Techniques for Guiding Excision of Non Palpable Breast Lesions

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Currently, wire localization (WL):
    • Is the most commonly used technique for guiding excision of nonpalpable lesions in the breast
    • Disadvantages of WL include:
      • Coordination of scheduling in the operating room and radiology
      • Patient discomfort
      • Potential for dislodgement or malpositioning
  • Localization devices that do not require wires are increasing in popularity to overcome some of these issues:
    • Commonly used devices include:
      • Radioactive seeds
      • Radar reflectors
      • Magnetic seeds
        • They can be implanted prior to surgery via mammographic or sonographic guidance
        • These can be placed in patients undergoing surgery upfront or after completion of neoadjuvant chemotherapy
  • Studies comparing the various techniques to WL:
    • Have demonstrated similar rates of positive margins, specimen volumes, and need for re-excision
  • While removal of the lesion can be determined simply by confirming signal within the specimen:
    • Specimen radiograph is still essential to document retrieval of the clip and/or targeted lesion.4Radioactive seed placement has not been shown to interfere with the isotope utilized in sentinel node mapping. Although initially used mostly for non-palpable breast lesions, use of these techniques is increasing in localization of lymph nodes, especially after neoadjuvant chemotherapy.5
  • References
  • 1. Lovrics PJ, Goldsmith CH, Hodgson N, et al. A multicentered, randomized, controlled trial comparing radioguided seed localization to standard wire localization for nonpalpable, invasive and in situ breast carcinomas. Ann Surg Oncol. 2011;18(12):3407-3414.
  • 2. Patel SN, Mango VL, Jadeja P, et al. Reflector-guided breast tumor localization for lumpectomies: a comparison of surgical outcomes. Clin Imaging. 2018;47:14-17.
  • 3. Harvey JR, Lim Y, Murphy J, et al. Safety and feasibility of breast lesion localization using magnetic seeds (Magseed): a multi-centre, open-label cohort study. Breast Cancer Res Treat. 2018;169(3):531-536.
  • 4. American Society of Breast Surgeons: Performance and Practice Guidelines for Breast-Conserving Surgery/Partial Mastectomy, v.2015. https://www.breastsurgeons.org/statements/guidelines/PerformancePracticeGuidelines_Breast-ConservingSurgery-PartialMastectomy.pdf. Accessed February 15, 2019.
  • 5. Caudle AS, Yang WT, Mittendorf EA et al. Selective surgical localization of axillary lymph nodes containing metastases in patients with breast cancer: a prospective feasibility trial. JAMA Surg. 2015;150(2):137-143.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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