Scientific publications

Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411)

Feb 12, 2023 | Magazine: Cancers

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.

CITATION  Cancers (Basel). 2023 Feb 12;15(4):1173.  doi: 10.3390/cancers15041173