Resection Of Nonpalpable Breast Lesions Research Articles

Evaluation of Carbon Nanoparticle Suspension and Methylene Blue Localization for Preoperative Localization of Nonpalpable Breast Lesions: A Comparative Study.

Background: The resection of nonpalpable breast lesions (NPBLs) largely depends on the preoperative localization technology. Although several techniques have been used for the guidance of NPBL resection, more comfortable and effective methods are needed. This aim of this study was to evaluate the use and feasibility of carbon nanoparticle suspension (CNS) and methylene blue (MB)-guided resection of NPBL, to introduce alternative techniques.Methods: A total of 105 patients with 172 NPBLs detected by breast ultrasound were randomized to CNS localization (CNSL) group and MB localization (MBL) group. The injection times of the two groups were divided into 2, 4, 6, 12, 16, and 20 h before surgery. In this study, localization time, stained area, operation time, total resection volume (TRV), calculated resection ratio (CRR), and pathological diagnosis were assessed.Results: All of the 172 lesions were finally confirmed benign. Dye persisted in all cases in the CNSL group (109/109, 100%), while that persisted in only 53 cases in the MBL group (53/63, 84.1%) (P < 0.001). There was a significant correlation between dyeing time and dyeing area in the MBL group (r = −0.767, P < 0.001); however, there was no significant correlation in the CNSL group (r = −0.154, P = 0.110). The operation time was 11.05 ± 3.40 min in the CNSL group and 13.48 ± 6.22 min in the MBL group (P < 0.001). The TRV was 2.51 ± 2.42 cm3 in the CNSL group and 3.69 ± 3.24 cm3 in the MBL group (P = 0.016). For CRR, the CNSL group was lower than the MBL group (7.62 ± 0.49 vs. 21.93 ± 78.00, P = 0.018). There is no dye remained on the skin in the MBL group; however, dye persisted in 12 patients (19.4%) in the CNSL group (P = 0.001).Conclusion: Carbon nanoparticle suspension localization and MBL are technically applicable and clinically acceptable procedures for intraoperatively localizing NPBL. Moreover, given the advantages of CNSL compared to MBL, including the ability to perform this technique 5 days before operation and smaller resection volume, it seems to be a more attractive alternative to be used in intraoperative localization of NPBL.

System for image-guided resection of nonpalpable breast lesions: Proof of concept.

In breast-conserving surgery (BCS), the cancer is sometimes incompletely excised, leading to reduced patient survival. To pursue complete excisions, radioactive seed localization (RSL) may be used to insert an iodine-125 seed into the tumor. The seed is used as a marker for the location of the tumor during surgery. RSL does not, however, show the extent of the tumor. Based on RSL, we pursue to visualize the seed location together with the extent from diagnostic images. A system with two gamma-camera heads and two parallel-hole collimators was recently proposed to triangulate the location of an iodine-125 seed during BCS. In the present study, this system was extended with a range camera to visualize a sphere centered on the seed in relation to the breast. This sphere contains the entire tumor and thus defines the target volume for BCS. Physical experiments with acrylic block phantoms (thickness ranging from 3.5 to 6.5cm) were performed to assess the absolute bias and the precision with which this sphere can be visualized. When a 6.5cm thick phantom was used, along the horizontal plane, the target volume was visualized with an absolute bias and a precision of 2.1 and 0.8mm, respectively. Along the vertical axis (i.e., z-axis), these values were 4.2 and 2.8mm, respectively. The proposed system visualizes the target volume with an absolute bias that may be acceptable for BCS.

Use of the ROLL technique for lumpectomy in non-palpable breast lesions.

To evaluate the efficiency of radioguided occult lesion localising in non-palpable breast lesions (NPBL) compared to the surgical wire technique. A prospective study was conducted on 161 women with NPBL, of whom 80 marked with the wire (group 1), whereas 81 women were marked with an intratumour injection of 99mTc-nanocoloid (group 2). The NPBL were located by ultrasound or stereotactic guidance. The lumpectomies were performed following the wire direction in group 1, and with the aid of a gamma-probe in group 2. Surgical margins were then checked, determining the need of extension if the margin was less than 5mm in the intra-surgical study, and less than 2mm in the deferred study. Data were collected on the mean number detected by surgery, surgical margins, number of extensions, presence of residual tumour in the extension, second surgeries, lumpectomy volume, as well as total resected volume, volume/tumour ratio, and complications. No significant differences were observed between the two groups in the mean number detected, surgical margins, number of extensions, presence of residual tumour in the extension, second surgeries, lumpectomy volume, total resected volume, volume/tumour ratio or complications. The multivariate analysis showed the determining factors of the resected volume were the radiological guidance technique, as well as the surgeon. The radioguided occult lesion localising technique helps in the detection and resection of NPBL with the same efficiency as the surgical wire, and adds the possibility of sentinel node detection in the same surgery. The determining factors of the resected volume were the radiological guidance technique and the surgeon.

Use of the ROLL technique for lumpectomy in non-palpable breast lesions

ObjectiveTo evaluate the efficiency of radioguided occult lesion localizing in non-palpable breast lesions (NPBL) compared to the surgical wire technique. MethodA prospective study was conducted on 161 women with NPBL, of whom 80 were marked with the wire (group 1), whereas 81 women were marked with an intratumor injection of 99mTc-nanocoloid (group 2). The NPBL were located by ultrasound or stereotactic guidance. The lumpectomies were performed following the wire direction in group 1, and with the aid of a gamma-probe in group 2. Surgical margins were then checked, determining the need of extension if the margin was less than 5mm in the intra-surgical study, and less than 2mm in the deferred study. Data were collected on the mean number detected by surgery, surgical margins, number of extensions, presence of residual tumor in the extension, second surgeries, lumpectomy volume, as well as total resected volume, volume/tumor ratio, and complications. ResultsNo significant differences were observed between the two groups in the mean number detected, surgical margins, number of extensions, presence of residual tumor in the extension, second surgeries, lumpectomy volume, total resected volume, volume/tumor ratio or complications. The multivariate analysis showed that the determining factors of the resected volume were the radiological guidance technique, as well as the surgeon. ConclusionsThe radioguided occult lesion localizing technique helps in the detection and resection of NPBL with the same efficiency as the surgical wire, and adds the possibility of sentinel node detection in the same surgery. The determining factors of the resected volume were the radiological guidance technique and the surgeon.

Application of Localization and Needle Placement Guided by Mammographic, Ultrasound and Fiberoptic Ductoscopy for Resection of Non-palpable Breast Lesions.

To evaluate the usefulness of localization needles under mammographic, ultrasound or fiberoptic ductoscopy guidance for non-palpable breast lesions. Eighty-three patients undergoing needle localization and biopsy of non-palpable breast lesions under mammographic, ultrasound or fiberoptic ductoscopy guidance from June 2013 to December 2014 in Beijing Friendship Hospital were included in the study. The preoperative imaging assessment, application of localization needles, surgical operation and pathological examination were recorded and analyzed retrospectively. A total of 83 localization and biopsies were carried out, of which 27 were performed under mammographic guidance, 32 under ultrasound guidance and 24 under fiberoptic ductoscopy guidance. Twenty-seven cases of breast microcalcifications were localized under mammographic guidance and surgically removed, of which eight cases were pathologically diagnosed as malignant. Thirty-two cases of non-palpable breast lesions were localized under ultrasound guidance and 30 pathologically diagnosed, of these, four cases were pathologically diagnosed as malignant. Twenty-four cases of intraductal space-occupying lesions were localized under ductoscopy guidance and surgically removed, of which five cases were pathologically diagnosed as malignant. Utilization of localization needles under mammographic, ultrasound or fiberoptic ductoscopy guidance for non-palpable breast lesions is a safe and effective procedure, and is helpful in the diagnosis of breast cancer. With the help of this procedure, more malignant lesions can be localized and surgically removed.

Application of three-dimensional wire localization and orientation in the resection of non-palpable breast lesions.

The aim of the present study was to compare the application value of the 3D stereo wire localization technique guided by a full digital breast X-ray machine, and general location technique in the resection of breast non-palpable lesions. A retrospective analysis of the clinical data of 80 patients with abnormal findings for non-palpable breast molybdenum target X-ray was conducted between June, 2011 and July, 2014. The patients were divided into two groups: 40 cases with a general location of lesions identified by perturbation axial + standard lateral radiograph to guide the clinical operation biopsy (group A); and 40 cases with a general location of lesions identified by the 3D stereo wire localization method to guide the clinical operation biopsy (group B). The one-time success rate of the resection of breast lesions of the two groups of patients was compared. Both groups of patients completed the operation. Of the 40 cases in group A, 33 cases had one-time complete resection of lesions, 5 cases had incomplete resection with the second resection, and the lesions of 2 cases were not excised and the one-time success rate of the breast lesion resection was 82.5%. Of the 40 cases in group B, lesions of 38 cases were one-time complete resection and 2 had vagal reaction; thus, the one-time success rate of breast lesion resection being 95%. Compared to group A, the one-time success rate of breast lesion resection of group B was statistically and significantly higher (χ2=3.638, P<0.05). In conclusion, the 3D stereo wire localization technique guided by the full digital breast X-ray machine for the excision of non-palpable breast lesions has high positioning accuracy with small operation excision scope. It is therefore an effective method that can be utilized for the qualitative diagnosis of non-palpable breast lesions.

Preoperative Radioactive Seed Localization for Nonpalpable Breast Lesions: Technique, Pitfalls, and Solutions

Iodine 125 ((125)I) radioactive seed localization has emerged as a reliable and safe alternative to wire localization for guidance during the surgical resection of nonpalpable breast lesions. The breast imager has a responsibility to be familiar with the general principles of this evolving technique, including its advantages and disadvantages as well as the technical differences involved in placement of seeds versus traditional wire localization. Although placement of (125)I seeds is conceptually similar to wire placement, there are additional technical considerations and safety measures that need to be addressed and implemented when radioactive seeds are used. We draw from our experience with more than 1000 cases of radioactive seed localization since inception of our program in 2009 to provide illustrative examples of not only the proper technique of radioactive seed localization, but also mishaps that may occur during this procedure, along with practical suggestions to prevent these problems. We examine some of the difficulties that we have encountered during radioactive seed localization at our institution, including bone wax mimicking the seed, the inadvertent deployment of seeds, the need for multiple seeds or supplemental wires, problematic seed locations, and difficulty in surgical retrieval of the seed. Recognizing the potential pitfalls of radioactive seed localization and understanding the appropriate guidelines and precautions for the safe, secure handling and placement of radioactive seeds is essential for a successful radioactive seed localization program.

Patent blue and air as an alternative for resection of nonpalpable breast lesions: a case series.

Use of mammography for breast cancer screening has resulted in a significantly increased number of patients with nonpalpable radiological findings that need histopathological study for better management. The present study evaluated an alternative to excision of nonpalpable breast lesions, using injection of patent blue (CAS 3536-49-0) dye and air. Cohort study of 64 consecutive patients at a private clinic in the city of Teresina (Piauí), between January 2009 and December 2010. The patients had received mammographic diagnoses of nonpalpable breast lesions classified as BI-RADS 3, 4 and 5, with indication of histopathological study. They underwent stereotaxy and/or ultrasound-guided injection of patent blue, for marking and subsequent excision of the lesion. The patients' mean age was 47.7 years. Nodes accounted for 53.1% of the breast abnormalities; microcalcifications, 37.5%; and complex cysts, 9.4%. In 89.1% of cases, the lesions were BI-RADS 4; 7.8% were BI-RADS 5 and 3.1% were BI-RADS 3. The histopathological findings were benign in 70.3% of the cases; atypical hyperplasia, 9.4%; and malignant, 20.3%. Among the malignant cases, 53.8% were carcinoma in situ and 46.2%, invasive carcinoma. The percentage of malignancy was 0% in BI-RADS 3 lesions; 14.3% in BI-RADS 4 and 100% in BI-RADS 5. In the cases of malignancy, the margins were clear in 92.3%. Reoperation to widen the margins was required in one patient. Excision of nonpalpable breast lesions marked with patent blue and air was possible in all cases.

Radio-guided occult lesion localization versus wire-guided localization in non-palpable breast lesions

‘Radio-guided occult lesion localization’ is a new technique in the breast conservative surgery performed for the localization and resection of non-palpable breast lesions. The purpose of this study is to evaluate the results of this breast surgical procedure provided by several published papers.

Radioguided occult lesion localisation in breast cancer using an intraoperative portable gamma camera: first results

The role of the radioguided occult lesion localisation (ROLL) technique in breast cancer has been increasing in recent years. One of the important drawbacks of such a technique is radiotracer spillage within the mammary gland that makes the precise lesion resection difficult, and this requires the use of a hook-wire collocation to reach the lesion. The possibility of obtaining an intraoperative image of the specimen could help to confirm whether the lesion is correctly removed. Some types of portable gamma cameras have been designed, but up to now, intraoperative use has been confined to surgery of parathyroid adenomas and sentinel lymph node location. The aim of the study was to value the usefulness of an intraoperative gamma camera to assess the resection of non-palpable breast lesions. The study involved 42 women diagnosed with non-palpable early breast cancer. Lymphoscintigraphy was performed on the day before surgery by injection of (99m)Tc-labelled nanocolloid. During surgery a gamma probe was used to guide the surgeon, and afterwards images of the surgical bed and the tumoral specimen were acquired by means of a portable gamma camera, fitted with a pinhole collimator. A (99m)Tc pointer was used to draw an outline image around the specimen. On lymphoscintigraphy, radiotracer was concentrated in 31 cases. During surgery, all lesions were removed. In the images acquired by the portable gamma camera, the lesion was centred inside the surgical specimen in 23 of 42 cases, non-centred in 15 and in contact in 4 cases. Congruence of 60% was found between the intraoperative images and the histopathological results. The posterior margin was the most frequently involved. The whole acquisition time for the tumoral specimen with its margins was 5 min at most. The use of portable gamma cameras in theatre is in an early phase. The short period of time required during the surgical procedure will allow the surgical team to improve this technique until it can replace hand-held probes. The intraoperative acquisition of such images can predict the involvement of surgical margins, avoiding future surgical procedures.