Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: A systematic review and meta-analysis

Abstract

Pre-operative localization of non-palpable breast lesions with non-wired non-ionizing (NWNI) techniques may improve clinical outcomes as reoperation rate, cosmetic outcome and contribute to organizational aspects improvement in breast-conserving surgery (BCS). However only limited literature is available and clinical studies involving these forefront devices are often small and non-randomized. Furthermore, there is a lack of consensus on free margins and cosmetic outcomes definitions. The objective of the present meta-analysis was to determine the crude clinical outcomes reported for the NWNI techniques on BCS. A literature search was performed of PubMed, Embase and Scopus databases up to February 2021 in order to select all prospective or retrospective clinical trials on pre-operative breast lesion localization done with NWNI devices. All studies were assessed following the PRISMA recommendations. Continuous outcomes were described in averages corrected for sample size, while binomial outcomes were described using the weighted average proportion. Twenty-seven studies with a total of 2103 procedures were identified. The technique is consolidated, showing for both reflectors' positioning and localization nearly the 100% rate of success. The re-excision and clear margins rates were 14% (95% CI, 11-17%) and 87% (80-92%), respectively. Overall, positive margins rates were 12% (8-17%). In studies that compared NWNI and wire localization techniques, positive margin rate is lower for the first techniques (12%, 6-22% vs 17%, 12-23%) and re-excision rate is slightly higher using the latter (13%, 9-19% vs 16%, 13-18%). Pre-operative NWNI techniques are effective in the localization of non-palpable breast lesions and are promising in obtaining clear (or negative) margins minimizing the need for re-excision and improving the cosmetic outcomes. Randomized trials are needed to confirm these findings.

Keywords: Breast; Breast-conserving surgery; Clear margin; Cosmetic outcome; Localization; Meta-analysis; Non-palpable lesion; Non-wired; Preoperative; Re-excison; Re-operation; Systematic review.

Graphical abstract

Fig. 1

Flowchart of literature search based on PRISMA example.

Fig. 2

Panel A Pooled estimates of positive margins rates. - Panel B Pooled estimates of clear margins rates. - Panel C Pooled estimates of re-excision rates. Squares represent study-specific estimates (size of the square reflects the study-specific statistical weight); horizontal lines represent 95% CIs; diamonds represent the pooled estimate with corresponding 95% CI; p values are from testing for heterogeneity between study-specific estimates. Abbreviation: CI, confidence interval.

Fig. 3

Panel A Pooled estimates of positive margins rates among NWNI and WGL techniques. Panel B Pooled estimates of re-excision rates among NWNI and WGL techniques, Squares represent study-specific estimates (size of the square reflects the study-specific statistical weight); horizontal lines represent 95% CIs; diamonds represent the pooled estimate with corresponding 95% CI; p values are from testing for heterogeneity between study-specific estimates. Abbreviation: CI, confidence interval; NWNI, non-wired non-ionizing.

Fig. 4

Panel A Comparison of specimen's volume between NWNI and WGL techniques. Panel B Comparison of specimen's weight between NWNI and WGL techniques. Squares represent standardized mean difference (size of the square reflects the study-specific statistical weight); horizontal lines represent 95% CIs; diamonds represent the pooled standardized mean difference with corresponding 95% CI; p values are from testing for heterogeneity between study-specific estimates. Abbreviation: CI, confidence interval; NWNI, non-wired non-ionizing; Std, standardized.