Surgical marker navigation system in breast conserving surgery and excision of non-palpable lesions: first Spanish single-center experience.

BACKGROUND: Due to the establishment of screening mammography for breast cancer detection, the number of non-palpable lesions has increased. Thus, an optimal localization system is mandatory for the excision of non-palpable breast tumors. OBJECTIVE: The aim of the study is to report the feasibility Surgical Marker Navigation (SMN) system Sirius Pintuition® for the excision of non-palpable breast tumors and non-palpable axillary lymph nodes. METHODS: A retrospective observational study of patients undergoing breast-conserving surgery and lymph node excision guided by SMN between December 2022 and May 2023 was performed. RESULTS: A total of 84 patients underwent excision of non-palpable breast tumors (77; 91.7%) or non-palpable axillary lymph-nodes (7; 8.3%) using SMN. In total, 94 markers were placed, in 74 patients (88.1%) only one marker was placed, whereas in 10 patients (11.9%) two markers were placed to correctly localize the lesion in the operating room. Most markers were placed using ultrasonographic guidance (69; 82.1%). Seventy-seven patients underwent breast-conserving surgery (91.7%) and 7 (8.3%) lymph node excision. In 10 cases (11.9%), the marker was accidentally displaced during surgery due to the use of magnetized instruments, although the specimen could be removed. In sum, all the markers were removed from the patients, although the marker retrieval rate, as we defined it (percentage of patients in whom the initial excised specimen contained the marker divided by the total number of patients), was 88.1%. CONCLUSION: The use of Sirius Pintuition® SMN for non-palpable breast tumors and non-palpable lymph nodes is feasible, with a retrieval rate of 88.1%.

Errores frecuentes en el diagnóstico mamográfico / Frequent mistakes in mammographic diagnosis

El error forma parte de nuestro trabajo y es importante aprender sobre él para evitarlo. Uno de los datos más llamativos repetidos en la literatura es que, en el contexto del cribado, entre un 25 y un 75% de los cánceres se pueden ver en las mamografías previas informadas como normales. Sin embargo, analizando con detenimiento las cifras, descubriremos que gran parte de esos cánceres visibles no informados se presentan con apariencia inespecífica o benigna, y por tanto no representan verdaderos errores. Es importante tener presente el concepto del cáncer visible pero no reconocible, para no considerar un error lo que en realidad no lo es. Del mismo modo, no debemos confundir los hallazgos inespecíficos (que objetivamente no indican cáncer) con los hallazgos sutiles (que objetivamente sí indican cáncer, aunque son difíciles de detectar). En la segunda parte de nuestro artículo repasaremos uno a uno, aportando soluciones para evitarlos, los 9 errores más frecuentemente citados en la literatura. Estos son (o se asocian a): el hallazgo en una proyección, la mala aplicación del BI-RADS, «la satisfacción de encontrar», el cáncer de crecimiento lento, la mama densa, benignidad junto a malignidad, el error de técnica o posición, la mala correlación entre pruebas de imagen y la mala correlación con el contexto clínico (AU)

Errors form part of our work and it is important to learn about them so that they can be avoided. One of the most striking findings repeated in the literature is that, in the context of screening, between 25% and 75% of cancers can be seen on previous mammograms reported as normal. However, careful analysis of the figures reveals that a large proportion of these visible non-reported cancers appear as non-specific or benign findings, and thus do not represent true errors. It is important to keep in mind the concept of visible but not recognisable cancer, in order not to mistakenly identify something as an error. Likewise, we should not confuse non-specific findings (which objectively do not suggest cancer) with subtle findings (which objectively do suggest cancer, although they are difficult to detect). In the second part of our article, we review, one-by-one, the nine errors most frequently cited in the literature and provide strategies for their avoidance. These are (or are associated with): one-view findings, incorrect use of BI-RADS, "satisfaction of search", slow-growing cancer, dense breasts, benignancy with malignancy, technical or positioning errors, poor correlation among imaging techniques, and poor correlation with the clinical context (AU)