Magnetic Seed Localisation for Non-Palpable Breast Lesions: A Comparison with Hooked-Wire

Introduction: Screening programs and improved imaging result in higher frequency of non-palpable breast lesions, requiring preoperative localisation. Several localisation methods have been developed, with Magseed® among the more recent techniques. This observational study registered safety, effectiveness and surgeon satisfaction of Magseed® localisation. Data were compared with hooked-wire procedure. Methods: Data regarding safety, effectiveness and surgeon satisfaction of 100 patients who underwent Magseed® localisation were prospectively collected between September 2018 and April 2019, and compared with retrospectively collected data of 91 patients who underwent hooked-wire localisation between March 2018 and September 2018. Results: In total, 103 seeds and 102 wires were included. All magnetic seeds were placed under ultrasound guidance, with a median of two days preoperative. Complication rate did not significantly differ between Magseed® and hooked-wire (2.97% vs. 2.13%; p = 1.000). 94.06% of the seeds were detected with Sentimag®, with a retrieval rate of 100%. Positive margin rate was lower for Magseed®, although not significant (4.76% vs. 10.39%; p = 0.233). Due to positive margins, 1 additional mastectomy was performed, in contrast with 3 mastectomies and 1 additional re-excision in the hooked-wire group. Surgeons scored 81% of the Magseed® procedures as ’easier than hookedwire’. Conclusion: Rate of positive margins and re-excision/mastectomy showed a tendency to be lower with Magseed® localisation compared to hooked-wire localisation. Complication rate was equal. Moreover, high surgeon satisfaction and logistical advantages designate Magseed® as preferable over hooked-wire.

Magnetic Seed (Magseed) Localisation in Breast Cancer Surgery: A Multicentre Clinical Trial

<b><i>Introduction:</i></b> The aim of this study was to evaluate the accuracy and reliability of the Magseed magnetic marker in breast cancer surgery. <b><i>Methods:</i></b> Thirty-nine patients with 41 implanted Magseeds undergoing surgical treatment in 3 surgical oncology departments were included in the retrospective trial to study pilot use of the Magseed magnetic marker in the Czech Republic for localisation of breast tumours or pathological axillary nodes in breast cancer patients. <b><i>Results:</i></b> Thirty-four breast cancer and 7 pathological lymph node localisations were performed by Magseed implantation. No placement failures, or perioperative detection failures of Magseeds were observed (0/41, 0.0%), but one case of Magseed migration was present (1/41, 2.4%). All magnetic seeds were successfully retrieved (41/41, 100.0%). Negative margins were achieved in 29 of 34 (85.3%) breast tumour localisations by Magseed. <b><i>Conclusion:</i></b> Magseed is a reliable marker for breast tumour and pathological axillary node localisation in breast cancer patients. Magseed is comparable to conventional localisation methods in terms of oncosurgical radicality and safety.

Update on Management of Non-Palpable Breast Lesion

Halstedian radical mastectomy is practiced over 40 years as surgical treatment of breast cancer. For the last twenty years, breast conserving surgery (BCS) has been more practiced in the treatment of breast cancer as it provides oncological safety as well as cosmesis. Non palpable breast lesions are being increasingly diagnosed in the recent years as a result of introduction of breast cancer screening, high quality digital mammography and increase in public awareness. Accurate localisation of small, nonpalpable breast lesions is mandatory for accurate surgical management. The purpose of this article is to review the techniques systematically those have been used to locate non-palpable breast lesions which could easily be introduced in Bangladesh. Breast conserving surgery means complete removal of the tumour with a concentric margin of surrounding healthy tissue with maintenance of acceptable cosmesis. It should be followed by radiation therapy (RT) to achieve an acceptably low rate of local recurrence. Breast conserving surgery with radiotherapy has same survival benefit as mastectomy. BCS plus RT provided better outcome than mastectomy for early breast cancer and should be offered as a preferred treatment option. Experience, logistical support, and multidisciplinary approach is key to success. Radiological support with ultrasound or stereotactic localization with wires and /or ultrasound skin marking are key to have accurate wide local excision of non palpable lesions which is gold standard. Other newer techniques such as radio guided occult lesion localisation (ROLL), magnetic seeds, radiofrequency seeds localisation are a feasible and safe method of breast lesion localization as well and gaining popularity slowly. Faridpur Med. Coll. J. Jul 2019;14(2): 93-99

Targeted axillary dissection in breast cancer by marking lymph node metastasis with a magnetic seed before starting neoadjuvant treatment

We report the first documented clinical case of the use of magnetic seeds to mark axillary lymph node metastasis in breast cancer before neoadjuvant chemotherapy. After chemotherapy, the patient showed a complete radiological response. One single sentinel lymph node was detected using a radiotracer, while the marked node was intraoperative magnetometer-guided identified. The analysis of the nodes showed negative sentinel lymph node and positive marked node, and the subsequent targeted axillary dissection was performed. Marking axillary positive lymph nodes with a magnetic seed is a simple and effective procedure for the intraoperative localisation of the node after neoadjuvant treatment.