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

• Published in: Cancers 2023-02, Vol.15 (4), p.1173
• Main Authors: Banys-Paluchowski, Maggie, Kühn, Thorsten, Masannat, Yazan, Rubio, Isabel, de Boniface, Jana, Ditsch, Nina, Karadeniz Cakmak, Güldeniz, Karakatsanis, Andreas, Dave, Rajiv, Hahn, Markus, Potter, Shelley, Kothari, Ashutosh, Gentilini, Oreste Davide, Gulluoglu, Bahadir M, Lux, Michael Patrick, Smidt, Marjolein, Weber, Walter Paul, Aktas Sezen, Bilge, Krawczyk, Natalia, Hartmann, Steffi, Di Micco, Rosa, Nietz, Sarah, Malherbe, Francois, Cabioglu, Neslihan, Canturk, Nuh Zafer, Gasparri, Maria Luisa, Murawa, Dawid, Harvey, James
• Format: Article
• Language: English
• Subjects: Biopsy; Breast cancer; Care and treatment; Clinical trials; Cost analysis; Diagnosis; Excision (Surgery); intraoperative ultrasound; Iodine; Lesions; Localization; localization technique; magnetic seed; Mammography; Methods; non-palpable lesion; Patient satisfaction; Patients; radar reflector; Radiation; radioactive seed; radiofrequency identification tag; Review; Safety standards; Standardization; Surgery; Tumors; Ultrasonic imaging; Ultrasound; wire-guided localization
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15041173

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. We performed a systematic review on localization techniques for non-palpable breast cancer. 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. 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.