Wire- and magnetic-seed-guided localization of impalpable breast lesions: iBRA-NET localisation study

Wire localization is historically the most common method for guiding excision of non-palpable breast lesions, but there are limitations to the technique. Newer technologies such as magnetic seeds may allow some of these challenges to be overcome. The aim was to compare safety and effectiveness of wi...

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Bibliographic Details
Published in:	British journal of surgery 2022-02, Vol.109 (3), p.274-282
Main Authors:	Dave, Rajiv V, Barrett, Emma, Morgan, Jenna, Chandarana, Mihir, Elgammal, Suzanne, Barnes, Nicola, Sami, Amtul, Masudi, Tahir, Down, Sue, Holcombe, Chris, Potter, Shelley, Somasundaram, Santosh K, Gardiner, Matthew, Mylvaganam, Senthurun, Maxwell, Anthony, Harvey, James
Format:	Article
Language:	eng
Subjects:	Aged Breast Neoplasms - pathology Breast Neoplasms - surgery Female Fiducial Markers Humans Magnets - adverse effects Margins of Excision Mastectomy, Segmental - adverse effects Mastectomy, Segmental - instrumentation Mastectomy, Segmental - methods Middle Aged Neoplasm Staging Original Postoperative Complications Prospective Studies
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Summary:	Wire localization is historically the most common method for guiding excision of non-palpable breast lesions, but there are limitations to the technique. Newer technologies such as magnetic seeds may allow some of these challenges to be overcome. The aim was to compare safety and effectiveness of wire and magnetic seed localization techniques. Women undergoing standard wire or magnetic seed localization for non-palpable lesions between August 2018 and August 2020 were recruited prospectively to this IDEAL stage 2a/2b platform cohort study. The primary outcome was effectiveness defined as accurate localization and removal of the index lesion. Secondary endpoints included safety, specimen weight and reoperation rate for positive margins. Data were accrued from 2300 patients in 35 units; 2116 having unifocal, unilateral breast lesion localization. Identification of the index lesion in magnetic-seed-guided (946 patients) and wire-guided excisions (1170 patients) was 99.8 versus 99.1 per cent (P = 0.048). There was no difference in overall complication rate. For a subset of patients having a single lumpectomy only for lesions less than 50 mm (1746 patients), there was no difference in median closest margin (2 mm versus 2 mm, P = 0.342), re-excision rate (12 versus 13 per cent, P = 0.574) and specimen weight in relation to lesion size (0.15 g/mm2versus 0.138 g/mm2, P = 0.453). Magnetic seed localization demonstrated similar safety and effectiveness to those of wire localization. This study has established a robust platform for the comparative evaluation of new localization devices.
ISSN:	0007-1323 1365-2168