Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411)
Maggie Banys-Paluchowski 1 , Thorsten Kühn 2 , Yazan Masannat 3 , Isabel Rubio 4 , Jana de Boniface 5 6 , Nina Ditsch 7 , Güldeniz Karadeniz Cakmak 8 , Andreas Karakatsanis 9 10 , Rajiv Dave 11 , Markus Hahn 12 , Shelley Potter 13 , Ashutosh Kothari 14 , Oreste Davide Gentilini 15 , Bahadir M Gulluoglu 16 , Michael Patrick Lux 17 , Marjolein Smidt 18 , Walter Paul Weber 19 , Bilge Aktas Sezen 20 , Natalia Krawczyk 21 , Steffi Hartmann 22 , Rosa Di Micco 15 , Sarah Nietz 23 , Francois Malherbe 24 , Neslihan Cabioglu 25 , Nuh Zafer Canturk 26 , Maria Luisa Gasparri 27 28 29 , Dawid Murawa 30 , James Harvey 31
Background: Surgical excision of a non-palpable breast lesion requires a localization step. Among available techniques, wire-guided localization (WGL) is most commonly used. Other techniques (radioactive, magnetic, radar or radiofrequency-based, and intraoperative ultrasound) have been developed in the last two decades with the aim of improving outcomes and logistics.
Methods: We performed a systematic review on localization techniques for non-palpable breast cancer.
Results: For most techniques, oncological outcomes such as lesion identification and clear margin rate seem either comparable with or better than for WGL, but evidence is limited to small cohort studies for some of the devices. Intraoperative ultrasound is associated with significantly higher negative margin rates in meta-analyses of randomized clinical trials (RCTs). Radioactive techniques were studied in several RCTs and are non-inferior to WGL. Smaller studies show higher patient preference towards wire-free localization, but little is known about surgeons' and radiologists' attitudes towards these techniques.
Conclusions: Large studies with an additional focus on patient, surgeon, and radiologist preference are necessary. This review aims to present the rationale for the MELODY (NCT05559411) study and to enable standardization of outcome measures for future studies.