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Review
. 2021 Feb 4;11(2):99.
doi: 10.3390/jpm11020099.

Image-Guided Localization Techniques for Surgical Excision of Non-Palpable Breast Lesions: An Overview of Current Literature and Our Experience with Preoperative Skin Tattoo

Gianluca Franceschini  1   2 , Elena Jane Mason  1 , Cristina Grippo  3 , Sabatino D'Archi  1 , Anna D'Angelo  4 , Lorenzo Scardina  1 , Alejandro Martin Sanchez  1 , Marco Conti  4 , Charlotte Trombadori  4 , Daniela Andreina Terribile  1   2 , Alba Di Leone  1 , Beatrice Carnassale  1 , Paolo Belli  4 , Riccardo Manfredi  4 , Riccardo Masetti  1   2
Affiliations
Review

Image-Guided Localization Techniques for Surgical Excision of Non-Palpable Breast Lesions: An Overview of Current Literature and Our Experience with Preoperative Skin Tattoo

Gianluca Franceschini et al. J Pers Med. .

Abstract

Breast conserving surgery has become the standard of care and is more commonly performed than mastectomy for early stage breast cancer, with recent studies showing equivalent survival and lower morbidity. Accurate preoperative lesion localization is mandatory to obtain adequate oncological and cosmetic results. Image guidance assures the precision requested for this purpose. This review provides a summary of all techniques currently available, ranging from the classic wire positioning to the newer magnetic seed localization. We describe the procedures and equipment necessary for each method, outlining the advantages and disadvantages, with a focus on the cost-effective preoperative skin tattoo technique performed at our centre. Breast surgeons and radiologists have to consider ongoing technological developments in order to assess the best localization method for each individual patient and clinical setting.

Keywords: breast cancer; breast ultrasound; breast-conserving surgery; image-guided localization; non-palpable breast lesions; preoperative breast localization.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Wire-guided localization. Craniocaudal (a) and mediolateral (b) oblique mammograms taken after hookwires insertion show optimal wires positioning, with the wires at the biopsy markers site. A specimen radiograph (c) contains the hookwire and the residual calcifications (circle).
Figure 2
Figure 2
Radio-guided occult lesion localization (ROLL) technique: (a) invasive ductal cancer (arrow) in the left upper outer quadrant in a 77-year-old woman. (b) Intratumoral injection (arrow head) of a small amount (0.2–0.3 mL) of human serum albumin marked with nuclear radiotracer technetium 99 in order to perform radio-guided occult lesion localization.
Figure 3
Figure 3
Magseed positioning in a 49-year-old woman with ductal carcinoma in situ. Ultrasound images of the right upper outer quadrant. Biopsy marker is visible in the lesion (a, arrow). Magseed magnetic marker is placed under ultrasound guidance (b, arrow shows the needle). Magseed® marker is clearly seen in the lesion (c, arrow).
Figure 4
Figure 4
Preoperative skin tattoo. Transverse sonogram showing hypoechoic, round shaped multifocal masses with indistinct margins in the upper outer quadrant of the right breast (a,b, arrows). The distance between separate lesions is measured (c). The dermographic skin markers of the tumor’s projection on the skin surface (d).
Figure 5
Figure 5
Lead marker positioning during mammographic technique. Metallic marker (a). Craniocaudal (b) and mediolateral oblique (c) views confirm the appropriate marker (arrow) placement on the microcalcifications’ (circle) projection on the skin surface. Specimen X-ray contains the microcalcifications (d).
Figure 6
Figure 6
Radiograph of a dense, glandular specimen with scarcely recognizable nodules (a). Subsequent specimen ultrasound demonstrates successful removal of two masses (arrows) (b,c).
See this image and copyright information in PMC

References

    1. Sharma R. Breast cancer incidence, mortality and mortality-to-incidence ratio (MIR) are associated with human development, 1990–2016: Evidence from Global Burden of Disease Study 2016. Breast Cancer. 2019;26:428–445. doi: 10.1007/s12282-018-00941-4. - DOI - PubMed
    1. Moo T.-A., Sanford R., Dang C., Morrow M. Overview of breast cancer therapy. PET Clin. 2018;13:339–354. doi: 10.1016/j.cpet.2018.02.006. - DOI - PMC - PubMed
    1. Franceschini G., Terribile D., Fabbri C., Magno S., D’Alba P., Chiesa F., Di Leone A., Masetti R. Management of locally advanced breast cancer. Mini-review. [(accessed on 8 November 2020)];Minerva Chir. 2007 62:249–255. Available online: http://europepmc.org/abstract/MED/17641585. - PubMed
    1. Fisher B., Anderson S., Bryant J., Margolese R.G., Deutsch M., Fisher E.R., Jeong J.-H., Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N. Engl. J. Med. 2002;347:1233–1241. doi: 10.1056/NEJMoa022152. - DOI - PubMed
    1. Veronesi U., Cascinelli N., Mariani L., Greco M., Saccozzi R., Luini A., Aguilar M., Marubini E. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N. Engl. J. Med. 2002;347:1227–1232. doi: 10.1056/NEJMoa020989. - DOI - PubMed

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