncological and aesthetic principles. Breast conservation surgery, Localisation, Non-palpable, Margins, Image intensifier.

Preoperative Ultrasound-Guided Marking, Mammogram, and Peroperative Use of Image Intensifier: A Cost-Effective Technique in Clipped Non-Palpable Breast Cancer Lesions to Achieve Adequate Surgical Margins.

To measure the effectiveness of localisation and removal of impalpable target lesions without compromising patient safety in a resource-limited setup using preoperative ultrasound and mammography with peroperative use of C-arm image intensifier. Descriptive study. Place and Duration of the Study: Department of Breast Surgery, Ittefaq Hospital (Trust), Lahore, Pakistan, from 25th October 2011 to 17th February 2023. All the breast cancer patients who achieved complete clinical response after neoadjuvant systemic treatment and underwent breast conservation surgery during the study period were included. Tumour / clip localisation was done using preoperative ultrasound or image-guided marking, a 2-view mammogram in all cases and the use of an image intensifier to confirm the presence of clips in the excised specimen. The primary outcome was the accurate localisation and removal of the index lesion, while the secondary outcome included the reoperation rate for positive margins and early local recurrence. Data from 144 patients were reviewed. Successful localisation was done in all the patients; only one patient had a positive margin for ductal carcinoma-in situ (DCIS), achieving a 99.3% clear margin rate. Local recurrence within two years after primary operation was seen in one patient only. Conclusion: By a combined approach of preoperative ultrasound-guided marking, a 2-view mammogram, and the use of image intensifier, successful localisation of an impalpable breast lesion is possible without compromising oncological and aesthetic principles. Breast conservation surgery, Localisation, Non-palpable, Margins, Image intensifier.

Non-Palpable Breast Cancer: A Targeting Challenge–Comparison of Radio-Guided vs. Wire-Guided Localization Techniques

Background: The incidence of non-palpable breast cancer is increasing due to widespread screening and neo-adjuvant therapies. Among the available tumor localization techniques, radio-guided occult lesion localization (ROLL) has largely replaced wire-guided localization (WGL). The aim of this study was to compare the ROLL and WGL techniques in terms of the effectiveness of isotopic marking of axillary sentinel lymph nodes and to assess patient perspectives along with surgeon and radiologist preferences. Methods: A single-center, prospective, randomized study enrolled 110 patients with non-palpable breast lesions (56 ROLL, 54 WGL). Breast type, tumor volume, location, histological and radiological features, and localization/surgical duration were evaluated in the context of sentinel lymph node marking using isotope (technetium-99m-labeled human serum albumin) and blue dye. Statistical analysis was performed with significance set at p < 0.05 and strong significance at p < 0.01. Results: A single-center, prospective, randomized study enrolled 110 patients with non-palpable breast lesions (56 ROLL, 54 WGL). Breast type, tumor volume, location, histological and radiological features, and localization/surgical duration were evaluated in the context of sentinel lymph node marking using isotope (technetium-99m-labeled human serum albumin) and blue dye. Statistical analysis was performed with significance set at p < 0.05 and strong significance at p < 0.01. Conclusions: While ROLL provided advantages in terms of patient comfort and logistical simplicity, WGL was superior for axillary sentinel lymph node marking, particularly in inner quadrant tumors, suggesting that WGL may be preferred in these cases.

Image-Guided Breast Conserving Surgery

Background: Breast-conserving surgery (BCS) has gained wide acceptance as the treatment of choice for early-stage breast cancer. One of the primary goals of BCS is to obtain tumor-free resection margins. In practice, the excision of a palpable breast carcinoma is guided by preoperative diagnostic images and the intraoperative tactile skills of the surgeon. The somewhat ‘blind’ approach of using palpation-guided surgery is known to be highly inaccurate, with studies worldwide reporting positive resection margins in up to 41% of patients. In recent years, ultrasonography has emerged as an effective guidance tool during surgery and ultrasound-guided surgery has been introduced into breast cancer surgery as a method of excising nonpalpable breast cancer. Objective: The aim of this study is comparing ultrasound-guided vs palpation-guided conservative breast surgery in obtaining tumor-free resection margins. Methods: This study was a prospective randomized controlled clinical trial where patients with early breast cancer (T1-T2) and eligible for breast conserving surgery are randomly assigned (1:1) into two arms. Arm A: included the patients who will undergo ultrasound-guided breast conserving surgery. Arm B: included the patients who will undergo the conventional palpation-guided breast conserving surgery. Results: Overall, 142 patients undergoing breast conserving surgery were enrolled: 71 were allocated to the Ultrasound-guided (US) group (Arm A) and 71 to the Palpation-guided (PG) group (Arm B). Patient and tumor characteristics were comparable between the two groups. Age, Body mass index, tumor laterality, tumor location and tumor stage were comparable in both groups and statistically insignificant. Despite that the final tumor size was comparable between both groups, IOUS significantly reduced the main specimen volume and the least negative margin width (p<0.001). The median operative time was significantly longer in the US group bey around 27 min than in the PG group and this was statistically significant in favor of the PG surgery (p<0.001). The involved resection margin rate was significantly higher in the PG group and thus the need for reoperation (p<0.001). Conclusion: IOUS is the only method allowing a true real-time visualization and continuous control of resection margins during all phases of BCS. In our single-institution study, IOUS demonstrated clear superiority over palpation-guided surgery in both oncological and surgical outcomes except for the operative time (smaller excision volume yet, with optimum resection margins). IOUs provides much better tumor localization in small breasts with dense fibroadenosis. Since all the other available localization techniques (including palpation) limit the surgeon’s visual guidance during BCS, IOUS could be regarded as one of the most significant modern technological innovations in the field of breast cancer surgery, restoring sight to the breast surgeon. Our findings strongly suggests that the integration of IOUS in breast conserving surgery could be regarded as a highly beneficial surgical approach.

Preoperative Ultrasound-guided Head and Neck Non-palpable Tumor Detection

Objective: Preoperative ultrasound-guided breast cancer detection was developed in the 1980s for non-palpable breast cancers. This technique was applied to neck surgery in 5 specific cases. Methods: Retrospective study to assess the efficacy and safety of this technique. Results: The mean surgical time was 35.2 ± 15.2 min. There were no complications of this percutaneous target location procedure. All surgical procedures allowed easy target retrieval without any complications. All targets were later confirmed to be the site of cancer. Conclusion: This adaptation of a senology technique to the head and neck region allows us to improve neck procedures by enhancing diagnostic precision, safety, and surgical efficiency.

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.

72229 - Ultralow dose of superparamagnetic iron oxide nanoparticles in combination with Magseed for sentinel node detection in nonpalpable breast cancer

72229 - Ultralow dose of superparamagnetic iron oxide nanoparticles in combination with Magseed for sentinel node detection in nonpalpable breast cancer

Reliability of Magseed® marking before neoadjuvant systemic therapy with subsequent contrast-enhanced mammography in patients with non-palpable breast cancer lesions after treatment: the MAGMA study

PurposeTo assess the reliability of excising residual breast cancer lesions after neoadjuvant systemic therapy (NAST) using a previously localized paramagnetic seed (Magseed®) and the subsequent use of contrast-enhanced spectral mammography (CESM) to evaluate response.MethodsObservational, prospective, multicenter study including adult women (> 18 years) with invasive breast carcinoma undergoing NAST between January 2022 and February 2023 with non-palpable tumor lesions at surgery. Radiologists marked tumors with Magseed® during biopsy before NAST, and surgeons excised tumors guided by the Sentimag® magnetometer. CESMs were performed before and after NAST to evaluate tumor response (Response Evaluation Criteria for Solid Tumors [RECIST]). We considered intraoperative, surgical, and CESM-related variables and histological response.ResultsWe analyzed 109 patients (median [IQR] age of 55.0 [46.0, 65.0] years). Magseed® was retrieved from breast tumors in all surgeries (100%; 95% CI 95.47–100.0%) with no displacement and was identified by radiology in 106 patients (97.24%), a median (IQR) of 176.5 (150.0, 216.3) days after marking. Most surgeries (94.49%) were conservative; they lasted a median (IQR) of 22.5 (14.75, 40.0) min (95% CI 23.59–30.11 min). Most dissected tumor margins (93.57%) were negative, and few patients (5.51%) needed reintervention. Magseed® was identified using CESM in all patients (100%); RECIST responses correlated with histopathological evaluations of dissected tumors using the Miller–Payne response grade (p < 0.0001) and residual lesion diameter (p < 0.0001). Also 69 patients (63.3%) answered a patient’s satisfaction survey and 98.8% of them felt very satisfied with the entire procedure.ConclusionLong-term marking of breast cancer lesions with Magseed® is a reliable and feasible method in patients undergoing NAST and may be used with subsequent CESM.

Three-dimensional automated breast ultrasound – a supplemental screening tool

Background. Three-dimensional automated breast ultrasound (ABUS) is an innovative technology that allows global visualization of the breast and eliminates the operator-dependence of hand held ultrasound. Three-projection scanning during ABUS is provided by an ultra-long (15.4 cm) probe with a frequency of 14–16 MHz, and then the slices are reconstructed on a workstation. At the same time, high-frequency converters create high-resolution images. Through a special coronal projection, ABUS identifies variants of minimal, non-palpable breast cancer, including those with women with high mammographic breast density, which makes it a promising additional (supplemental screening) method of oncomammoscreening.Aim. To assess the use of ABUS as a supplemental screening tool in women with high mammographic breast density.Materials and methods. The study was conducted in 2018 at the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia. As part of the study, 192 women underwent mammography, ABUS, and multiparametric ultrasound (B-mode, color Doppler, elatography) in standard manual mode.Results. In the course of the study, in 192 patients, mammography revealed 42 cases of breast cancer, while using the AUS and manual ultrasound, additionally were identified 9 cases of breast cancer. Also, the ABUS showed high accuracy in assessment of the distribution of breast cancer – multifocal, multicentric and bilateral.Conclusion. ABUS is a promising and highly effective diagnostic method in women with high mammographic breast density, with its advantages and disadvantages, which can be used in combination with mammography as a supplemental screening tool, especially in women at high risk of developing breast cancer.

Abstract PO1-23-04: The IBRAnet localisation study; a UK National multi-centre cohort study comparing the safety and effectiveness of guidewire, RFID, and magnetic seed- guided localisation for impalpable breast lesions

Abstract Background Wire-guided localisations (WGL) of breast cancers have been the gold-standard for pre-operative localisation of non-palpable breast cancers for many years but have significant limitations. Newer localisation techniques have been introduced including Radio Frequency ID tags (RFID) and magnetic seeds which aim to overcome these limitations. The UK iBRA-net group have designed a multi-centre platform study aiming to compare the safety and effectiveness of wire, RFID, magnetic seeds, and radar-based localisation. A second aim was the qualitative assessment of shared learning as users gained experience. Methods A UK national multi-centre prospective observational platform study was designed to compare a control arm of WGL for women undergoing breast conserving surgery with two interventional arms of RFID tags and magnetic seeds. Patient data were collected between August 2018 and July 2022 in UK centres. The primary outcome was accurate excision of the index lesion at the time of surgery. Secondary outcomes were defined as; resection margins, breast reoperation rate (planned and unplanned), complications, cancellation rate on day of surgery, and duration of the surgery. To account for lesion size in the assessment of excision weight, we used size as a denominator over two dimensions, reporting this as weight/size2, in g/mm2. Data was collected prospectively on a secure REDcap database following approval from local audit departments. To calculate the sample size a power calculation was employed, with n=950 patients per group the upper limit of the observed one-sided 95% confidence interval for the difference between identification rates (intervention vs WGL) is expected to be less than 0.9% with 80% power, assuming the two methods both have an expected identification rate of 99.4%. Simple summary statistics were calculated for each outcome and data were tested for distribution and differences between groups using unpaired t-tests, Mann-Whitney U tests, and Chi squared tests as appropriate. Analyses were conducted using Stata® IC version 14 (StataCorp, College Station, Texas, USA). Results Data were accrued from 3484 patients in 55 units. This included 1293 patients having WGL, 1188 RFID tags, and 1003 magnetic seeds. RFID had a lower rate of identification of the index lesion compared to magnetic seed and wire (97.9% vs. 99.8% vs. 99.1% respectively). When comparing the reasons behind failure of the primary outcome, the majority were not thought to be related to the modality of localisation. Data from 1560 patients with unifocal, unilateral breast lesions were included in subgroup analysis, excluding those having neo-adjuvant chemotherapy and those having therapeutic mammoplasty. Positive margins were lower in RFID excisions compared to wire (11.2% vs. 15% respectively, p&amp;lt; 0.05), whereas magnetic seed were equivalent (11.2 % vs 13.3%, P=0.22). Routine cavity shaves were performed in 64.5% of WGL vs 48.3% of RFID vs 64.3% of magnetic guided excisions. There was no difference in specimen weight/size2 (0.138 WGL vs. 0.131 RFID vs. 0.15 magnetic seed). Re-excision (for positive or close margins) was equivalent across the three groups (13.2% of wire vs 15% of RFID vs 12.3% of magnetic seed guided excisions, p=0.3). There have been four shared learning educational events focussing on three key themes relating to preoperative, intraoperative, and postoperative learning outcomes in addition to 130 database shared learning entries. This may aid other surgeons as they adopt these techniques. Conclusions All three localisation devices demonstrate high levels of localisation accuracy. There was a higher rate of device dislodgement in the RFID group, which was also identified in the shared learning events. However, re-excision rates were equivalent across the three groups. This study has demonstrated a robust platform for the comparative evaluation of new localisation technologies and of sharing learning and experience. Citation Format: Rachel Foster, James Harvey, Rajiv Dave, Anthony Maxwell, Senthurun Mylvaganam, Matthew Gardiner, Sue Down, Nicola Barnes, Mihir Chandarana, Shelley Potter, Yazan Masannat, Chris Holcombe, Tahir Masudi, Amtul Carmichael, Robert Milligan, Jenna Morgan. The IBRAnet localisation study; a UK National multi-centre cohort study comparing the safety and effectiveness of guidewire, RFID, and magnetic seed- guided localisation for impalpable breast lesions [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-23-04.

Clinicopathological and Genomic Identification of Breast Cancers with No Impact on Mortality.

Implementing mammogram screening means that clinicians are seeing many breast cancers that will never develop metastases. The purpose of this study was to identify subgroups of breast cancer patients who did not present events related to long-term breast cancer mortality, taking into account diagnosis at breast screening, absence of palpability and axillary involvement, and genomic analysis with PAM50. To identify them, a retrospective observational study was carried out selecting patients without any palpable tumor and without axillary involvement, and a genomic analysis was performed with PAM50. The probability of distant metastasis-free interval (DMFI) of 337 patients was 0.92 (95% CI, 0.90-0.93) at 20 years and 0.96 (95% CI, 0.92-1.00) in 95 patients (28%) with available PAM50 tests. In 22 (23.15%) luminal A tumors and in 9 (9.47%) luminal B tumors smaller than 1 cm, and in HER2 and basal type tumors, there were no metastatic events (20-year DMFI of 1.00). Patients with nonpalpable breast cancer found at screening with negative nodes are at very low risk. It is possible to identify subgroups without metastatic events by determining the intrinsic subtype and tumor size less than 1 cm. Therefore, de-escalation of treatment should be considered.

Specimen tomosynthesis provides no additional value to specimen ultrasound in ultrasound-visible malignant breast lesions.

The aim of this study was to evaluate the accuracy and added value of specimen tomosynthesis (ST) to specimen ultrasound (SUS) in margin assessment of excised breast specimens in breast-conserving therapy for non-palpable US-visible breast lesions. Between January 2018 and August 2019, all consecutive patients diagnosed with non-palpable breast cancer visible by ultrasound (US), treated with breast-conserving surgery (BCS) and requiring radiological intraoperative breast specimen assessment, were included in this study. Excised breast specimens were examined with SUS by radiologists blinded to the ST results, and margins smaller than 10 mm were recorded. STs were evaluated retrospectively by experienced radiologists. A total of 120 specimens were included. SUS showed a statistically significant correlation with pathological margin measurements, while ST did not and provided no additional information. The odds ratios (ORs) for SUS to predict a positive margin was 3.429 (confidence interval (CI) = 0.548-21.432) using a 10-mm cut-off point and 14.182 (CI = 2.134-94.254) using a 5-mm cut-off point, while the OR for ST were 2.528 (CI = 0.400-15.994) and 3.188 (CI = 0.318-31.998), respectively. SUS was superior in evaluating intraoperative resection margins of US-visible breast resection specimens when compared to ST. Therefore, ST could be considered redundant in applicable situations.

SENOSI Confocal Microscopy: A New and Innovating Way to Detect Positive Margins in Non-Palpable Breast Cancer?

In Switzerland, breast cancer is the leading cancer among women, with breast-conserving surgery (BCS) being the preferred treatment for small tumors. The margin status post-surgery is a critical predictor of local recurrence. Achieving negative margins remains a challenge, leading to re-excision in 20-30% of cases. Traditional methods like intraoperative examination palpation and radiography have limitations in assessing excised margins. This study introduces the Histolog® Scanner, a confocal microscopy tool, as a potential solution. It provides real-time images of tissue architecture, allowing for rapid and accurate assessment of excised margins. Our research compared the Histolog® Scanner with standard per-operative radiography in patients with non palpable breast cancer. Preliminary results indicate that the Histolog® Scanner offers a reliable and time-efficient method for margin assessment, suggesting its potential for clinical integration.

Combining Contrast-Enhanced Mammography and Radioactive-Free Magnetic Seed Localization of Non-palpable Breast Tumors: A Feasibility Study.

Background: Magnetic seed localization is a novel and reliable technique for perioperative localization of non-palpable breast cancers. However, due to susceptibility artifacts, magnetic seeds cannot be in situ during response monitoring of neoadjuvant chemotherapy with MRI. Contrast-enhanced mammography (CEM) could provide an alternative modality for response monitoring while magnetic seeds are in situ. This feasibility study aimed to investigate whether implanted magnetic seeds cause imaging artifacts in CEM examinations. Methods: A phantom experiment and patient studies were conducted to assess the presence of imaging artifacts caused by magnetic seeds on CEM. Chicken breast filet phantoms containing magnetic seeds were imaged using CEM and MRI. Next, twenty women with non-palpable breast tumors scheduled for breast-conserving surgery were included and received a magnetic marker seed preoperatively. Immediately after seed implantation, postprocedural images were taken using the CEM mode on our mammography units. All images were assessed by two experienced breast radiologists for the presence of artifacts. Descriptive statistics were used to present the study results. Results: The phantom experiment revealed no imaging artifacts on CEM, whereas significant artifacts were present on MRI. This allowed us to continue with the patient studies, in which no imaging artifacts associated with magnetic seeds were observed at all. Surgical outcomes demonstrated successful retrieval of all magnetic seeds and negative surgical margins in 19 out of 20 cases. Conclusion: To the best of our knowledge, this is the first study demonstrating that the combination of CEM and magnetic seeds is feasible and does not cause any significant imaging artifacts.

Combined localization technique with radio-guided occult lesion localization and Magseed for breast-conserving surgery for non-palpable multifocal breast cancer: a case report

Combined localization technique with radio-guided occult lesion localization and Magseed for breast-conserving surgery for non-palpable multifocal breast cancer: a case report

Comparison of ultrasound guided surgery and radio-guided occult lesions localization (ROLL) for nonpalpable breast cancer excision.

There is little literature comparing intraoperative ultrasound (IOUS) with radio-guided occult lesions localization (ROLL) in nonpalpable invasive tumors in breast conserving surgery (BCS). There is a need to compare these two methods in terms of safety and efficacy. This is an observational cohort study. All patients treated with BCS for nonpalpable invasive breast cancer using IOUS from March 2016 to March 2020 were included and compared with a historical reference control group operated on using ROLL from March 2013 to March 2017. For each detection method, the ability to locate tumors intraoperatively, tumor and surgical specimen sizes, total resection volume (TRV), optimal resection volume, excess of healthy tissue resected (ETR), margin status, re-excision rate, surgical time, complications and costs were studied. One hundred and fifty-eight were included, 83 with IOUS and 75 with ROLL. The mean tumor size is equivalent in both groups (11.88 mm IOUS vs. 12.29 mm ROLL, P=0.668). TRV is significantly lower with IOUS (24.92 vs. 60.32 cm3, P<0.001), and the ETR is also significantly lower in the IOUS group (21.74 vs. 58.37 cm3, P<0.001). The rate of positive margins did not differ (10.98% vs. 12.16%, P=1), nor did re-excision rate (10.98% vs. 8.11%, P=0.597). Complication rate did not differ (12.2% IOUS vs. 10.81% ROLL, P=0.808). Surgical time was shorter in IOUS (45.5 vs. 57 min, P>0.05). IOUS in BCS for nonpalpable invasive breast cancer is more accurate than ROLL because it decreases excision volumes with the same rate of free margins and re-excision. Also, IOUS is a more efficient and comfortable technique, and just as safe as ROLL.

Evaluation of Wire Localization in Management of Non-Palpable Breast Cancer

Abstract Background Breast-conserving surgery (BCS) is considered the goldstandard treatment for early breast cancer. Various techniques have been proposed for identifying non-palpable breast tumors, but the most popular method is the wireguided localization (WGL technique). The most important drawback of BCS is the possible presence of microscopic tumor at or close to the margin of excision. Objective To highlighting the significance of screening programs, early detection and recent advances in the management of early non palpable breast cancer. Methods This is a prospective study on 30 patients with a single nonpalpable breast lesion. A preoperative USG or MMG-guided hook wire localization technique was performed then intraoperative frozen section was done. Results Of the prospective study, 30 patients were treated with wire-guided localization and BCS. And intraoperative frozen sections. According to positive margins, patient age, menopausal status, tumor size and histologic type were associated with increased risk of positive margins. The reexcision at the time of original operation was (6/30) (20%) and need for second operation in (1/30) (3.3%) of cases. According to postoperative complication increased by neoadjuvant chemotherapy, size of mass, specimen volume, margin status and LNs affection. Conclusion In early diagnosis of breast cancer, the validity of the imagingguided hook wire localization biopsy of non-palpable breast lesions has been proved. The cooperation of surgeon, radiologist and pathologist increases the successful results of hook wire localization technique.

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.

Detection of microcalcifications using nonlinear beamforming techniques.

Abundant research demonstrates that early detection of cancer leads to improved patient prognoses. By detecting cancer earlier, when tumors are in their primary stages, treatment can be applied before metastases have occurred. The presence of microcalcifications (MCs) is indicative of malignancy in the breast, i.e., 30-50% of all nonpalpable breast cancers detected using mammograms are based on identifying the presence of MCs. Therefore, improving the ability to detect MCs with modern imaging technology remains an important goal. Specifically, improving the sensitivity of ultrasound imaging techniques to detect MCs in the breast will provide an important role for the early detection and diagnosis of breast cancer. In this work, a novel nonlinear beamforming technology for ultrasonic arrays is investigated for its ability to detect MCs. The beamforming technique, called null subtraction imaging (NSI), utilizes nulls in the beam pattern to create images using ultrasound. NSI provides improved lateral resolution, a reduction in side lobes, and an accentuation of bright singular targets. Therefore, it was hypothesized that the use of NSI would result in identification of more MCs in rat tumors having a speckle background. To test this hypothesis, rats with tumors were injected with Hydroxyapatite (HA) particles to mimic MCs. Ultrasound was used to scan the rat tumors and images were constructed using conventional delay and sum and using NSI beamforming. Three readers with experience in diagnostic ultrasound imaging examined the 1,344 images and scored the presence or absence of MCs. In all, 336 different tumor image slices were recorded and each reconstructed using NSI or conventional delay and sum with Hann apodization. In every image where one or MCs were detected in the Hann reconstructions, MCs were detected in the NSI images. In nine rat tumor images, one or more MCs were detected in the NSI images but not in the Hann images. Statistically, the results did support the hypothesis that NSI would increase the number of MCs detected in the rat tumors.

Evaluation of the efficacy and safety of ultrasound guided injection of carbon nanoparticles as a preoperative localizing tool of non-palpable breast cancer and sentinel lymph nodes detection

Objective This study aimed to measure the efficacy of using carbon nanoparticles in the preoperative localization of early breast cancer (BC) cases as well as in the detection of sentinel lymph nodes in Egypt. In addition, the purpose of the study was to determine whether the efficacy of carbon nanoparticles outweighs their high price and additional shipping fees. Material and methods The current pilot study enrolled 16 early BC patients, particularly those eligible for breast-conserving surgery. All patients underwent standardized injection techniques. The operating surgeons provided comprehensive intraoperative findings and postoperative histopathological reports of the excised tissues. Results After neoadjuvant chemotherapy (NAC), downstaging of the study subjects was achieved until reaching the TNM stage of T1N1M0 and T1N0M0 in 2 cases (12.5%) and 14 cases (87.5%), respectively. Ultrasound-guided injection of carbon nanoparticles was done, followed by surgical excision on the same day or the day after injection. Eleven patients had positive mass lesions preoperatively, with a mean tumoral size of less than 1 cm in maximum dimension. Moreover, 6 out of the 11 patients showed positive black staining intraoperatively with an accuracy of 68.75%. Postoperative histopathological examination (the gold standard) of axillary specimens revealed that 3 out of 16 of the study population have positive tumor-infiltrated lymph nodes. However, only 2 of these cases demonstrated intra-operative black staining, with the black dye’s positive and negative predictive values of staining being 100% and 92.2%, respectively. Conclusions Preoperative carbon nanoparticle suspension injection is a safe and effective method for adequate tumoral localization in BC patients. Nevertheless, this pilot study did not provide strong evidence for the adequacy of sentinel lymph node detection due to the small sample size, high cost, and extra shipping fees of the carbon nanoparticles.