1. Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411)
- Author
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Maggie Banys-Paluchowski, Thorsten Kühn, Yazan Masannat, Isabel Rubio, Jana de Boniface, Nina Ditsch, Güldeniz Karadeniz Cakmak, Andreas Karakatsanis, Rajiv Dave, Markus Hahn, Shelley Potter, Ashutosh Kothari, Oreste Davide Gentilini, Bahadir M. Gulluoglu, Michael Patrick Lux, Marjolein Smidt, Walter Paul Weber, Bilge Aktas Sezen, Natalia Krawczyk, Steffi Hartmann, Rosa Di Micco, Sarah Nietz, Francois Malherbe, Neslihan Cabioglu, Nuh Zafer Canturk, Maria Luisa Gasparri, Dawid Murawa, James Harvey, and Banys-Paluchowski M., Kuehn T., Masannat Y., Rubio I., de Boniface J., Ditsch N., Karadeniz Cakmak G., Karakatsanis A., Dave R., Hahn M., et al.
- Subjects
Internal Diseases ,Cancer Research ,radiofrequency identification tag ,radioactive seed ,intraoperative ultrasound ,Sağlık Bilimleri ,İç Hastalıkları ,Clinical Medicine (MED) ,breast cancer ,radar reflector ,Health Sciences ,Klinik Tıp (MED) ,ddc:610 ,CANCER PATIENTS ,Internal Medicine Sciences ,Klinik Tıp ,Kirurgi ,non-palpable lesion ,RADIOACTIVE SEED LOCALIZATION ,WIRE-GUIDED LOCALIZATION ,RADIOGUIDED LOCALIZATION ,Dahili Tıp Bilimleri ,REOPERATION RATES ,CLINICAL MEDICINE ,CARBON LOCALIZATION ,CONSERVING SURGERY ,magnetic seed ,Onkoloji ,wire-guided localization ,Tıp ,Oncology ,localization technique ,AGO RECOMMENDATIONS ,CARCINOMA IN-SITU ,Medicine ,ONKOLOJİ ,Surgery ,Radiologi och bildbehandling ,INTRAOPERATIVE ULTRASOUND GUIDANCE ,Radiology, Nuclear Medicine and Medical Imaging - Abstract
Simple Summary Most breast cancers are small and can be treated using breast-conserving surgery. Since these tumors are non-palpable, they require a localization step that helps the surgeon to decide which tissue needs to be removed. The oldest localization technique is a guidewire placed into the tumor before surgery, usually using ultrasound or mammography. Afterwards, the surgeon removes the tissue around the wire tip. However, this technique has several disadvantages: It can cause the patient discomfort, requires a radiologist or another professional specialized in breast diagnostics to perform the procedure shortly before surgery, and 15-20% of patients need a second surgery to completely remove the tumor. Therefore, new techniques have been developed but most of them have not yet been examined in large, prospective, multicenter studies. In this review, we discuss all available techniques and present the MELODY study that will investigate their safety, with a focus on patient, surgeon, and radiologist preference. 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.
- Published
- 2023