Pre-Operative Localization

2018 ◽  
Author(s):  
Vilert A. Loving
Keyword(s):  
Image Guidance ◽  
Breast Conserving Surgery ◽  
Screening Mammography ◽  
Breast Cancers ◽  
Mri Guidance ◽  
Operative Specimen ◽  
Radiofrequency Identification ◽  
Magnetic Resonance Imaging Mri ◽  
Palpable Breast

Non-palpable, surgical breast lesions require image guidance to direct the site of excision. With the widespread adoption of screening mammography and increased identification of non-palpable breast cancers, image guidance is critical to support the surgeon in successful breast-conserving surgery. Pre-operative localization procedures are typically performed under mammography guidance or ultrasound guidance, and less commonly under magnetic resonance imaging (MRI) guidance. This chapter, appearing in the section on interventions and surgical changes, reviews protocols and pitfalls, pre-/peri-/post-procedure clinical management, and imaging follow-up of pre-operative localization procedures. Topics discussed include mammography-guided, ultrasound-guided, and MRI-guided localization procedures. This chapter also introduces the radioactive seed and radiofrequency identification localization procedures and discusses post-operative specimen radiographs.

The LOCalizer Radiofrequency Identification System: An Effective New Technology for Localizing Non-Palpable Breast Lesions for Surgery

2020 ◽  
pp. 155335062096785
Author(s):  
Carolyn M. Cullinane ◽  
James Byrne ◽  
Liga Akmenkalne ◽  
Donal P. O’ Leary ◽  
Alissa M. Connors ◽  
...  
Keyword(s):  
Complication Rate ◽  
Breast Conserving Surgery ◽  
Identification System ◽  
Surgical Removal ◽  
Breast Lesions ◽  
Breast Cancers ◽  
Index Lesion ◽  
Rfid Tag ◽  
Radiofrequency Identification ◽  
Palpable Breast

Background. Breast screening has decreased morbidity and mortality due to detection of early, non-palpable breast cancers. One of the challenges of performing breast-conserving surgery on non-palpable breast tumours is accurate localization of the cancer. We aimed to perform a feasibility study to examine the outcomes associated with the introduction of a novel radiofrequency identification system (RFID) called LOCalizer as an alternative to traditional wire-guided localization. Methods. Data were prospectively collected on all patients undergoing breast-conserving surgery using the LOCalizer RFID system in a regional cancer centre between July 2019 and March 2020. Patients had a RFID tag placed preoperatively and underwent surgical removal of the tag with the index lesion guided by a handheld LOCalizer probe. The primary aim was successful placement and retrieval of the RFID tag. Re-excision rates, specimen size, specimen weight, cancer subtype and complication rate were all recorded. Results. Sixty-nine patients aged between 50 and 69 years had a LOCalizer tag inserted between July 2019 and March 2020. Of these, 6 (8.7%) were diagnostic and 63 (91.3%) were therapeutic. There was no migration of RFID tags, and all tags were retrieved with the index lesion. The overall re-excision of margin rate was 17.4% (12/69). All re-excision of margins was due to positive radial margins. The overall complication rate was 1.4% with one grade 1 Clavien-Dindo morbidity. Conclusion. The LOCalizer RFID is an effective and safe wire-free localization method for non-palpable breast lesions.

scholarly journals Salvage Laparoscopic-Assisted Anorectoplasty after Failed Vestibular Fistula Repair Using Magnetic Resonance Image Guidance

2019 ◽  
Vol 07 (01) ◽  
pp. e12-e15 ◽  
Author(s):  
Matthew W. Ralls ◽  
Brian P. Fallon ◽  
Maria Ladino-Torres ◽  
Peter F. Ehrlich ◽  
Marcus D. Jarboe
Keyword(s):  
Magnetic Resonance ◽  
Functional Outcomes ◽  
Image Guidance ◽  
Anorectal Surgery ◽  
Salvage Operation ◽  
Sphincter Complex ◽  
Vestibular Fistula ◽  
Magnetic Resonance Imaging Mri ◽  
Laparoscopic Assisted

AbstractPatients with vestibular fistula have a good functional outcome after posterior sagittal anorectoplasty (PSARP). While continence is often preserved, close follow-up and management of constipation are often required. Redo anorectal surgery has been associated with worse functional outcomes compared with primary procedures, possibly due to injury and scarring of the pelvic floor musculature and sphincter complex. Our group has a growing experience in the use of intraoperative real-time magnetic resonance imaging (MRI) for anorectal malformation repairs. We present a case of salvage operation of a failed PSARP for vestibular fistula.

Ten-Year Multi-Institutional Results of Breast-Conserving Surgery and Radiotherapy in BRCA1/2-Associated Stage I/II Breast Cancer

2006 ◽  
Vol 24 (16) ◽  
pp. 2437-2443 ◽  
Author(s):  
Lori J. Pierce ◽  
Albert M. Levin ◽  
Timothy R. Rebbeck ◽  
Merav A. Ben-David ◽  
Eitan Friedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Breast Conservation Surgery ◽  
Breast Cancers ◽  
Mutation Status ◽  
High Risk Women ◽  
Mutation Carriers ◽  
Significant Difference

Purpose We compared the outcome of breast-conserving surgery and radiotherapy in BRCA1/2 mutation carriers with breast cancer versus that of matched sporadic controls. Methods A total of 160 BRCA1/2 mutation carriers with breast cancer were matched with 445 controls with sporadic breast cancer. Primary end points were rates of in-breast tumor recurrence (IBTR) and contralateral breast cancers (CBCs). Median follow-up was 7.9 years for mutation carriers and 6.7 years for controls. Results There was no significant difference in IBTR overall between carriers and controls; 10- and 15-year estimates were 12% and 24% for carriers and 9% and 17% for controls, respectively (hazard ratio [HR], 1.37; P = .19). Multivariate analyses for IBTR found BRCA1/2 mutation status to be an independent predictor of IBTR when carriers who had undergone oophorectomy were removed from analysis (HR, 1.99; P = .04); the incidence of IBTR in carriers who had undergone oophorectomy was not significantly different from that in sporadic controls (P = .37). CBCs were significantly greater in carriers versus controls, with 10- and 15-year estimates of 26% and 39% for carriers and 3% and 7% for controls, respectively (HR, 10.43; P < .0001). Tamoxifen use significantly reduced risk of CBCs in mutation carriers (HR, 0.31; P = .05). Conclusion IBTR risk at 10 years is similar in BRCA1/2 carriers treated with breast conservation surgery who undergo oophorectomy versus sporadic controls. As expected, CBCs are significantly increased in carriers. Although the incidence of CBCs was significantly reduced in mutation carriers who received tamoxifen, this rate remained significantly greater than in controls. Additional strategies are needed to reduce contralateral cancers in these high-risk women.

Can Radiologic Tumor Size Following Neoadjuvant Therapy Reliably Guide Tissue Resection in Breast Conserving Surgery in Patients with Invasive Breast Cancer?

2020 ◽  
Vol 86 (10) ◽  
pp. 1248-1253
Author(s):  
Sarah Walcott-Sapp ◽  
Marissa K. Srour ◽  
Minna Lee ◽  
Michael Luu ◽  
Farin Amersi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Invasive Breast Cancer ◽  
Tumor Size ◽  
Disease Free Survival ◽  
Positive Margin ◽  
Breast Conserving Surgery ◽  
Breast Cancers ◽  
Positive Margin Rate

Optimum tissue resection volume for patients with invasive breast cancer undergoing breast conserving surgery following neoadjuvant therapy (NAT) is not known. We compared positive margin and in-breast tumor recurrence (IBTR) between 2 groups that were created based on radiologic tumor size (RTS (cm3)) at diagnosis, RTS post-NAT, and volume of tissue resected (VTL): Pre-NAT group, patients with VTL closer to RTS at diagnosis, and post-NAT group, patients with VTL closer to post-NAT RTS. 82 patients with 84 breast cancers treated with NAT between 2007 and 2017 who had pre- and post-NAT imaging were identified from a prospectively maintained database. RTS at diagnosis, RTS post-NAT, and VTL were determined. Clinical and treatment characteristics, IBTR, and disease-free survival (DFS) were compared between pre-NAT (n = 51) and post-NAT (n = 33) groups. Compared to post-NAT patients, pre-NAT patients had smaller RTS at presentation (9.2 vs. 33.5 cm3, P < .001) and post-NAT (1.2 vs. 8.2 cm3, P = .024). At median follow-up of 4 years, there were no differences between groups in pathologic tumor size, positive margin rate, adjuvant therapy, IBTR, or DFS. Resection volumes that matched RTS on post-NAT imaging were not associated with increased positive margins or IBTR. It may be appropriate to use post-NAT imaging to guide lumpectomy volume.

scholarly journals Intra-operative ultrasound refines breast conserving surgery for palpable breast cancers

The Breast ◽  
2014 ◽  
Vol 23 (4) ◽  
pp. S2
Author(s):  
G.A. Regalo ◽  
C.J. O'Neill ◽  
C. Douglas ◽  
D.A. Clark
Keyword(s):  
Breast Conserving Surgery ◽  
Breast Cancers ◽  
Palpable Breast ◽  
Operative Ultrasound

Oncoplastic breast-conservative surgery for breast cancers: a uni-institutional case–control study

2021 ◽  
Author(s):  
David Atallah ◽  
Wissam Arab ◽  
Nadine EL Kassis ◽  
Emilia Cortbaoui ◽  
Clement El Khoury ◽  
...  
Keyword(s):  
Conservative Surgery ◽  
Breast Conserving Surgery ◽  
Local Relapse ◽  
Control Group ◽  
Breast Cancers ◽  
Oncological Safety ◽  
Long Term Follow Up ◽  
And Control

The current study was designed to compare oncological outcomes between oncoplastic (OBCS) and conventional breast-conserving surgery (BCS). Data collected retrospectively from two groups of patients diagnosed with breast cancer, cases group (OBCS) and control group (BCS), were analyzed. A total of 277 women were included in the analysis: 193 (69.7%) in the cases group and 84 (30.3%) in the control group. Resected volume was larger in the OBCS group (438.05 ± 302.26 cm3 vs 223.34 ± 161.75 cm3; p < 0.001). Re-excision was required for 7.1% of patients receiving BCS versus 4.7% in the OBCS group (p = 0.402). After long-term follow up, no local recurrences occurred in the OBCS group, while 2.4% of patients receiving BCS had local relapse (p = 0.045). Compared with BCS, OBCS increases oncological safety in terms of re-excision rate and local recurrence.

Dense Breast Notification Laws: Impact on Downstream Imaging After Screening Mammography

2018 ◽  
Vol 77 (2) ◽  
pp. 143-154 ◽  
Author(s):  
Michal Horný ◽  
Alan B. Cohen ◽  
Richard Duszak ◽  
Cindy L. Christiansen ◽  
Michael Shwartz ◽  
...  
Keyword(s):  
New York ◽  
North Carolina ◽  
Breast Tissue ◽  
Private Health Insurance ◽  
Screening Mammography ◽  
Dense Breast ◽  
Common Finding ◽  
Dense Breast Tissue ◽  
Magnetic Resonance Imaging Mri

Dense breast tissue is a common finding that decreases the sensitivity of mammography in detecting cancer. Many states have recently enacted dense breast notification (DBN) laws to provide patients with information to help them make better-informed decisions about their health. To test whether DBN legislation affected the probability of screening mammography follow-up by ultrasound and magnetic resonance imaging (MRI), we examined the proportion of times screening mammography was followed by ultrasound or MRI for a series of months pre- and post-legislation. The subjects were women aged 40 to 64 years, covered by private health insurance, undergoing screening mammography from 2007 to 2014. Except for Hawaii, Maryland, and New York, DBN legislation significantly increased the probability of ultrasound follow-up in all states that implemented DBN legislation before December 2014. It also increased the probability of MRI follow-up in California, North Carolina, Pennsylvania, and Texas. The financial and access consequences merit further study.

scholarly journals Decreased Survival With Mastectomy Vis-à-Vis Breast-Conserving Surgery in Stage II and III Breast Cancers: A Comparative Treatment Effectiveness Study

2017 ◽  
Vol 3 (4) ◽  
pp. 304-313 ◽  
Author(s):  
Ambakumar Nandakumar ◽  
Goura Kishor Rath ◽  
Amal Chandra Kataki ◽  
P. Poonamalle Bapsy ◽  
Prakash C. Gupta ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Clinical Stage ◽  
Survival Rates ◽  
Cancer Registries ◽  
Breast Conserving Surgery ◽  
Hazard Ratio ◽  
Stage Ii ◽  
Natural Setting ◽  
Breast Cancers

Purpose The primary purpose of hospital-based cancer registries is assessing patient care. Clinical stage–based survival and treatment-based survival are some of the key parameters for such assessment. Because of the challenges in obtaining follow-up parameters, a separate study on patterns of care and survival was undertaken by the Indian National Cancer Registry Program. The results for cancer of the female breast are presented here. Patients and Methods Data abstracted in a standardized patient information form were transmitted online to a central repository. Treatment patterns were assessed for 9,903 patients diagnosed between January 1, 2006, and December 31, 2008, from 13 institutions. Survival analysis was restricted to 7,609 patients from nine institutions wherein follow-up details (as of December 31, 2012) were available for at least 60% of patients. Results The overall 5-year survival rates with breast-conserving surgery (BCS) and mastectomy (MS) were 94.0% and 85.8%, respectively, for stage II disease (adjusted hazard ratio, 2.40; 95% CI, 1.8 to 3.2) and 87.1% and 69.0%, respectively, for stage III disease (hazard ratio, 2.82; 95% CI, 2.2 to 3.7). Patients who had MS did better with systemic therapy (chemotherapy and/or hormone therapy), whereas patients with BCS required just local radiation therapy to achieve best survival. Conclusion This observational study in the natural setting of care of patients with cancer in India showed significantly decreased survival with MS when compared with BCS. The reasons for lower survival with MS and the biologic or scientific rationale of the necessity of systemic therapy to achieve optimal survival in patients undergoing MS but not in those with BCS need further investigation.

Core biopsy versus FNAC for palpable breast cancers. Is image guidance necessary?

2003 ◽  
Vol 39 (1) ◽  
pp. 52-56 ◽  
Author(s):  
T. Agarwal ◽  
B. Patel ◽  
P. Rajan ◽  
D.A. Cunningham ◽  
A. Darzi ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Image Guidance ◽  
Breast Cancers ◽  
Palpable Breast
Sign in / Sign up

Export Citation Format

Share Document