Nonpalpable Breast Cancer Research Articles

Hastanemizde Nonpalpabl Meme Lezyonlu Bir Hasta Serisinde Stereotaktik Biyopsi Sonuçları

Aim: Although screening mammography has a high sensitivity in the clinical detection of nonpalpable breast cancer, most mammographically suspicious lesions referred to biopsy are seen to be benign. The rate of malignancy in such lesions that are biopsied with needle–wire localization ranges from 10 to 36%. In this study, we aimed to compare with the literature the pathological results and Breast Imaging Reporting and Data System (BI-RADS) scores of lesions subjected to mammography and excisional biopsy after ultrasonography-guided needle–wire localization and calculate a positive predictive value for each category. Materials and Methods: By electronically reviewing patient files and using the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, we identified patients who underwent excisional biopsy after stereotactic marking at the General Surgery Clinic of the Istanbul Sisli Hamidiye Etfal Training and Research Hospital between January 2003 and March 2009. A total of 64 patients were included in the study, of whom 43 had benign and 21 had malignant lesions on postoperative histopathological examination. Data on patient demographic characteristics, indications for marking, and histopathological diagnoses were recorded. The patient BI-RADS scores were determined based on the mammography and breast ultrasonography reports. The BI-RADS classification and histopathological examination results were compared in percentages. Results: The mean patient age was 48.9 (32–76) years. Based on the mammography reports, the most common indications for stereotactic marking and excisional biopsy were microcalcification cluster and spiculated mass. Histopathological examination results revealed malignancy in 8%, 51%, and 100% of the patients whose BI-RADS scores were mammographically determined to be BI-RADS 3, BI-RADS 4, and BI-RADS 5, respectively. Discussion and Conclusion: The BI-RADS-based classification of lesions detected by mammography and ultrasonography can help in predicting malignancy. While BI-RADS 4 and BI-RADS 5 lesions are referred to biopsy primarily, short-term follow-up of BI-RADS 3 lesions as an alternative to biopsy could reduce unnecessary biopsies.

The LOCalizer Radiofrequency Identification System: An Effective New Technology for Localizing Non-Palpable Breast Lesions for Surgery.

Background. Breast screening has decreased morbidity and mortality due to detection of early, non-palpable breast cancers. One of the challenges of performing breast-conserving surgery on non-palpable breast tumours is accurate localization of the cancer. We aimed to perform a feasibility study to examine the outcomes associated with the introduction of a novel radiofrequency identification system (RFID) called LOCalizer as an alternative to traditional wire-guided localization. Methods. Data were prospectively collected on all patients undergoing breast-conserving surgery using the LOCalizer RFID system in a regional cancer centre between July 2019 and March 2020. Patients had a RFID tag placed preoperatively and underwent surgical removal of the tag with the index lesion guided by a handheld LOCalizer probe. The primary aim was successful placement and retrieval of the RFID tag. Re-excision rates, specimen size, specimen weight, cancer subtype and complication rate were all recorded. Results. Sixty-nine patients aged between 50 and 69years had a LOCalizer tag inserted between July 2019 and March 2020. Of these, 6 (8.7%) were diagnostic and 63 (91.3%) were therapeutic. There was no migration of RFID tags, and all tags were retrieved with the index lesion. The overall re-excision of margin rate was 17.4% (12/69). All re-excision of margins was due to positive radial margins. The overall complication rate was 1.4% with one grade 1 Clavien-Dindo morbidity. Conclusion. The LOCalizer RFID is an effective and safe wire-free localization method for non-palpable breast lesions.

Is specimen radiography still necessary in patients with non-palpable breast cancer undergoing breast-conserving surgery using radioactive I-125 seed localization?

AimTo evaluate the diagnostic performance for margin assessment of specimen radiography (SR) in breast conserving surgery (BCS) using radioactive I125-seed localization (RSL). MethodsThe clinical, radiographic and histopathological data of women who underwent BCS after pre-operative RSL with intraoperative SR during nine consecutive years were analyzed. The histological margin and radiographic margin outcomes on SR were compared and results of intraoperative re-excisions were investigated. ResultsA consecutive series of 448 women with invasive carcinoma (n = 211), ductal carcinoma in situ (DCIS) (n = 79) and a combination of DCIS and invasive carcinoma (n = 158) were included. The median minimal margins for the radiological masses and microcalcifications measured on SR were 14 mm and 11 mm, respectively. Based on a radiological cut-off SR margin value of 1 mm, the overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were 21.0%, 95.0%, 26.0%, and 94.0%, respectively. The area under the receiver-operating curve was 0.73. Intraoperative re-excisions based on SR were performed in 31 (6.9%) patients; histopathological examination of the additional excised tissue revealed DCIS or invasive carcinoma in 6 (19.4%) patients. Hence, SR was beneficial for 6/448 patients (1.3%), and unnecessary intraoperative re-excisions were performed in 20/448 patients (4.5%). The number need to treat is 75; this implies that per 75-SR one resection with involved margins is prevented. ConclusionSR has a moderate diagnostic performance for margin involvement using RSL. A more accurate intraoperative margin assessment tool is warranted.

A Breast-Specific MR Guided Focused Ultrasound Platform and Treatment Protocol: First-in-Human Technical Evaluation.

This paper presents and evaluates a breast-specific magnetic resonance guided focused ultrasound (MRgFUS) system. A first-in-human evaluation demonstrates the novel hardware, a sophisticated tumor targeting algorithm and a volumetric magnetic resonance imaging (MRI) protocol. At the time of submission, N = 10 patients with non-palpable T0 stage breast cancer have been treated with the breast MRgFUS system. The described tumor targeting algorithm is evaluated both with a phantom test and in vivo during the breast MRgFUS treatments. Treatments were planned and monitored using volumetric MR-acoustic radiation force imaging (MR-ARFI) and temperature imaging (MRTI). Successful technical treatments were achieved in 80 % of the patients. All patients underwent the treatment with no sedation and 60 % of participants had analgesic support. The total MR treatment time ranged from 73 to 114 minutes. Mean error between desired and achieved targeting in a phantom was 2.9 ±1.8mm while 6.2 ±1.9mm was achieved in patient studies, assessed either with MRTI or MR-ARFI measurements. MRTI and MR-ARFI were successful in 60 % and 70 % of patients, respectively. The targeting accuracy allows the accurate placement of the focal spot using electronic steering capabilities of the transducer. The use of both volumetric MRTI and MR-ARFI provides complementary treatment planning and monitoring information during the treatment, allowing the treatment of all breast anatomies, including homogeneously fatty breasts.

A Single institution's randomized double-armed prospective study of lumpectomy margins with adjunctive use of the MarginProbe in nonpalpable breast cancers.

Breast conservation surgery (BCS) aims to excise all cancerous tissue while minimizing the amount of healthy breast tissue removed. Up to 30% of patients undergoing BCS require a second operation for re-excision to obtain negative margins. Previous studies reported a lower re-excision rate with intraoperative use of the MarginProbe device (Dune Medical Devices). This device utilizes radiofrequency spectroscopy to detect differences between cancerous and normal tissue. From July 2009 to January 2010, our institution enrolled 46 patients electing for BCS in a prospective double-arm randomized controlled trial and had a significantly lower re-excision rate than that reported in the multicenter trial. Intraoperatively, after performing conventional lumpectomy with excision of any additional shavings deemed necessary based on palpation and visual inspection alone, patients were then randomized. In the device arm, the surgeon used the MarginProbe to interrogate the lumpectomy specimen, taking additional shavings from the cavity surfaces corresponding to the parts of the specimen read as positive by the device. In the control arm, only standard intraoperative assessments were performed. All specimens were evaluated by pathologists who were blinded to the study arm. In this population, 72% had invasive ductal carcinoma (IDC), 20% had ductal carcinoma in situ (DCIS), and 8% had invasive lobular carcinoma (ILC). Average age was 64years old. The average size of the specimen was 5.6cm, the average volume was 37.8cm3 , and the average weight was 32.7g. The mean size of DCIS was 1.4cm. For invasive specimens, 32 were T1 and 7 were T2. Prior to randomization, 43 patients were thought to have positive or close margins and therefore underwent additional shavings. Twenty-three patients were randomized to the device arm and 23 to the control arm. In the device arm, 14 (60%) patients had IDC, 7 (30%) had DCIS, and 2 (8%) had ILC, vs the control arm where 19 (82%) patients had IDC, 2 (8%) had DCIS, and 2 (8%) had ILC. Eight (35%) patients in the control group vs 1 (4%) in the device group underwent re-excision for margin involvement (P<.05). The use of the MarginProbe device at our institution significantly improved the ability of our surgeons to obtain clear margins during initial BCS. Our results show a lower re-excision rate (4%) than those published in the multicenter trial (19.8%). We postulate that in the face of more patients having DCIS in our device group (30%), our surgeons responded by taking thicker shavings when the MarginProbe device reported margin involvement during the initial lumpectomy, resulting in greater success achieving clear final margins on the shaved tissue and a significantly lower re-excision rate than previously reported with the MarginProbe device.

Is SNOLL a good localization technique in early breast cancer treatment? A single center's experience.

The aim of this study was to evaluate the method and present one center's experience in applying the SNOLL technique to patients with non-palpable suspicious breast lesions. 371 patients with suspected malignant lesions or diagnosed non-palpable breast cancer were subjected to a preoperative SNOLL procedure. The day before the surgery, they were administered two radiotracers to localize the tumor in the breast and the sentinel node. The following day, with the help of a handheld gamma probe the breast conserving surgery was performed. All 371 patients (100%) had their suspected occult breast lesions resected. Histo-pathological examination revealed cancer in 339 patients all these patients had their sentinel nodes examined. The intraoperative tests showed the sentinel node to be metastatic in 35 patients, who were then given a simultaneous axillary lymphadenectomy. Another 7 patients were diagnosed with positive lymph nodes in the final pathology and had to undergo a second operation. Reoperations compelled by positive surgical margins were performed in 26 cases. SNOLL as a good technique of intraoperative localization, enables to remove a nonpalpable breast cancer together with sentinel lymph node in a single surgical procedure. It seems to be a optional method to be used in patients treated with breast conserving therapy.

Early budget impact analysis on magnetic seed localization for non-palpable breast cancer surgery.

IntroductionCurrent localization techniques used in breast conserving surgery for non-palpable tumors show several disadvantages. Magnetic Seed Localization (MSL) is an innovative localization technique aiming to overcome these disadvantages. This study evaluated the expected budget impact of adopting MSL compared to standard of care.MethodsStandard of care with Wire-Guided Localization (WGL) and Radioactive Seed Localization (RSL) use was compared with a future situation gradually adopting MSL next to RSL or WGL from a Dutch national perspective over 5 years (2017–2022). The intervention costs for WGL, RSL and MSL and the implementation costs for RSL and MSL were evaluated using activity-based costing in eight Dutch hospitals. Based on available list prices the price of the magnetic seed was ranged €100-€500.ResultsThe intervention costs for WGL, RSL and MSL were respectively: €2,617, €2,834 and €2,662 per patient and implementation costs were €2,974 and €26,826 for MSL and RSL respectively. For standard of care the budget impact increased from €14.7m to €16.9m. Inclusion of MSL with a seed price of €100 showed a budget impact of €16.7m. Above a price of €178 the budget impact increased for adoption of MSL, rising to €17.6m when priced at €500.ConclusionMSL could be a cost-efficient localization technique in resecting non-palpable tumors in the Netherlands. The online calculation model can inform adoption decisions internationally. When determining retail price of the magnetic seed, cost-effectiveness should be considered.

Surgical Trends in Breast Cancer in Turkey: An Increase in Breast-Conserving Surgery.

PURPOSEBreast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018.PATIENTS AND METHODSBetween January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients’ choices, surgical approaches, and academic institutions.RESULTSAll surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia (P < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery.CONCLUSIONIncreasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey.

Abstract P1-20-20: Intraoperative ultrasound localization (IOUS) for non-palpable breast cancer

Abstract Background: With the introduction of breast cancer screening the number of non-palpable breast cancers and so the number of breast conserving surgery (BCS) has increased. Wire-guided localization (WGL) is used as invasive standard method for localization. IOUS is an alternative non-invasive, time-sparing and safe localization method with many cost benefits. Patient and methods: A retrospective observational study was performed in a single breast unit where IOUS was used as localization method by two surgeons in the period June 2013 to October2016. The surgeons did not have any special experience with Ultrasound (US) apart from one week of bed-side training. Results: During a 41 months period the two surgeons treated 452 with BCS. Of them 126 were non-palpable and visible by US 28%. The 126 cancers were identified with IOUS at surgery and removed successfully by the surgeons. In the period a total of 156 had a BCS with WGL. These cases had a nonpalpable cancer which were non-visible on US with either calcifications, DCIS or non-specific lesions. In the study we also found that the re-lumpectomy rate for BCS with IOUS was lower than without IOUS. In the entire breast unit, the number of BCS were 848 and number of BCS+WGL were 320 in the same period. Of them 263 (22.5%) had a re-lumpectomy. The number BCS with IOUS were 452 and the number of BCS+WGL with IOUS were 156. Of them 72 (11.8%) had a re-lumpectomy. Conclusion: In our breast unit, IOUS was used after a short bed-side training, with 100% success rate, to remove non-palpable cancers if visible on US. IOUS is easy to learn and easy to use and offers many financial and time-sparing benefits. IOUS has a reasonable learning curve and can reduce the work load on the Radiology Department. Citation Format: Shideh Pour Zahed, Thor Knudsen Andersen. Intraoperative ultrasound localization (IOUS) for non-palpable breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-20.

Magnetic Marker Localization for Non-Palpable Breast Cancer Using the Magseed and Sentimag Systems.

Magnetic Marker Localization for Non-Palpable Breast Cancer Using the Magseed and Sentimag Systems.

Occult lesion localization by indocyanine green fluorescence for nonpalpable breast cancer.

The Breast JournalVolume 26, Issue 5 p. 1101-1103 COMMENTARY Occult lesion localization by indocyanine green fluorescence for nonpalpable breast cancer Sarah Francini MD, Sarah Francini MD Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorGauthier Rathat MD, Corresponding Author Gauthier Rathat MD g-rathat@chu-montpellier.fr orcid.org/0000-0002-0783-154X Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, France Correspondence Gauthier Rathat, Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, 371 Av. du Doyen Gaston Giraud, 34090 Montpellier, France. Email: g-rathat@chu-montpellier.frSearch for more papers by this authorFederico Manna MD, Federico Manna MD Epidemiology and Clinical Research Department, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorEmmanuelle Pages MD, Emmanuelle Pages MD Radiology Department, CHU Lapeyronie, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorLucie Rebel MD, Lucie Rebel MD Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorHélène Perrochia MD, Hélène Perrochia MD Department of Pathology, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorPatrice Taourel MD, PhD, Patrice Taourel MD, PhD Radiology Department, CHU Lapeyronie, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorNoémie Ranisavljevic MD, PhD, Noémie Ranisavljevic MD, PhD Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorMartha Duraes MD, Martha Duraes MD Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, FranceSearch for more papers by this author Sarah Francini MD, Sarah Francini MD Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorGauthier Rathat MD, Corresponding Author Gauthier Rathat MD g-rathat@chu-montpellier.fr orcid.org/0000-0002-0783-154X Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, France Correspondence Gauthier Rathat, Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, 371 Av. du Doyen Gaston Giraud, 34090 Montpellier, France. Email: g-rathat@chu-montpellier.frSearch for more papers by this authorFederico Manna MD, Federico Manna MD Epidemiology and Clinical Research Department, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorEmmanuelle Pages MD, Emmanuelle Pages MD Radiology Department, CHU Lapeyronie, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorLucie Rebel MD, Lucie Rebel MD Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorHélène Perrochia MD, Hélène Perrochia MD Department of Pathology, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorPatrice Taourel MD, PhD, Patrice Taourel MD, PhD Radiology Department, CHU Lapeyronie, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorNoémie Ranisavljevic MD, PhD, Noémie Ranisavljevic MD, PhD Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, FranceSearch for more papers by this authorMartha Duraes MD, Martha Duraes MD Gynecologic and Breast Surgery Department, CHU Arnaud de Villeneuve, Univ Montpellier, Montpellier, FranceSearch for more papers by this author First published: 28 January 2020 https://doi.org/10.1111/tbj.13760Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume26, Issue5May 2020Pages 1101-1103 RelatedInformation

Intraoperative ultrasound-guided lumpectomy versus wire-guided excision for nonpalpable breast cancer.

ObjectiveThis study was designed to compare the margin clearance and re-excision rates of ultrasound (US)- and wire-guided excision in a large number of patients with nonpalpable breast cancer.MethodsIn total, 520 women who were histologically diagnosed with nonpalpable breast cancer were recruited in this study. All nonpalpable lesions were visible by US. The patients were randomly divided into two groups: those who underwent wire-guided breast-conserving surgery (BCS) and those who underwent US-guided BCS. Re-excision rates and positive surgical margins were recorded.ResultsA total of 262 patients underwent US-guided excision and 258 patients underwent wire-guided excision. No differences were found in tumor or patient characteristics. The positive margin rate was 4.6% in the US-guided group and 19.4% in the wire-guided group with a significant difference. Age, menopausal status, excision volume, histological grade, and tumor type significantly influenced the positive surgical margin rate. The intraoperative re-excision rate was significantly lower in the US-guided group than wire-guided group (11.1% vs. 24.0%, respectively).ConclusionsUS-guided BCS seems to be more effective than wire-guided BCS for treatment of nonpalpable breast cancers in terms of the margin clearance and re-excision rates. Patients can avoid the discomfort caused by preoperative wire placement.

Step by step: Planning a needle localization procedure

In patients with nonpalpable early-stage breast cancer eligible for breast conservation surgery (BCS), wire-guided localization (WGL) is widely accepted as a standard technique for preoperative image-guided lesion localization. In preparation for this procedure, lesion location, size, type and configuration play important roles in preoperative localization planning. Successful preoperative planning requires review of all pertinent imaging studies, imaging reports and pathology reports, with special attention to pre- and post-biopsy imaging and evaluation of the targeted lesions and the type and the position of the marker clips. Preoperative communication with the surgeon is key in the planning process to ensure that clarity in localization objectives are reached in complex cases. This pictorial essay will provide a methodical, step by step approach to planning successful image-guided preoperative needle localizations. These steps include selection of the imaging modality, the equipment, the procedure and intraoperative specimen radiography. The case-based review will also include key steps and considerations during the planning stage, the procedure stage, and the post-procedure stage. These same techniques can also be applied to newer, non-wire image-guided breast localization techniques now available for widespread commercial use.

Real-time electromagnetic navigation for breast-conserving surgery using NaviKnife technology: A matched case-control study.

Breast-conserving surgery (BCS) is a mainstay in breast cancer treatment. For nonpalpable breast cancers, current strategies have limited accuracy, contributing to high positive margin rates. We developed NaviKnife, a surgical navigation system based on real-time electromagnetic (EM) tracking. The goal of this study was to confirm the feasibility of intraoperative EM navigation in patients with nonpalpable breast cancer and to assess the potential value of surgical navigation. We recruited 40 patients with ultrasound visible, single, nonpalpable lesions, undergoing BCS. Feasibility was assessed by equipment functionality and sterility, acceptable duration of the operation, and surgeon feedback. Secondary outcomes included specimen volume, positive margin rate, and reoperation outcomes. Study patients were compared to a control group by a matched case-control analysis. There was no equipment failure or breach of sterility. The median operative time was 66 (44-119)minutes with NaviKnife vs 65 (34-158)minutes forthe control (P=.64). NaviKnife contouring time was 3.2 (1.6-9)minutes. Surgeons rated navigation as easy to setup, easy to use, and useful in guiding nonpalpable tumor excision. The mean specimen volume was 95.4±73.5cm3 with NaviKnife and 140.7±100.3cm3 for the control (P=.01). The positive margin rate was 22.5% with NaviKnife and 28.7% for the control (P=.52). The re-excision specimen contained residual disease in 14.3% for NaviKnife and 50% forthe control (P=.28). Our results demonstrate that real-time EM navigation is feasible in the operating room for BCS. Excisions performed with navigation result in the removal of less breast tissue without compromising postivemargin rates.

Comparison of Radio-guided Occult Lesion Localization (ROLL) and Magnetic Occult Lesion Localization (MOLL) for Non-palpable Lesions: A Phantom Model Study

BackgroundLocalization of nonpalpable breast cancers can be achieved with several techniques. We sought to compare radio-guided localization (ROLL) and magnetic tracer localization (MOLL) techniques by using a phantom model we previously developed, which can provide an accurate simulation for excision of nonpalpable breast lesions. Materials and MethodsWe designed 20 phantom models (10 MOLL, 10 ROLL group) for localization. A handheld gamma probe for the ROLL group and a manual magnetometer (SentiMag) for the MOLL group were used to test the ability of the modality to detect olives in turkey breasts. The excision time for each procedure, specimen size, and weight of the specimens removed from the turkey breasts were recorded. ResultsBoth techniques resulted in 100% retrieval of the lesions. There was no difference between the groups in the duration of operative excision, specimen weight, or specimen volume. ConclusionThis experimental trial found similar success rates for ROLL and MOLL in localization of occult lesions using the turkey breast phantom model. MOLL can be performed in clinics without the need for a nuclear medicine team and radiation safety procedures.

A Screening CAD Tool for the Detection of Microcalcification Clusters in Mammograms.

Breast cancer is the most common cancer diagnosed in women worldwide. Up to 50% of non-palpable breast cancers are detected solely through microcalcification clusters in mammograms. This article presents a novel and completely automated algorithm for the detection of microcalcification clusters in a mammogram. A multiscale 2D non-linear energy operator is proposed for enhancing the contrast between the microcalcifications and the background. Several texture, shape, intensity, and histogram of oriented gradients (HOG)-based features are used to distinguish microcalcifications from other brighter mammogram regions. A new majority class data reduction technique based on data distribution is proposed to counter data imbalance problem. The algorithm is able to achieve 100% sensitivity with 2.59, 1.78, and 0.68 average false positives per image on Digital Database for Screening Mammography (scanned film), INbreast (direct radiography) database, and PGIMER-IITKGP mammogram (direct radiography) database, respectively. Thus, it might be used as a second reader as well as a screening tool to reduce the burden on radiologists.

A Randomized Prospective Trial of Supine MRI-Guided Versus Wire-Localized Lumpectomy for Breast Cancer.

Wire-localized excision of non-palpable breast cancer is imprecise, resulting in positive margins 15-35% of the time. Women with a confirmed diagnosis of non-palpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) were randomized to a new technique using preoperative supine magnetic resonance imaging (MRI) with intraoperative optical scanning and tracking (MRI group) or wire-localized (WL group) partial mastectomy. The main outcome measure was the positive margin rate. In this study, 138 patients were randomly assigned. Sixty-six percent had IBC and DCIS, 22% had IBC, and 12% had DCIS. There were no differences in patient or tumor characteristics between the groups. The proportion of patients with positive margins in the MRI-guided surgery group was half that observed in the WL group (12 vs. 23%; p = 0.08). The specimen volumes in the MRI and WL groups did not differ significantly (74 ± 33.9mL vs. 69.8 ± 25.1mL; p = 0.45). The pathologic tumor diameters were underestimated by 2cm or more in 4% of the cases by MRI and in 9% of the cases by mammography. Positive margins were observed in 68% and 58% of the cases underestimated by 2cm or more using MRI and mammography, respectively, and in 15% and 14% of the cases not underestimated using MRI and mammography, respectively. A novel system using supine MRI images co-registered with intraoperative optical scanning and tracking enabled tumors to be resected with a trend toward a lower positive margin rate compared with wire-localized partial mastectomy. Margin positivity was more likely when imaging underestimated pathologic tumor size.

The Outcome of Primary Architectural Distortion in Mammography: Which are the Important Factors?

Background: Architectural distortion is an important mammographic finding for non-palpable breast cancer, which is a difficult part of mammographic reporting. Objectives: In this study, we assessed the relationship between architectural distortion without mass or history of previous breast intervention with pathological findings, as well as the risk of malignancy associated with architectural distortion. The factors that might increase the chance of malignancy in architectural distortion were also evaluated. Methods: In this descriptive, comparative cross sectional survey, 30 consecutive patients with mammographic primary architectural distortion were enrolled. The pathological findings were determined through core needle biopsy and compared across the other variables. Results: The pathological results were fibrocystic changes, carcinoma in situ, invasive ductal carcinoma, other benign pathology, and high-risk lesion of adenosis sclerosing with 5 (16.7%), 5 (16.7%), 13 (43.3%), 6 (20%), and 1 (3.3%) patients, respectively. Higher BI-RADS category (P = 0.064), accompanying mammographic lesion (P = 0.004), positive clinical symptoms (P = 0.040), and positive ultrasonography finding (P = 0.013) were related to greater chance of malignant pathology result. Conclusions: Based on our findings, it can be concluded that architectural distortion in imaging is accompanied by malignancy in 60% of the cases and there are some important factors that can increase the risk of malignancy for architectural distortion (AD).

Surgery of nonpalpable breast cancer: First step to a virtual per-operative localization? First step to virtual breast cancer localization.

Preoperative localization procedures of occult breast cancer (radioisotopic and wire localization) are invasive and uncomfortable. We have evaluated a novel technique which allows a virtual localization. Our retrospective study focused on patients treated for occult and unifocal breast cancer from September 2016 to June 2017. All patients had radioisotopic preoperative localization. We included patients who had a preoperative prone Magnetic Resonance Imaging (MRI) and an intraoperative 3D optical scan. During surgery, the surgeon localized the tumor thanks to a gamma detection probe and marked the localization on the skin with a black marker. The breast was then optically scanned. MRI was adjusted to the optical surface to match the exact breast position in the Operating Room. The virtual localization provided by the 3D breast modeling tool was retrospectively compared with the radioisotopic localization, defined as the pen mark visible in the optical scan. Nine patients were included in this feasibility study. Tumors were successfully localized in the respective breast quadrant. The mean cutaneous distance between virtual and radioisotopic localization was 1.4cm in patients with low breast volume (5/9) and 2.8cm in those with large breast volume (4/9). We developed a research prototype which enables virtual preoperative localization of nonpalpable breast lesions using MRI images and intraoperative optical scanning. Parameter optimization is required and will lead to a precise and noninvasive tool. By adding augmented reality, it will be possible to initiate a prospective study to compare this tool with the traditional localizations.

Surgeon-led Intraoperative Ultrasound Localization for Nonpalpable Breast Cancers: Results of 5 Years of Practice

BackgroundThe uptake of breast screening has led to a rise in the number of nonpalpable breast cancer diagnoses. Breast conserving therapy (BCT) is the treatment of choice for early breast cancer, and this requires localization of the lesion. Commonly detection is achieved by wire-guided localization in the radiology department. This technique has complications and requires utilization of a radiologist. Intraoperative ultrasound (IOUS) has been shown to be a safe alternative, but there is little data on its use. The aim of this study is to report the use of surgeon-led IOUS over the past 5 years, assessing the ability to detect lesions and the re-excision rate for involved margins. Patients and MethodsA retrospective observational study was performed on consecutive patients undergoing IOUS-marked BCT between 2014 and 2018. The technique is described, and patients’ records were reviewed to assess the histologic specimen reports and need for subsequent re-excision. ResultsNinety-five IOUS BCT operations were performed. Every cancer was identified by IOUS and removed. Fourteen margins were positive and required re-excision. Of these, only 2 contained residual tumor. ConclusionThis is the first data from the United Kingdom for IOUS skin marking without wire localization. IOUS is a safe method of localization in BCT. It offers advantages both to the patient and the unit as it reduces pressure on the radiology department.