by Francesco Garzotto, Rosanna Irene Comoretto, Silvia
Michieletto, Gianpaolo Franzoso, Marcello Lo Mele, Dario Gregori, Maria
Giuseppina Bonavina, Fernando Bozza, Francesca Caumo, Tania Saibene
The Breast: VOLUME 58, P93-105, AUGUST
01, 2021
Highlights
•Positioning and localization of reflectors' is nearly of
the 100% rate of success. Overall, positive margins rates were 12% (8–17%).
•The re-excision and clear margins rates were 12% (95% CI,
8–17%) and 87% (80–92%), respectively.
•Comparing NWNI and WGL techniques, positive margin rate is
lower for the first one and re-excision rate is slightly higher using the
latter.
•This technology overcomes the limitations related to other
techniques: migrations, the coordination between radiology and surgery, the use
of radioactive substances.
•The procedure is comfortable for the radiologist while
allow surgeon at resecting the non-palpable lesions ensuring clear margins,
avoiding the re-excisions.
•The cosmetic outcome can be obtained minimizing the
resection of healthy-tissue.
Abstract
Pre-operative localization of non-palpable breast lesions
with non-wired non-ionizing (NWNI) techniques may improve clinical outcomes as
reoperation rate, cosmetic outcome and contribute to organizational aspects
improvement in breast-conserving surgery (BCS). However only limited literature
is available and clinical studies involving these forefront devices are often
small and non-randomized. Furthermore, there is a lack of consensus on free
margins and cosmetic outcomes definitions. The objective of the present
meta-analysis was to determine the crude clinical outcomes reported for the
NWNI techniques on BCS. A literature search was performed of PubMed, Embase and
Scopus databases up to February 2021 in order to select all prospective or
retrospective clinical trials on pre-operative breast lesion localization done
with NWNI devices. All studies were assessed following the PRISMA
recommendations. Continuous outcomes were described in averages corrected for
sample size, while binomial outcomes were described using the weighted average
proportion.
Twenty-seven studies with a total of 2103 procedures were
identified. The technique is consolidated, showing for both reflectors’
positioning and localization nearly the 100% rate of success. The re-excision
and clear margins rates were 14% (95% CI, 11–17%) and 87% (80–92%),
respectively. Overall, positive margins rates were 12% (8–17%). In studies that
compared NWNI and wire localization techniques, positive margin rate is lower
for the first techniques (12%, 6–22% vs 17%, 12–23%) and re-excision rate is
slightly higher using the latter (13%, 9–19% vs 16%, 13–18%).
Pre-operative NWNI techniques are effective in the
localization of non-palpable breast lesions and are promising in obtaining
clear (or negative) margins minimizing the need for re-excision and improving
the cosmetic outcomes. Randomized trials are needed to confirm these findings.
