Comparison of Wireless Localization Alternatives to Wire Localization for Non-Palpable Breast Lesions
Bridget Kelly, Alexandra J. Webster, Caroline McGugin, Suzanne B. Coopey, Barbara L. Smith, Michele A. Gadd, Kevin S. Hughes, Michelle C. Specht
Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts, United States
Objective
Radiofrequency identification (RFID) localization (TL) and magnetic seed localization (MSL) are alternatives to wire localization (WL) for excision of non-palpable breast lesions. In this study, we compared these three localization methods with respect to specimen size, operative time, and re-excision rate. To our knowledge, this is the largest comparison of TL, MSL, and WL at a single institution.
Design
Retrospective cohort study
Setting
High-volume academic center
Patients
528 patients who underwent localization and excision of non-palpable breast lesions by six dedicated breast surgeons were identified: 147 (27.8%) TL, 146 (27.8%) MSL, and 234 (44.4%) WL. Data from four months of consecutive procedures were collected for each localization technique: TL (07/2018-10/2018), MSL (04/2017-07/2017), and WL (10/2015-01/2016).
Intervention
N/A
Main Outcome Measures
Specimen size, operative time, and re-excision rate
Results
TL, MSL, and WL cohorts were similar with regards to patient age, surgery type, surgical indication, final pathology, and use of shaved cavity margins. The cohorts differed in terms of use of bracketing, surgeon, and pre-operative lesion size. While specimen volume did not vary significantly between localization methods across surgery types, operative time was longer with TL indicating a learning curve. On logistic regression analysis of all lumpectomy procedures, neither TL (WL vs TL OR 1.000, 95% CI 0.407-2.454; p=0.999) nor MSL (WL vs MSL OR 1.002, 95% CI 0.466-2.154; p=0.997) were associated with increased need for re-excision.
Conclusion
TL and MSL are equivalent alternatives to WL for excision of non-palpable breast lesions. Although initial operative times are longer, marker placement prior to day of surgery has the potential to increase overall operative room efficiency and times will likely decrease with additional experience.
| RFID N=147 | Magnetic Seed N=147 | Wire N=234 | p-value | |
| Specimen volume (cm^3), median (range) | ||||
| Excisional biopsy | 15.8 (1.6-72.1) | 12.4 (0.8-78.7) | 14.6 (0.6-83.2) | 0.285 |
| Lumpectomy | 28.6 (0.7-154.0) | 38.8 (1.2-215.5) | 38.3 (1.0-311.9) | 0.952 |
| Lumpectomy + axillary surgery | 31.2 (2.6-254.2) | 31.4 (3.2-305.6) | 40.5 (0.8-302.4) | 0.253 |
| Operative time (min), median (range) | ||||
| Excisional biopsy | 35 (17-65) | 37 (10-82) | 32.5 (11-86) | 0.002 |
| Lumpectomy | 56 (15-93) | 36 (22-66) | 45 (12-118) | 0.011 |
| Lumpectomy + axillary surgery | 69.5 (29-125) | 64 (24-108) | 61 (30-121) | 0.015 |
| Re-excision rate, N (%) | ||||
| Lumpectomy | 12 (31.6%) | 13 (37.1%) | 15 (30.6%) | 0.806 |
| Lumpectomy + axillary surgery | 8 (13.3%) | 11 (18.0%) | 17 (18.3%) | 0.695 |
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