Nationwide registry study on trends in localization techniques and reoperation rates in non-palpable ductal carcinoma in situ and invasive breast cancer.

BACKGROUND: There is a transition from wire-guided localization (WGL) of non-palpable breast cancer to other localization techniques. Multiple prospective studies have sought to establish superior clinical outcomes for radioactive-seed localization (RSL), but consistent and congruent evidence is missing. METHODS: In this study, female patients with breast cancer operated with breast-conserving surgery after tumour localization of a non-palpable breast cancer or ductal carcinoma in situ (DCIS) were included. The cohort was identified from the nationwide Netherlands Breast Cancer Audit conducted between 2013 and 2018. Trends in localization techniques were analysed. Univariable and multivariable analyses were performed to assess the association between the localization technique and the probability of a reoperation. RESULTS: A total of 28 370 patients were included in the study cohort. The use of RSL increased from 15.7 to 61.1 per cent during the study years, while WGL decreased from 75.4 to 31.6 per cent. The localization technique used (RSL versus WGL) was not significantly associated with the odds of a reoperation, regardless of whether the lesion was DCIS (odds ratio 0.96 (95 per cent c.i. 0.89 to 1.03; P = 0.281)) or invasive breast cancer (OR 1.02 (95 per cent c.i. 0.96 to 1.10; P = 0.518)). CONCLUSION: RSL is rapidly replacing WGL as the preoperative localization technique in breast surgery. This large nationwide registry study found no association between the type of localization technique and the odds of having a reoperation, thus confirming the results of previous prospective cohort studies.

Randomized controlled trial comparing magnetic marker localization (MaMaLoc) with wire-guided localization in the treatment of early-stage breast cancer.

Wire-guided localization (WGL) is the standard of care in the surgical treatment of nonpalpable breast tumors. In this study, we compare the use of a new magnetic marker localization (MaMaLoc) technique to WGL in the treatment of early-stage breast cancer patients. Open-label, single-center, randomized controlled trial comparing MaMaLoc (intervention) to WGL (control) in women with early-stage breast cancer. Primary outcome was surgical usability measured using the System Usability Scale (SUS, 0-100 score). Secondary outcomes were patient reported, clinical, and pathological outcomes such as retrieval rate, operative time, resected specimen weight, margin status, and reoperation rate. Thirty-two patients were analyzed in the MaMaLoc group and 35 in the WGL group. Patient and tumor characteristics were comparable between groups. No in situ complications occurred. Retrieval rate was 100% in both groups. Surgical usability was higher for MaMaLoc: 70.2 ± 8.9 vs. 58.1 ± 9.1, p < 0.001. Patients reported higher overall satisfaction with MaMaLoc (median score 5/5) versus WGL (score 4/5), p < 0.001. The use of magnetic marker localization (MaMaLoc) for early-stage breast cancer is effective and has higher surgical usability than standard WGL.

Comparing position and orientation accuracy of different electromagnetic sensors for tracking during interventions.

PURPOSE: To compare the position and orientation accuracy between using one 6-degree of freedom (DOF) electromagnetic (EM) sensor, or the position information of three 5DOF sensors within the scope of tumor tracking. METHODS: The position accuracy of Northern Digital Inc Aurora 5DOF and 6DOF sensors was determined for a table-top field generator (TTFG) up to a distance of 52 cm. For each sensor 716 positions were measured for 10 s at 15 Hz. Orientation accuracy was determined for each of the orthogonal axis at the TTFG distances of 17, 27, 37 and 47 cm. For the 6DOF sensors, orientation was determined for sensors in-line with the orientation axis, and perpendicular. 5DOF orientation accuracy was determined for a theoretical 4 cm tumor. An optical tracking system was used as reference. RESULTS: Position RMSE and jitter were comparable between the sensors and increasing with distance. Jitter was within 0.1 cm SD within 45 cm distance to the TTFG. Position RMSE was approximately 0.1 cm up to 32 cm distance, increasing to 0.4 cm at 52 cm distance. Orientation accuracy of the 6DOF sensor was within 1[Formula: see text], except when the sensor was in-line with the rotation axis perpendicular to the TTFG plane (4[Formula: see text] errors at 47 cm). Orientation accuracy using 5DOF positions was within 1[Formula: see text] up to 37 cm and 2[Formula: see text] at 47 cm. CONCLUSIONS: The position and orientation accuracy of a 6DOF sensor was comparable with a sensor configuration consisting of three 5DOF sensors. To achieve tracking accuracy within 1 mm and 1[Formula: see text], the distance to the TTFG should be limited to approximately 30 cm.