Nonpalpable Breast Lesions Research Articles

Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411).

Surgical excision of a non-palpable breast lesion requires a localization step. Among available techniques, wire-guided localization (WGL) is most commonly used. Other techniques (radioactive, magnetic, radar or radiofrequency-based, and intraoperative ultrasound) have been developed in the last two decades with the aim of improving outcomes and logistics. We performed a systematic review on localization techniques for non-palpable breast cancer. For most techniques, oncological outcomes such as lesion identification and clear margin rate seem either comparable with or better than for WGL, but evidence is limited to small cohort studies for some of the devices. Intraoperative ultrasound is associated with significantly higher negative margin rates in meta-analyses of randomized clinical trials (RCTs). Radioactive techniques were studied in several RCTs and are non-inferior to WGL. Smaller studies show higher patient preference towards wire-free localization, but little is known about surgeons' and radiologists' attitudes towards these techniques. Large studies with an additional focus on patient, surgeon, and radiologist preference are necessary. This review aims to present the rationale for the MELODY (NCT05559411) study and to enable standardization of outcome measures for future studies.

Magnetic marker to detect primary lesion and sentinel node in breast cancer. The MAGTOTAL randomised controlled trial.

Background: Several markers have been developed as an alternative to guidewires for non-palpable breast lesion localisation. The study aim was to compare a magnetic marker (seed) with guidewire (wire) for non-palpable breast lesion localisation in combination with a magnetic SLN tracer.

Comparison of magnetic seed localization to skin tattoo localization for non-palpable breast lesions: preliminary data.

Background: Magnetic seed localization (MSL) is a relatively new method to identify non-palpable breast lesions during surgery. Traditional methods include skin tattoo localization (STL), carbon marking, wire-guided localization, radio-guided occult lesion localization, and many others. We compared Sirius Pintuition system, a novel MSL technology with STL with respect to operative time, intra- and post-operative complications, specimen volume, and re-excision rate.

Combined use of magnetic seed and tracer in breast conserving surgery with sentinel lymph node biopsy for non-palpable breast lesions: A pilot study describing pitfalls and solutions

BackgroundsTraditionally, breast conserving surgery for non-palpable breast cancer is guided by wire or radioactive seed and radioactive tracer for sentinel lymph node biopsy (SLNB). Alternatively, a stain-less magnetic seed and superparamagnetic iron oxide tracer (SPIO) can be combined as a radioactive-free technique. The aim of this study was to define the pitfalls we encountered during implementation of this combined technique and provide solutions resulting in an instruction manual for a radio-active free procedure. MethodsBetween January and March 2021, seventeen consecutive patients with cN0 non-palpable breast cancer were included. The magnetic seed was placed to localize the lesion and SPIO was used to identify the sentinel lymph node (SLN). A lymphoscintigraphy with Technetium-99m nano colloid was performed concomitantly in all patients as a control procedure for SPIO. Surgical outcomes are reported, including problems with placing and retrieval of the seed and SPIO and corresponding solutions. ResultsSurgical excision was successful with invasive tumor-free margins in all patients. SLN detection was successful in 82% patients when compared to Technetium-99m. The most challenging issue was an overlapping magnetic signal of the seed and SPIO. Solutions are provided in detail. ConclusionsCombined use of magnetic seed and SPIO for wide local excision and SLNB patients with non-palpable breast lesions appeared challenging due to overlapping magnetic signals. After multiple adaptations, the protocol proved to be feasible with an added advantage of eliminating the use of radioisotopes. We described the pitfalls and solutions resulting in an instruction manual for a totally radioactive-free procedure.

Image-Guided Radar Reflector Localization for Small Soft-Tissue Lesions in the Musculoskeletal System.

Preoperative localization of nonpalpable breast lesions using a radar reflector surgical guidance system has become commonplace, but the clinical utility of this emerging technology in the musculoskeletal system has not yet been well established. The system components include a console, a handpiece, an implanted radiofrequency reflector that works as a lesion marker, and an infrared light-emitting probe to guide the surgeon. The reflector can be deployed to localize small nonpalpable nodules within the subcutaneous fat as well as lesions within the deeper soft tissues. It can also be used for lymph nodes and foreign bodies. Localization can be performed both before and after treatment. The objective of this article is to describe the potential applications and our technique and initial experience for radar reflector localization within the musculoskeletal system.

Fluoroscopic Intraoperative Breast Neoplasm and Node Detection.

Preoperative localization is necessary for nonpalpable breast lesions. A novel procedure, fluoroscopic intraoperative neoplasm and node detection (FIND), obviates the preoperative painful and potentially expensive localization by using intraoperative visualization of the standard clip placed during diagnostic biopsy. We hypothesized FIND would improve negative margin rates. This is an IRB-approved retrospective study (September 2016 to March 2021). Electronic chart review identified breast and axillary node procedures using wire localization (WL) or FIND. Primary outcome was margin status. Secondary outcomes included re-excision rate, specimen weight, surgery time, and axillary node localization rate. We identified 459 patients, of whom 116 (25.3%) underwent FIND and 343 (74.7%) WL. Of these, 68.1% of FIND and 72.0% of WL procedures were for malignant lesions. Final margin positivity was 5.1% (4 of 79) for FIND and 16.6% (41 of 247) for WL (p = 0.008). This difference lost statistical significance on multivariable logistic regression (p = 0.652). Re-excision rates were 7.6% and 14.6% for FIND and WL (p = 0.125), with an equivalent mean specimen weight (p = 0.502), and mean surgery time of 177.5 ± 81.7 and 157.1 ± 66.8 minutes, respectively (mean ± SD; p = 0.022). FIND identified all (29 of 29) targeted axillary nodes, and WL identified only 80.1% (21 of 26) (p = 0.019). FIND has lower positive margin rates and a trend towards lower re-excision rates compared with WL, proving its value in localizing nonpalpable breast lesions. It also offers accurate localization of axillary nodes, valuable in the era of targeted axillary dissection. It is a method of visual localization, using a skill and equipment surgeons already have, and saves patients and medical systems an additional schedule-disruptive, painful procedure, especially valuable when using novel localization devices is cost-prohibitive.

Intraoperativni ultrazvuk u lokalizovanju nepalpabilnih lezija dojke

Introduction: Intraoperative ultrasound in breast tumor surgery is a relatively new technique used for localizing nonpalpable breast lesions. This procedure has multiple advantages over wire needle localization (WNL), which is a standard approach to localizing nonpalpable breast lesions. It has been shown that intraoperative application of ultrasound is presented with a decrease in tumor-infiltrated resection margins, and with less excised healthy tissue around the tumor. Aim: The purpose of this article is to evaluate the success rate of nonpalpable breast lesion excisions by localizing them with intraoperative ultrasound. Material and methods: This is a retrospective study, which involves patients from the Department of surgical oncology at "Bežanijska kosa" treated in the period between January 2013 and December 2017. Medical records of the patients who were not operated on for nonpalpable breast lesions using intraoperative ultrasound were isolated. Success rate of identifying and excising nonpalpable lesions is presented in percentages, so this finding can be compared to other published studies. Results: Of the 2627 patients operated on during this period, 317 (11.9%) patients had nonpalpable lesions, of which 173 were localized by WNL, and 144 were localized by intraoperative ultrasound (IOUS). Of 144 patients whose lesions were localized by IOUS, 61 patients had breast cancer, while 83 patients had benign lesions. Based on the medical records, all non-palpable lesions were successfully located and excised with intraoperative ultrasound (144/144-100%). Conclusion: Intraoperative ultrasound represents an optimal technique for localizing nonpalpable breast lesions that are visible on ultrasound and are an indication for surgical removal.

The significance of ultrasound-guided localization of nonpalpable breast lesions using carbon suspension

The significance of ultrasound-guided localization of nonpalpable breast lesions using carbon suspension

Ultrasound-Guided Intervention for Breast Lesions

The role of ultrasound-guided interventions in the diagnosis and treatment of breast lesions is gaining importance and prevalence, particularly as the instances of non-palpable breast lesion detection, breast-conserving surgery, and neoadjuvant chemotherapy are increasing. This review attempts to summarize the types and techniques of breast ultrasound-guided interventional procedures, such as biopsy, tissue marker insertion, and preoperative localization, and their indications. Furthermore, we highlight the pro and cons of the most commonly used procedures with the intention of promoting their use in clinical practice.

A novel surgical marker navigation system to localise and remove non-palpable breast lesions: A Dutch centre experience

A novel surgical marker navigation system to localise and remove non-palpable breast lesions: A Dutch centre experience

Radar reflector guidance system in breast surgery: A single-institution feasibility study.

Mammography breast cancer screening programs and continuing improvements in early diagnosis of the disease have led to more frequent detection of nonpalpable breast lesions. The commonly used technique in guiding the surgical removal of these lesions is hook wire-guided localization (WGL). However, the WGL procedure has been criticized for the last years. Key disadvantages of WGL are possible wire transection, wire migration before or during surgery, patient discomfort and pneumothorax. Over the last decade, alternatives to wire localization have emerged. In this study the authors present their initial experience with a wireless, nonradioactive, wave reflection implant system that enables surgeons to safely and accurately remove breast lesions (Tab. 2, Fig. 4, Ref. 20). Keywords: breast cancer, breast surgery, nonpalpable lesions, preoperative localization.

Fusion biopsy or real time virtual sonography (RVS) technique – the first experience in verification of hypervascular breast lesions under combined US/MR control

One of the actual problems of oncology is the early diagnosis of breast cancer. However, there are some difficulties not only in diagnostic but also in the verification of lesions. Image-guided cor-biopsy nowadays became the gold standard for verification of non-palpable breast lesions. The main issue is to choose the method of visualization. According to up-to-date recommendations, there is no universal method with all requirements (high visualization quality, convenience, and accessibility for biopsy). Fusion-biopsy or virtual real-time sonography can combine MRI diagnostic potential and facility of USAim: to leverage the technique of fusion biopsy under combined ultrasound/MR control for verification of breast lesions identified only on MRI and occult on MG and US.Methods. 30 high-risk patients, who had pathological breast lesions detected by diagnostic CE-MRI, classified as BI-RADS 4, 5 yet occult on the other visualization methods were enrolled in the study. All patients underwent supine MRI prebiopsy examination, real-time virtual sonography of the lesions, image-guided biopsy or excisional biopsy, histopathologic examination.Results. The breast fusion-biopsy method was developed based on up-to-date scientific publications and optimized for the technical equipment of N.N. Petrov National Medicine Research Center of Oncology. According to the designed protocol of examination, there were the following steps: interpretation of breast CE-MRI in the standard prone position for breast lesion detection, prebiopsy CE-MRI performed in the supine position, real-time virtual sonography for comparison of breast MRI and US, histopathologic examination.Conclusion. Being one of the perspectives methodic of morphological verification Fusion-biopsy might become a more common procedure in breast lesions diagnostics. The simplicity of US-guided biopsy and high MRI breast diagnostic sensitivity are combined in fusion-biopsy technology.

Retrospective Cohort Study of Practical Applications of Paramagnetic Seed Localisation in Breast Carcinoma and Other Malignancies.

(1) Background: Paramagnetic seeds are a safe alternative for the wire-guided localisation of non-palpable breast lesions, but can also be applied for non-breast lesions. This study presents the experience with a paramagnetic seed, MagSeed® (Endomagnetics Ltd., Cambridge, UK, CE-registered and FDA-cleared), in an academic and non-academic breast centre. (2) Methods: Multicentre, retrospective analysis of 374 consecutive patients who underwent surgery after paramagnetic seed localisation (MSL) between 2018 and 2020. Indications for localisation included non-palpable breast lesions (n = 356), lymph nodes (n = 15) or soft tissue lesions (n = 3). The primary outcome was feasibility and the rate of positive section margins. The secondary outcome was predictive factors for positive section margins. (3) Results: The accurate excision of high-risk breast lesions, lymph nodes and soft tissue lesions was seen in 91.07% (n = 56). Positive section margins were observed in 7.86% (n = 25) after breast conserving surgery for invasive or ductal carcinoma in situ (DCIS) (n = 318). Invasive breast cancer associated with DCIS (p = 0.043) and the size of DCIS (p < 0.001) were significantly correlated with the positive section margins. (4) Conclusion: This study confirms the feasibility of MSL, as well as the higher risk for positive margins in cases of breast carcinoma with associated DCIS. Soft tissue lesions and lymph nodes associated with other malignancies, e.g., melanoma, can also be localised with paramagnetic seeds. This offers perspectives for future applications, such as the de-escalation of axillary treatment in breast cancer.

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Role of imaging guided wire localization of non-palpable breast lesions: Effect of localization accuracy on surgical outcome and histopathological safety margins

Role of imaging guided wire localization of non-palpable breast lesions: Effect of localization accuracy on surgical outcome and histopathological safety margins

Efficacy and Accuracy of Using Magnetic Seed for Preoperative Non-Palpable Breast Lesions Localization: Our Experience with Magseed.

In this retrospective study we share our single-center experience using a magnetic seed for the preoperative localization of non-palpable breast lesions. Patients who underwent a preoperative localization with Magseed® (Endomagnetics, Cambridge, UK) placement between 2020 and 2022 were enrolled. Indications to Magseed placement have been established during multidisciplinary meetings prior to surgery and all patients underwent breast-conserving surgery (BCS). 45 patients were included. Magnetic seeds have been introduced under ultrasound guidance in 40 patients (88.9%) and under stereotactic guidance in 5 patients (11.1%). We registered a highly successful placement rate (97.8%), with only one case of migration (2.2%). After BCS, all the magnetic seeds were recovered (100% retrieval rate). The re-excision rate for positive margins was 0%. Our experience, with a highly successful placement and retrieval rate and a re-excision rate equal to 0%, is consistent with the encouraging literature published on Magseed so far, suggesting this technique to be extremely effective. Moreover, our single case of seed migration supports the existing data stating that Magseed migration is rare. In conclusion, despite acknowledging Magseed limitations, we highly value the advantages linked to this technique, and we, therefore, uphold its use.

Evaluation of Magseed marker in location of non-palpable breast lesions

Introduction Currently, more and more cases of breast cancer are detected in the early stages of advancement. Removal of the minimum required tissue volume ensures that the proper shape of the breast is maintained. On the other hand, it is important to get negative tissue margins. Objective To present your own experience with the use of preoperative breast tumor determination using the Magseed marker. Material and methods On the eve of the procedure, a Magtrace magnetic marker was administered to determine the lymph nodes and, under ultrasound control, a Magseed magnetic marker to the tumor, and the site of the lesion was marked with a skin marker as the operated site. Before the skin incision, the lesion was located using intraoperative ultrasound and the Sentimag probe. After the tumor was excision, the presence of the marker was confirmed in the preparation using the magnetic method and the compatibility of the ultrasound image before and after the procedure. The results of the research group were 23 patients. Radicality of the procedure was achieved in 20 patients (87%). To assess the size of the preparation and tumor, a formula from the work of Angarita et al. on the volume of the ellipsoid was used. It was assessed what part of the excised preparation was a tumor marked using the Magseed marker. Cohorts of 11 patients at the beginning and end of the evaluated group were compared, showing a significant increase in this parameter. Together with the learning curve, you can identify the tumor much more precisely and save healthy breast tissues by improving the aesthetic effect in the breast range. Conclusions The method of localization of non-pallpatory lesions in the mammary gland using the Magseed marker is simple to use, and the high detection rate directly translates into a reduction in the percentage of non-radical treatments in the case of sparing treatment.

Radiofrequency Identification—RFID using LOCalizer-Tag in Non-palpable Breast Lump

For many years, wire-guided localization represented the gold standard method for the detection of non-palpable breast lesions, despite the acknowledged limitations. LOCalizer™ is the most recent and promising radiofrequency identification system, characterized by the capability of measuring the distance from the tagged lesion in millimeters and the association of each marker with a unique code. A 45-year-old woman with two lesions suspected of cancer in the same breast was referred to our department. She underwent double localization with LOCalizer™ (Hologic, Santa Carla, CA, USA) of the lumps into opposite quadrants. We performed a mini-invasive and oncologically safe surgical excision through a tunneling approach after a peri-areolar incision. The surgical technique realized with Localizer™ could be an effective method for locating multiple non-palpable breast lesions and is able to offer excellent oncological and cosmetic results, as also confirmed by several reports in the literature.

Radar Localisation of Non-palpable Breast Lesions in a Chinese Population: a Pilot Study

Radar Localisation of Non-palpable Breast Lesions in a Chinese Population: a Pilot Study

Image-guided Localisation of Nonpalpable Breast Lesions: a Comparative Analysis of Magnetic Seeds and Hookwires in an Asian Population

Image-guided Localisation of Nonpalpable Breast Lesions: a Comparative Analysis of Magnetic Seeds and Hookwires in an Asian Population