8 research outputs found

    Radiofrequency localization of nonpalpable breast cancer in a multicentre prospective cohort study: feasibility, clinical acceptability, and safety

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    PURPOSE: In breast conserving surgery, accurate lesion localization is essential for obtaining adequate surgical margins. Preoperative wire localization (WL) and radioactive seed localization (RSL) are widely accepted methods to guide surgical excision of nonpalpable breast lesions but are limited by logistical challenges, migration issues, and legislative complexities. Radiofrequency identification (RFID) technology may offer a viable alternative. The purpose of this study was to evaluate the feasibility, clinical acceptability, and safety of RFID surgical guidance for localization of nonpalpable breast cancer. METHODS: In a prospective multicentre cohort study, the first 100 RFID localization procedures were included. The primary outcome was the percentage of clear resection margins and re-excision rate. Secondary outcomes included procedure details, user experience, learningcurve, and adverse events. RESULTS: Between April 2019 and May 2021, 100 women underwent RFID guided breast conserving surgery. Clear resection margins were obtained in 89 out of 96 included patients (92.7%), re-excision was indicated in three patients (3.1%). Radiologists reported difficulties with the placement of the RFID tag, partially related to the relatively large needle-applicator (12-gauge). This led to the premature termination of the study in the hospital using RSL as regular care. The radiologist experience was improved after a manufacturer modification of the needle-applicator. Surgical localization involved a low learning curve. Adverse events (n = 33) included dislocation of the marker during insertion (8%) and hematomas (9%). The majority of adverse events (85%) occurred using the first-generation needle-applicator. CONCLUSION: RFID technology is a potential alternative for non-radioactive and non-wire localization of nonpalpable breast lesions

    Technical innovations in breast cancer surgery

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    Breast cancer is the most common cancer among women worldwide, often requiring surgical intervention alongside additional pre- or post-treatment measures. Managing the disease effectively necessitates ongoing research, screening, and advancements in surgical techniques, particularly crucial for early-stage breast cancer where accurate lymph node staging and image-guided localization for non-palpable lesions are essential. Optimization of surgical treatments involves considerations such as oncological safety, cost-effectiveness, workflow efficiency, physician and patient preference, and ease of use. Efforts to transition towards radiation-free approaches for staging and identifying non-palpable breast lesions are actively pursued. Accurate disease staging during the diagnostic phase is imperative, ideally achieved through noninvasive, and highly accurate methods. The replacement of invasive sentinel lymph node biopsy (SLNB) with preoperative SLN staging utilizing superparamagnetic iron oxide (SPIO)-enhanced MRI offers advantages such as decreased patient morbidity and healthcare costs. While preliminary research comparing histopathological and MR images of magnetic SLNs shows potential, further development is needed to accurately quantify metastatic involvement.Recent years, hospitals are increasingly exploring non-radioactive alternatives for intraoperative tumour localization, driven by logistical advantages, regulatory considerations, and sustainability goals. Innovations like magnetic marker localization are proving comparable to traditional techniques, offering significant savings by circumventing radioactive material regulations, reducing hospital stays, minimizing re-excisions, and high satisfaction among medical specialists.SPIO as a magnetic tracer for SLNB demonstrates high concordance with traditional methods but may lead to skin discoloration and MRI artifacts. Me ta-analyses suggest improved detection rates with specific injection protocols, but the risk of iron residue remains a barrier to widespread adoption. Another radiation-free SLN detection alternative, indocyanine green (ICG), is well-received for intraoperative lymph node visualisation, yet challenges like spillage and the absence of preoperative mapping may complicate the procedure. Further exploration of combined tracers, such as SPIO for MRI-based mapping and ICG for intraoperative imaging, is warranted. When considering combining magnetic tumour localization with magnetic SLNB, challenges such as overlapping magnetic signals and potential iron residue must be ad dressed.Postoperative imaging plays an important role in monitoring treatment efficacy and detecting recurrence. However, magnetic tracers used in surgery may induce MRI artifacts, potentially impacting diagnostic accuracy during follow-up. The duration of these artifacts post-injection is uncertain, but an adjusted injection protocol or contrast-enhanced mammography (CEM) emerges as a potential alternative for postoperative MRI. In conclusion, recent technical advancements in breast cancer diagnosis and treatment aim to improve accuracy, efficiency, and patient outcomes. While preoperative staging with SPIO-enhanced MRI holds promise for the future, further refinement is necessary. Magnetic markers for tumour localization offer a safe and reliable alternative to conventional techniques, while combined ICG-SPIO tracer approaches show potential in optimizing intraoperative SLN detection. Patient stratification may be crucial, with different tracers suited to varying clinical scenarios.<br/

    A multicenter prospective cohort study to evaluate feasibility of radio-frequency identification surgical guidance for nonpalpable breast lesions: design and rationale of the RFID Localizer 1 Trial

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    Background: Breast cancer screening and improving imaging techniques have led to an increase in the detection rate of early, nonpalpable breast cancers. For early breast cancer, breast conserving surgery is an effective and safe treatment. Accurate intraoperative lesion localization during breast conserving surgery is essential for adequate surgical margins while sparing surrounding healthy tissue to achieve optimal cosmesis. Preoperative wire localization and radioactive seed localization are accepted standard methods to guide surgical excision of nonpalpable breast lesions. However, these techniques present significant limitations. Radiofrequency identification (RFID) technology offers a new, nonradioactive method for localizing nonpalpable breast lesions in patients undergoing breast conserving surgery. This study aims to evaluate the feasibility of RFID surgical guidance for nonpalpable breast lesions. Methods: This multicenter prospective cohort study was approved by the Institutional Review Board of the University Medical Center Utrecht. Written informed consent is obtained from all participants. Women with nonpalpable, histologically proven in situ or invasive breast cancer, who can undergo breast conserving surgery with RFID localization are considered eligible for participation. An RFID tag is placed under ultrasound guidance, up to 30 days preoperatively. The surgeon localizes the RFID tag with a radiofrequency reader that provides audible and visual real-time surgical guidance. The primary study outcome is the percentage of irradical excisions and reexcision rate, which will be compared to standards of the National Breast Cancer Organisation Netherlands (NABON)(≤ 15% irradical excisions of invasive carcinomas). Secondary outcomes include user acceptability/experiences, learning curve, duration and ease of the placement- and surgical procedure and adverse events. Discussion: This study evaluates the feasibility of RFID surgical guidance for nonpalpable breast lesions. Results may have implications for the future localization techniques in women with nonpalpable breast cancer undergoing breast conserving surgery. Trial registration: Netherlands National Trial Register, NL8019, registered on September 12th 2019

    A complete magnetic sentinel lymph node biopsy procedure in oral cancer patients: A pilot study

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    Objectives: To assess the feasibility and merits of a complete magnetic approach for a sentinel lymph node biopsy (SLNB) procedure in oral cancer patients. Materials and methods: This study included ten oral cancer patients (stage cT1-T2N0M0) scheduled for elective neck dissection (END). Superparamagnetic iron oxide nanoparticles (SPIO) were administered peritumorally prior to surgery. A preoperative MRI was acquired to identify lymph nodes (LNs) with iron uptake. A magnetic detector was used to identify magnetic hotspots prior, during, and after the SLNB procedure. The resected sentinel LNs (SLNs) were evaluated using step-serial sectioning, and the neck dissection specimen was assessed by routine histopathological examination. A postoperative MRI was acquired to observe any residual iron. Results: Of ten primary tumors, eight were located in the tongue, one floor-of-mouth (FOM), and one tongue-FOM transition. SPIO injections were experienced as painful by nine patients, two of whom developed a tongue swelling. In eight patients, magnetic SLNs were successfully detected and excised during the magnetic SLNB procedure. During the END procedure, additional magnetic SLNs were identified in three patients. Histopathology confirmed iron deposits in sinuses of excised SLNs. Three SLNs were harboring metastases, of which one was identified only during the END procedure. The END specimens revealed no further metastases. Conclusion: A complete magnetic SLNB procedure was successfully performed in eight of ten patients (80% success rate), therefore the procedure seems feasible. Recommendations for further investigation are made including: use of anesthetics, magnetic tracer volume, planning preoperative MRI, comparison to conventional technique and follow-up

    A Comprehensive Grading System for a Magnetic Sentinel Lymph Node Biopsy Procedure in Head and Neck Cancer Patients

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    A magnetic sentinel lymph node biopsy ((SLN)B) procedure has recently been shown feasible in oral cancer patients. However, a grading system is absent for proper identification and classification, and thus for clinical reporting. Based on data from eight complete magnetic SLNB procedures, we propose a provisional grading system. This grading system includes: (1) a qualitative five-point grading scale for MRI evaluation to describe iron uptake by LNs; (2) an ex vivo count of resected SLN with a magnetic probe to quantify iron amount; and (3) a qualitative five-point grading scale for histopathologic examination of excised magnetic SLNs. Most SLNs with iron uptake were identified and detected in level II. In this level, most variance in grading was seen for MRI and histopathology; MRI and medullar sinus were especially highly graded, and cortical sinus was mainly low graded. On average 82 ± 58 µg iron accumulated in harvested SLNs, and there were no significant differences in injected tracer dose (22.4 mg or 11.2 mg iron). In conclusion, a first step was taken in defining a comprehensive grading system to gain more insight into the lymphatic draining system during a magnetic SLNB procedure

    Breast MRI in patients after breast conserving surgery with sentinel node procedure using a superparamagnetic tracer

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    Background: A procedure for sentinel lymph node biopsy (SLNB) using superparamagnetic iron-oxide (SPIO) nanoparticles and intraoperative sentinel lymph node (SLN) detection was developed to overcome drawbacks associated with the current standard-of-care SLNB. However, residual SPIO nanoparticles can result in void artefacts at follow-up magnetic resonance imaging (MRI) scans. We present a grading protocol to quantitatively assess the severity of these artefacts and offer an option to minimise the impact of SPIO nanoparticles on diagnostic imaging. Methods: Follow-up mammography and MRI of two patient groups after a magnetic SLNB were included in the study. They received a 2-mL subareolar dose of SPIO (high-dose, HD) or a 0.1-mL intratumoural dose of SPIO (low-dose, LD). Follow-up mammography and MRI after magnetic SLNB were acquired within 4 years after breast conserving surgery (BCS). Two radiologists with over 10-year experience in breast imaging assessed the images and analysed the void artefacts and their impact on diagnostic follow-up. Results: A total of 19 patients were included (HD, n = 13; LD, n = 6). In the HD group, 9/13 patients displayed an artefact on T1-weighted images up to 3.6 years after the procedure, while no impact of the SPIO remnants was observed in the LD group. Conclusions: SLNB using a 2-mL subareolar dose of magnetic tracer in patients undergoing BCS resulted in residual artefacts in the breast in the majority of patients, which may hamper follow-up MRI. This can be avoided by using a 0.1-mL intratumoural dose
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