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Background: 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. Methods: We performed a systematic review on localization techniques for non-palpable breast cancer. Results: 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. Conclusions: 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.

Purpose To 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. Methods Observational, 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. Results We 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. Conclusion Long-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.

Background Due to the establishment of screening mammography for breast cancer detection, the number of non-palpable lesions has increased. Thus, an optimal localization system is mandatory for the excision of non-palpable breast tumors. Objective The aim of the study is to report the feasibility Surgical Marker Navigation (SMN) system Sirius Pintuition® for the excision of non-palpable breast tumors and non-palpable axillary lymph nodes. Methods A retrospective observational study of patients undergoing breast-conserving surgery and lymph node excision guided by SMN between December 2022 and May 2023 was performed. Results A total of 84 patients underwent excision of non-palpable breast tumors (77; 91.7%) or non-palpable axillary lymph-nodes (7; 8.3%) using SMN. In total, 94 markers were placed, in 74 patients (88.1%) only one marker was placed, whereas in 10 patients (11.9%) two markers were placed to correctly localize the lesion in the operating room. Most markers were placed using ultrasonographic guidance (69; 82.1%). Seventy-seven patients underwent breast-conserving surgery (91.7%) and 7 (8.3%) lymph node excision. In 10 cases (11.9%), the marker was accidentally displaced during surgery due to the use of magnetized instruments, although the specimen could be removed. In sum, all the markers were removed from the patients, although the marker retrieval rate, as we defined it (percentage of patients in whom the initial excised specimen contained the marker divided by the total number of patients), was 88.1%. Conclusion The use of Sirius Pintuition® SMN for non-palpable breast tumors and non-palpable lymph nodes is feasible, with a retrieval rate of 88.1%.

Background Pseudomyxoma peritonei (PMP) is a rare neoplastic disease that can occasionally present with pulmonary metastases as an even rarer manifestation. Although cytoreductive surgery represents the primary treatment option for PMP, surgical management of pulmonary metastases presents unique challenges owing to their mucinous nature. The aim of this case series was to present key considerations for the surgical management of PMP lung metastases, particularly regarding solid-appearing nodules that are impalpable during surgical resection, requiring more extensive resection owing to the risk of recurrence. Case presentation Between November 2013 and May 2023, we performed a total of 13 surgical procedures for pulmonary metastases in seven patients with PMP at our institution. During these procedures, 18 pulmonary lesions were resected. Some patients underwent multiple surgeries; multiple lesions were resected in a single procedure in certain cases. Notable characteristics of PMP pulmonary metastases, attributed to their mucinous dissemination pattern, included cases wherein subpleural solid nodules that would typically be palpable in patients with conventional solid tumour metastases were non-palpable and cases requiring right upper lobectomy following repeated surgical margin recurrence. Median follow-up results showed a progression-free survival of 20.0 months and overall survival of 40.3 months. Three of the seven patients experienced postoperative recurrence, with two patients having intrapulmonary metastatic recurrence involving low-grade tumours. Conclusions Surgical resection can be an effective treatment option for PMP pulmonary metastases; however, careful patient selection and appropriate surgical planning are essential. The unique characteristics of PMP metastases necessitate specific surgical strategies. Since computed tomography-apparent solid nodules may be non-palpable intraoperatively and surgical margin recurrence should be avoided, selecting surgical approaches that minimise unnecessary lung palpation, such as preoperative marking or anatomical lung resection, is crucial. The mechanisms of PMP pulmonary metastasis development and progression remain unclear, warranting further research into blood-borne dissemination patterns and optimal surgical techniques for non-palpable lesions.

Background Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women. Approximately 50% of breast cancers are discovered at an early stage in patients for whom conservative surgery is indicated. Intraoperative localization of non-palpable breast lesions is generally accomplished using a hook wire to mark the area of concern under ultrasound or stereotactic localization. But this technique has several drawbacks (painful, stressful…). We propose the use of a wire-free breast lesion system using miniature radiofrequency identification (RFID) tags. This technique could improve patient comfort and surgical comfort for surgeons. We therefore propose a study to assess the interest of introducing the RFID localization technique at the Jean PERRIN comprehensive cancer center. Methods This is a single-center prospective trial designed to assess the interest in introducing the RFID localization technique at the Jean Perrin center. It aims to show the superiority of the RFID technique in terms of patient tolerance compared to the gold-standard (hook wire). A sequential inclusion in time will be performed: 20 inclusions in the gold-standard group, then 20 patients in the RFID group before repeating the inclusion scheme. Any patient requiring preoperative localization will receive a senology consultation. The RFID tag will be placed during this consultation. The hook wire localization will be done the day before the surgery. Patients will fill out a Hospital Anxiety and Depression scale (HAD) questionnaire at the time of inclusion. They will then fill out a satisfaction questionnaire in 2 steps: during the placement of the device (RFID tag or hook wire) or during the postoperative consultation at 1 month. Radiologists and surgeons will fill out a questionnaire to evaluate the localization technique, respectively after the localization and surgery procedures. Discussion The RFID study is the first study in France which specifically assesses the interest of the RFID localization in terms of patients comfort. Patient comfort is one of the key elements to take into consideration when managing patients in oncology and new technologies such as RFID tags could improve it. Trial registration ClinicalTrials.gov ID; NCT04750889 registered on February 11, 2021.

Background: Preoperative localization of non-palpable breast lesions is critical for accurate resection and margin control in breast-conserving surgery. Traditional methods, such as wire or radioguided localization, have limitations in terms of logistics, patient comfort, and procedural flexibility. SCOUT® is a wireless, radar-based alternative that may improve surgical precision and workflow. This study aimed to evaluate the clinical performance of the SCOUT® in the localization of non-palpable breast and axillary lesions, including detection success, margin status, reoperation rates, and device-related events. Methods: We conducted a retrospective, single-centre observational study including 427 patients who underwent breast-conserving surgery after preoperative localization using the SCOUT® between January 2023 and May 2024 at a tertiary academic hospital. Variables included lesion type, location, neoadjuvant treatment, device detection, seed deactivation, MRI interference, margin status, and reoperation rate. Results: The mean age was 58 ± 12.7 years, with malignant pathology in 88.5% of cases. SCOUT® achieved a 100% detection rate in axillary localizations and 98.1% in breast lesions. Seed deactivation occurred in 1.2% of cases, all successfully managed intraoperatively. MRI artefacts were observed in 1.6% of patients, without diagnostic interference. Positive margins were reported in 8.3% of cases, representing an improvement compared with the institution’s historic 12% rate, with 5.9% requiring reoperation. Carcinoma in situ showed the highest rate of positive margins, at 26%. Conclusions: SCOUT® was associated with high detection rates, a low incidence of device-related events, and favourable margin outcomes, supporting its reliability for the localization of non-palpable breast lesions.

Background/Aim: With the increase in detection of non-palpable breast lesions through screening, wire-guided localisation (WGL) has long been the favoured method for preoperative localisation. However, this technique comes with several limitations. New methods have been developed, including several non-radioactive, wireless options. We aimed to assess the effectiveness of Savi Scout® localisation (SSL) through this pooled analysis and systematic review. Materials and Methods: A number of databases were searched for records reporting data on localisation and retrieval of SSL reflectors, as well as re-excision rate. We included our own data from 20 patients (22 reflectors) at our institution. Results: A total of 842 reflectors were inserted across eleven studies and our own data. Pooled analysis revealed an overall successful deployment rate of 99.64% and a successful retrieval rate of 99.64% using SSL. A statistically significant difference in re-excision rate was found in a smaller pooled analysis conducted across four studies comparing SSL and WGL (12.9% and 21.1% respectively, p<0.01). Conclusion: The Savi Scout® localisation system is a safe and effective alternative to WGL. It facilitates flexible scheduling by decoupling radiology and surgery interventions and may reduce the need for re-excision procedures for positive surgical margins.

Background The number of patients with non-palpable breast lesions has increased gradually. This is because of the technological development in imaging techniques and the screening programs that lead to early detection of breast lesions. The number of patients with non-palpable breast lesions has increased gradually. This is because of the technological development in imaging techniques and the screening programs that lead to early detection of breast lesions. The aim of marking the non-palpable breast lesions is to achieve accurate lesion localization, to obtain the better cosmetic result with less tissue loss and to provide negative surgical margin. Aim of the study In the current study, we aimed to compare the wire-guided localization (WGL) technique with the radio-guided occult lesion localization (ROLL) technique to assess their accuracy and efficacy in non-palpable breast lesions localization. Methods This is a retrospective study conducted at Baheya center for Early Detection and Treatment of Breast Cancer from January 2018 and June2022,where 670 patients with non-palpable breast lesions underwent an excision were enrolled randomly in ROLL group ( n  = 320) and WGL ( n  = 350). Results Both the localization time and the time of operation were significantly decreased with the ROLL in comparison to WGL( P  < 0.001). Complete lesion excision with clear margins were reported in 119/135(88.2%) of ROLL group and in 130/159 (81.8%) of WGL group and the difference was significant ( P  < 0.001). Reoperations (re-lumpectomy or mastectomy) were done as a second procedure on 16(11.8%) of the ROLL patients compared with 29(18.2%) in the WGL patients( P  < 0.001). Conclusion This study shows that ROLL is as effective as WGL for non-palpable breast lesions excision. Also, ROLL improve the outcomes by decreasing the duration of surgery, localization time, achieving a higher percentage of clear margin in spite of lower specimen size and scar length.

PurposeRadiofrequency identification (RFID) tag localization (TL) is a technique of localizing non-palpable breast lesions that can be performed prior to surgery. We sought to evaluate whether TL is comparable to wire localization (WL) in regard to specimen size, operative time, and re-excision rate.MethodsA retrospective cohort analysis was performed on TL and WL excisional biopsies and lumpectomies performed by 5 surgeons at 2 institutions. Cases were stratified by surgery type and surgical indication. Associations between localization technique and specimen volume, operative time, and re-excision rate were assessed by univariate and multivariate analyses.ResultsA total of 503 procedures were included, 147 TL (29.2%) and 356 WL (70.8%). Nineteen (12.9%) RFID tags were placed before surgery, ranging 1–22 days. All intended targets were removed. TL and WL excisional biopsy and lumpectomy specimen volumes were similar (p = 0.560 and 0.494). TL and WL excisional biopsy and lumpectomy + SLNB operative times were similar (p = 0.152 and 0.158), but TL lumpectomies without SLNB took longer than WL (57 min vs 49 min; p = 0.027). Re-excision rates were similar by surgical procedure (p = 0.615), surgical indication (DCIS p = 0.145; invasive carcinoma p = 0.759), and confirmed by multivariable analysis (OR 0.754, 95% CI 0.392–1.450; p = 0.397).ConclusionsTL has similar surgical outcomes to WL with added benefit that TL can occur prior to the day of surgery. TL is an acceptable alternative to WL and should be considered for non-palpable breast lesions.

The aim of the implementation of preoperative marking procedures in non-palpable breast cancer is to obtain a successful excision of the intended lesion with tumor-free resection margins while removing as little as possible of the surrounding healthy breast tissue to better preserve cosmetic integrity. Based on the intraoperative X-ray of the tumor specimen, intraoperative widening of selected surgical resection margins (IWSM) can be performed to decrease the positive margin rate. This study aims to evaluate the role of IWSM in breast-conserving surgery. All patients undergoing guidewire localized conservative surgery for non-palpable breast cancers were considered for the study. Patients, tumor characteristics, and pathological findings were collected. Tumor specimens undergoing intraoperative X-ray were considered for the analysis. The number of IWSM specimens, the IWSM specimens containing tumor cells at final histology, and the volume of IWSM specimens were calculated. Data from 771 tumorectomies for non-palpable breast cancer performed between 2017 and 2023 at the Centro di Senologia della Svizzera Italiana (CSSI) were collected. A total of 751 tumorectomies with intraoperative X-ray assessment of the margin's status were included. In 461/751 cases (61.4%), at least one IWSM specimen was obtained. At the final histopathology, in 354/461 IWSM specimens (76.8%), no tumor cells were reported, while they were reported in 107/461 (23.2%). Of these, 89/107 (83.2%) had overall negative margins, while 18/107 (16.8%) presented involved margins at the final histopathology. In 323/461 (70.1%) IWSM specimens, the pathological report provided three dimensions useful for volume calculation. The mean volume of these specimens was 9 ± 15 cm . IWSM can help increase the efficacy of tumorectomies for non-palpable breast cancer lesions. However, in the majority of cases, healthy breast tissue is removed as well. Tumor and patient characteristics may help in the selection of cases for which IWSM reduces the positive margin rate and the number of unnecessary procedures.