Abstract
Background: In 2020, 67% of primary breast cancer patients in the Netherlands underwent breast conserving surgery (BCS). Current standard-of-care for image-guided localization (IGL) of non-palpable breast cancer includes e.g. iodine seed (IS), wire guidance (WG), radio-guided localization (ROLL), ultrasound guidance (US), magnetic marker (MM) and radio-frequency (RFID). However, there is limited comparative data regarding oncological safety. Therefore, the aim of this retrospective population-based study is to assess oncological safety of non-palpable breast lesions regarding surgical margins and re-excision rates for various IGL techniques.
Methods: This study included 59,990 patients documented by the Netherlands Cancer Registry who underwent BCS with IGL between 2013 and 2022. The evaluation of resection margins (clear, focally positive, or more than focally positive) followed Dutch guidelines for re-excision. The relation between IGL technique and resection margin status was evaluated by a multinominal logistic regression, conducted separately for invasive cancer and ductal carcinoma in situ (DCIS). The odds ratio (OR) was calculated using iodine seed as reference.
Results: Large variation in the IGL methods employed by Dutch hospitals was observed over the years. The utilization of IS, MM and RFID consistently increased, while WG experienced a decline. Regarding surgical margins, there were no significant differences between the IGL techniques for patients with invasive carcinoma. For DCIS patients, MM had highest probability of a focally positive margin status (OR = 1.94) while US had the highest probability of a more than focally positive margin status (OR = 1.80). Regarding re-excision rate, both invasive carcinoma (OR = 1.37) and DCIS (OR = 1.45) showed an elevated likelihood of re-excision in cases involving WG. (A correction was made for confounders).
Conclusion: Regarding surgical margins in patients with invasive carcinoma, no significant differences were identified. With respect to focal irradical margin status in DCIS-patients, MM and WG performed inferior to IS. In case of a more than focal irradical margin status WG and US performed inferior to IS. Regarding the re-excision rate, WG performed inferior to IS for both invasive carcinoma and DCIS.
Methods: This study included 59,990 patients documented by the Netherlands Cancer Registry who underwent BCS with IGL between 2013 and 2022. The evaluation of resection margins (clear, focally positive, or more than focally positive) followed Dutch guidelines for re-excision. The relation between IGL technique and resection margin status was evaluated by a multinominal logistic regression, conducted separately for invasive cancer and ductal carcinoma in situ (DCIS). The odds ratio (OR) was calculated using iodine seed as reference.
Results: Large variation in the IGL methods employed by Dutch hospitals was observed over the years. The utilization of IS, MM and RFID consistently increased, while WG experienced a decline. Regarding surgical margins, there were no significant differences between the IGL techniques for patients with invasive carcinoma. For DCIS patients, MM had highest probability of a focally positive margin status (OR = 1.94) while US had the highest probability of a more than focally positive margin status (OR = 1.80). Regarding re-excision rate, both invasive carcinoma (OR = 1.37) and DCIS (OR = 1.45) showed an elevated likelihood of re-excision in cases involving WG. (A correction was made for confounders).
Conclusion: Regarding surgical margins in patients with invasive carcinoma, no significant differences were identified. With respect to focal irradical margin status in DCIS-patients, MM and WG performed inferior to IS. In case of a more than focal irradical margin status WG and US performed inferior to IS. Regarding the re-excision rate, WG performed inferior to IS for both invasive carcinoma and DCIS.
| Original language | English |
|---|---|
| Article number | 113753 |
| Number of pages | 1 |
| Journal | European journal of cancer |
| Volume | 200 |
| Issue number | Supplement 1 |
| DOIs | |
| Publication status | Published - 1 Mar 2024 |
| Event | 14th European Breast Cancer Conference, EBCC 2024 - Allianz MiCo • Milano Convention Centre, Milan, Italy Duration: 20 Mar 2024 → 22 Mar 2024 Conference number: 14 |