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Procedures for location of non-palpable breast lesions: a systematic review for the radiologist

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Abstract

Accurate location of small breast lesions is mandatory for proper surgical management. The purpose of this article is systematically review procedures used to locate non-palpable breast lesions, including a description of the current status, advantages, and disadvantages for each technique. A total of 47 articles were finally included: 7 articles for the wire location technique, 5 articles for the radioguided location technique, 13 articles that compare wire location with radioguided location, 3 articles for the carbon location technique, 2 articles that compare wire location with carbon location, and 17 articles for the clip location technique. The success of location and the clear margin are reported for each location technique and for the separate articles included; clip migration shift, also, is reported for the clip location technique. Odds ratio with related 95 % confidence intervals were also calculated for successful location. Comparative analysis or meta-analysis for all the different breast lesion location techniques is missing. Prospective investigations and randomized investigations for homogeneous populations are still needed to determine which is the most cost-effective modality among those used to date.

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Abbreviations

CI:

Confidence interval

CL:

Carbon location

MRI:

Magnetic resonance imaging

ROLL:

Radioguided occult location

WL:

Wire location

References

  1. Ernst MF, Avenarius JKA, Schuur KH, et al. Wire localization of non-palpable breast lesions: out of date? Breast. 2002;11:408–13.

    Article  CAS  PubMed  Google Scholar 

  2. Chu TYC, Lui CY, Hung WK, et al. Localisation of occult breast lesion: a comparative analysis of hookwire and radioguided procedures. Hong Kong Med J. 2010;16:367–72.

    PubMed  Google Scholar 

  3. van Riet YEA, Jansen FH, van Beek M, et al. Localization of non-palpable breast cancer using a radiolabelled titanium seed. Br J Surg. 2010;97:1240–5.

    Article  PubMed  Google Scholar 

  4. Liberman L, Kaplan J, Van Zee KJ, et al. Bracketing wires for preoperative breast needle localization. AJR. 2001;177:565–72.

    Article  CAS  PubMed  Google Scholar 

  5. Guenin MA. Clip placement during sonographically guided large-core breast biopsy for mammographic-sonographic correlation. AJR. 2000;175:1053–5.

    Article  CAS  PubMed  Google Scholar 

  6. Malvica RP. Sonographic location of the elusive breast lesion: a technical aid to stereotaxic large-needle core biopsy. AJR. 1996;167:183–4.

    Article  CAS  PubMed  Google Scholar 

  7. Oh JL, Nguyen G, Whitman GJ, et al. Placement of radiopaque clips for tumor localization in patients undergoing neoadjuvant chemotherapy and breast conservation therapy. Cancer. 2007;110:2420–7.

    Article  PubMed  Google Scholar 

  8. Edeiken BS, Fornage BD, Bedi DG, et al. US-guided implantation of metallic markers for permanent localization of the tumor bed in patients with breast cancer who undergo preoperative chemotherapy. Radiology. 1999;213:895–900.

    Article  CAS  PubMed  Google Scholar 

  9. Kruger BM, Burrowes P, MacGregor JH. Accuracy of marker clip placement after mammotome breast biopsy. Can Assoc Radiol J. 2002;53:137–40.

    PubMed  Google Scholar 

  10. Jakub JW, Gray RJ, Degnim AC, et al. Current status of radioactive seed for localization of non palpable breast lesions. Am J Surg. 2010;199:522–8.

    Article  PubMed  Google Scholar 

  11. Van der ploeg I, Hobbelink M, Vandenbosch M, et al. Radioguided occult lesion localisation (ROLL) for non-palpable breast lesions: a review of the relevant literature. Eur J Surg Oncol. 2008;34:1–5.

    Article  CAS  PubMed  Google Scholar 

  12. Lovrics PJ, Cornacchi SD, Vora R, et al. Systematic review of radioguided surgery for non-palpable breast cancer. Eur J Surg Oncol. 2011;37:388–97.

    Article  CAS  PubMed  Google Scholar 

  13. Genson CC, Blane CE, Helvie MA, et al. Effects on breast MRI of artifacts caused by metallic tissue marker clips. AJR. 2007;188:372–6.

    Article  PubMed  Google Scholar 

  14. Solin LJ, Yeh I, Kurtz J, et al. Ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast-conserving surgery and definitive irradiation correlation of pathologic parameters with outcome of treatment. Cancer. 1993;71:2532–42.

    Article  CAS  PubMed  Google Scholar 

  15. Parker SH, Lovin JD, Jobe WE, et al. Stereotactic breast biopsy with a biopsy gun. Radiology. 1990;176:741–7.

    Article  CAS  PubMed  Google Scholar 

  16. Weber WN, Sickles EA, Callen PW, et al. Nonpalpable breast lesion localization: limited efficacy of sonography. Radiology. 1985;155:783–4.

    Article  CAS  PubMed  Google Scholar 

  17. Caruso M, Gabrieli G, Marzullo G, et al. Core biopsy as alternative to fine-needle aspiration biopsy in diagnosis of breast tumors. Oncologist. 1998;3:45–9.

    PubMed  Google Scholar 

  18. Roux S, Logan-Young W. Private practice interdisciplinary breast centers: their rationale and impact on patients, physicians, and the health care industry: a bicoastal perspective. Surg Oncol Clin North Am. 2000;9:177–98.

    CAS  Google Scholar 

  19. Ross RJ, Thompson JS, Kim K, et al. Nuclear magnetic resonance imaging and evaluation of human breast tissue: preliminary clinical trials. Radiology. 1982;143:195–205.

    Article  CAS  PubMed  Google Scholar 

  20. Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology. 2001;220:13–30.

    Article  CAS  PubMed  Google Scholar 

  21. Philpotts LE, Lee CH. Clip migration after 11-gauge vacuum-assisted stereotactic biopsy: case report. Radiology. 2002;222:794–6.

    Article  PubMed  Google Scholar 

  22. Rosen EL, Vo TT. Metallic clip deployment during stereotactic breast biopsy: retrospective analysis. Radiology. 2001;218:510–6.

    Article  CAS  PubMed  Google Scholar 

  23. Perlet C, Sittek H, Reiser M, et al. Clip marker placement following MR-guided vacuum biopsy of the breast. Radiologe. 2005;45:230–6.

    Article  CAS  PubMed  Google Scholar 

  24. Kubota K, Gomi N, Wakita T, et al. Magnetic resonance imaging of the metal clip in a breast: safety and its availability as a negative marker. Breast Cancer. 2004;11:55–9.

    Article  PubMed  Google Scholar 

  25. Gossmann A, Bangard C, Warm M, et al. Real-time MR-guided wire localization of breast lesions by using an open 1.0-T imager: initial experience. Radiology. 2008;247:535–42.

    Article  PubMed  Google Scholar 

  26. Wolf G, Helbich T. Results of stereotactic guidance of breast excisional biopsy versus stereotactic core biopsy in occult breast lesions. Wien Med Wochenschr. 1998;148:316–20.

    CAS  PubMed  Google Scholar 

  27. Montrey J, Levy J, Brenner R. Wire fragments after needle localization. AJR. 1996;167:1267–9.

    Article  CAS  PubMed  Google Scholar 

  28. Bronstein AD, Kilcoyne RF, Moe RE. Complications of needle localization of foreign bodies and nonpalpable breast lesions. Arch Surg. 1988;123:775–9.

    Article  CAS  PubMed  Google Scholar 

  29. Intra M, Cicco C, Gentilini O, et al. Radioguided localisation (ROLL) of non-palpable breast lesions and simultaneous sentinel lymph node biopsy (SNOLL): the experience of the European Institute of Oncology. Eur J Nucl Med Mol Imaging. 2007;34:957–8.

    Article  PubMed  Google Scholar 

  30. Rose A, Collins JP, Neerhut P, et al. Carbon localisation of impalpable breast lesions. Breast. 2003;12:264–9.

    Article  CAS  PubMed  Google Scholar 

  31. Baron LF, Baron PL, Ackerman SJ, et al. Sonographically guided clip placement facilitates localization of breast cancer after neoadjuvant chemotherapy. AJR. 2000;174:539–40.

    Article  CAS  PubMed  Google Scholar 

  32. Dash N, Chafin SH, Johnson RR, et al. Usefulness of tissue marker clips in patients undergoing neoadjuvant chemotherapy for breast cancer. AJR. 1999;173:911–7.

    Article  CAS  PubMed  Google Scholar 

  33. Mariscal Martinez A, Sola M, de Tudela AP, et al. Radioguided localization of nonpalpable breast cancer lesions: randomized comparison with wire localization in patients undergoing conservative surgery and sentinel node biopsy. AJR. 2009;193:1001–9.

    Article  PubMed  Google Scholar 

  34. Luini A, Zurrida S, Paganelli G, et al. Comparison of radioguided excision with wire localization of occult breast lesions. Br J Surg. 1999;86:522–5.

    Article  CAS  PubMed  Google Scholar 

  35. Medina-Franco H, Abarca-Prez L, Garca-Alvarez MN, et al. Radioguided occult lesion localization (ROLL) versus wire-guided lumpectomy for non-palpable breast lesions: a randomized prospective evaluation. J Surg Oncol. 2008;97:108–11.

    Article  PubMed  Google Scholar 

  36. Aydogan F, Ozben V, Celik V, et al. Radio-guided occult lesion localization (ROLL) for non-palpable breast cancer: a comparison between day-before and same-day protocols. Breast. 2010;19:226–30.

    Article  PubMed  Google Scholar 

  37. Nadeem R, Chagla LS, Harris O, et al. Occult breast lesions: a comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL). Breast. 2005;14:283–9.

    Article  CAS  PubMed  Google Scholar 

  38. Rao R, Moldrem A, Sarode V, et al. Experience with seed localization for nonpalpable breast lesions in a public health care system. Ann Surg Oncol. 2010;17:3241–6.

    Article  PubMed  Google Scholar 

  39. Svane G. A stereotaxic technique for preoperative marking of non-palpable breast lesions. Acta Radiol. 1983;24:145–51.

    CAS  Google Scholar 

  40. Canavese G, Catturich A, Vecchio C, et al. Pre-operative localization of non-palpable lesions in breast cancer by charcoal suspension. Eur J Surg Oncol. 1995;21:47–9.

    Article  CAS  PubMed  Google Scholar 

  41. Mazy S, Galant C, Berlire M, et al. Localization of non-palpable breast lesions with black carbon powder (experience of the Catholic University of Louvain). J Radiol. 2001;82:161–4.

    CAS  PubMed  Google Scholar 

  42. Parikh JR. Delayed migration of gel mark ultra clip within 15 days of 11-gauge vacuum-assisted stereotactic breast biopsy. AJR. 2005;185:203–6.

    Article  PubMed  Google Scholar 

  43. Rosen EL, Baker JA, Soo MS. Accuracy of a collagen-plug biopsy site marking device deployed after stereotactic core needle breast biopsy. AJR. 2003;181:1295–9.

    Article  PubMed  Google Scholar 

  44. Kass R, Kumar G, Klimberg VS, et al. Clip migration in stereotactic biopsy. Am J Surg. 2002;184:325–31.

    Article  PubMed  Google Scholar 

  45. Uematsu T, Kasami M, Takahashi K, et al. Clip placement after an 11-gauge vacuum-assisted stereotactic breast biopsy: correlation between breast thickness and clip movement. Breast Cancer. 2011 (Epub ahead of print).

  46. Burbank F, Forcier N. Tissue marking clip for stereotactic breast biopsy: initial placement accuracy, long-term stability, and usefulness as a guide for wire localization. Radiology. 1997;205:407–15.

    Article  CAS  PubMed  Google Scholar 

  47. Esserman LE, Cura MA, DaCosta D. Recognizing pitfalls in early and late migration of clip markers after imaging-guided directional vacuum-assisted biopsy. RadioGraphics. 2004;24:147–56.

    Article  PubMed  Google Scholar 

  48. Harris AT. Clip migration within 8 days of 11-gauge vacuum-assisted stereotactic breast biopsy: case report. Radiology. 2003;228:552–4.

    Article  PubMed  Google Scholar 

  49. Cho KR, Seo BK, Lee J, et al. A comparative study of palpable and nonpalpable breast cancers determined by ultrasonography. J Breast Cancer. 2008;11:64–70.

    Article  Google Scholar 

  50. Berg WA, Gutierrez L, Nessaiver MS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233:830–49.

    Article  PubMed  Google Scholar 

  51. Londero V, Zuiani C, Furlan A, et al. Role of ultrasound and sonographically guided core biopsy in the diagnostic evaluation of ductal carcinoma in situ (DCIS) of the breast. Radiol Med. 2007;112:863–76.

    Article  CAS  PubMed  Google Scholar 

  52. Bassett L, Liu T, Giuliano A, et al. The prevalence of carcinoma in palpable vs impalpable, mammographically detected lesions. AJR. 1991;157:21–4.

    Article  CAS  PubMed  Google Scholar 

  53. Barros ACSD, Barros MAC, Andrade FE, et al. Combined radioguided nonpalpable lesion localization and sentinel lymph node biopsy for early breast carcinoma. Ann Surg Oncol. 2007;14:1472–7.

    Article  PubMed  Google Scholar 

  54. Chen B, Liu C, Jin F, et al. The role of fine-wire localization breast biopsy in the management of BI-RADS category 3–5 non-palpable breast lesions in northeastern Chinese women. Health. 2010;2:291–4.

    Article  Google Scholar 

  55. Chen X, Lehman CD, Dee KE. MRI-guided breast biopsy: clinical experience with 14-gauge stainless steel core biopsy needle. AJR. 2004;182:1075–80.

    Article  PubMed  Google Scholar 

  56. Gisvold JJ, Martin JK. Prebiopsy localization of nonpalpable breast lesions. AJR. 1984;143:477–81.

    Article  CAS  PubMed  Google Scholar 

  57. Landheer ML, Veltman J, van Eekeren R, et al. MRI-guided preoperative wire localization of nonpalpable breast lesions. Clin Imaging. 2006;30:229–33.

    Article  PubMed  Google Scholar 

  58. Ng CH, Lee KT, Taib NA, et al. Experience with hookwire localisation excision biopsy at a medical centre in Malaysia. Singapore Med J. 2010;51:306–10.

    CAS  PubMed  Google Scholar 

  59. Lehman CD, Shook JE. Position of clip placement after vacuum-assisted breast biopsy: is a unilateral two-view postbiopsy mammogram necessary? Breast J. 2003;9:272–6.

    Article  PubMed  Google Scholar 

  60. Liberman L, Bracero N, Morris E, et al. MRI-guided 9-gauge vacuum-assisted breast biopsy: initial clinical experience. AJR. 2005;185:183–93.

    Article  PubMed  Google Scholar 

  61. Phillips SW, Gabriel H, Comstock CE, et al. Sonographically guided metallic clip placement after core needle biopsy of the breast. AJR. 2000;175:1353–5.

    Article  CAS  PubMed  Google Scholar 

  62. Chadwick DR, Shorthouse AJ. Wire-directed localization biopsy of the breast: an audit of results and analysis of factors influencing therapeutic value in the treatment of breast cancer. Eur J Surg Oncol. 1997;23:128–33.

    Article  CAS  PubMed  Google Scholar 

  63. Allen MJ, Thompson WD, Stuart RC, et al. Management of non-palpable breast lesions detected mammographically. Br J Surg. 1994;81:543–5.

    Article  CAS  PubMed  Google Scholar 

  64. Gray RJ, Pockaj BA, Karstaedt PJ, et al. Radioactive seed localization of nonpalpable breast lesions is better than wire localization. Am J Surg. 2004;188:377–80.

    Article  PubMed  Google Scholar 

  65. Moss HA, Barter SJ, Nayagam M, et al. The use of carbon suspension as an adjunct to wire localisation of impalpable breast lesions. Clin Radiol. 2002;57:937–44.

    Article  CAS  PubMed  Google Scholar 

  66. Arman A, Kilicoglu G, Guner HH, et al. Marking of nonpalpable breast lesions using a custom carbon suspension. Acta Radiol. 2001;42:599–601.

    Article  CAS  PubMed  Google Scholar 

  67. Chen X, Lehman CD, Dee KE. MRI-guided breast biopsy: clinical experience with 14-gauge stainless steel core biopsy needle. AJR. 2004;182:1075–80.

    Article  PubMed  Google Scholar 

  68. Thind C, Desmond S, Harris O, et al. Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience. Clin Radiol. 2005;60:681–6.

    Article  CAS  PubMed  Google Scholar 

  69. Ronka R, Krogerus L, Leppnen E, et al. Radio-guided occult lesion localization in patients undergoing breast-conserving surgery and sentinel node biopsy. Am J Surg. 2004;187:491–6.

    Article  PubMed  Google Scholar 

  70. Zgajnar J, Hocevar M, Frkovic-Grazio S, et al. Radioguided occult lesion localization (ROLL) of the nonpalpable breast lesions. Neoplasma. 2004;51:385–9.

    CAS  PubMed  Google Scholar 

  71. Gray RJ, Salud C, Nguyen K, et al. Randomized prospective evaluation of a novel technique for biopsy or lumpectomy of nonpalpable breast lesions: radioactive seed versus wire localization. Ann Surg Oncol. 2001;8:711–5.

    Article  CAS  PubMed  Google Scholar 

  72. Riedl CC, Pfarl G, Helbich TH, et al. Comparison of wire versus carbon localization of non-palpable breast lesions. RöFo. 2002;174:1126–31.

    CAS  PubMed  Google Scholar 

  73. Moreno M, Wiltgen JE, Bodanese B, et al. Radioguided breast surgery for occult lesion localization—correlation between two methods. J Exp Clin Cancer Res. 2008;27:29.

    Article  PubMed Central  PubMed  Google Scholar 

  74. Rampaul RS, Bagnall M, Burrell H, et al. Randomized clinical trial comparing radioisotope occult lesion localization and wire-guided excision for biopsy of occult breast lesions. Br J Surg. 2004;91:1575–7.

    Article  CAS  PubMed  Google Scholar 

  75. Hughes JH, Mason MC, Gray RJ, et al. A multi-site validation trial of radioactive seed localization as an alternative to wire localization. Breast J. 2008;14:153–7.

    Article  PubMed  Google Scholar 

  76. Belloni E, Canevari C, Panizza P, et al. Nonpalpable breast lesions: preoperative radiological guidance in radioguided occult lesion localisation (ROLL). Radiol med. 2011;116(4):564–74.

    Article  CAS  PubMed  Google Scholar 

  77. Smathers RL. Marking the cavity site after stereotactic core needle breast biopsy. AJR. 2003;180:355–6.

    Article  PubMed  Google Scholar 

  78. Parker SH, Kaske TI, Gerharter JE, Dennis MA, Chavez JL. Placement accuracy and ultrasonographic visualization of a new percutaneous breast biopsy marker. Radiology. 2001;221(P):431.

    Google Scholar 

  79. Esserman LE, Costa D, Kusnick CA, Lowers K. Placement of a new ultrasound (US) visible breast biopsy marker in US-guided 11 gauge directional vacuum assisted biopsy (DVAB) (abstr). Radiology. 2002;25(P):459.

    Google Scholar 

  80. Margolin FR, Kaufman L, Denny SR, et al. Metallic marker placement after stereotactic core biopsy of breast calcifications: comparison of two clips and deployment techniques. AJR. 2003;181:1685–90.

    Article  PubMed  Google Scholar 

  81. Liberman L, Hann LE, Dershaw DD, et al. Mammographic findings after stereotactic 14-gauge vacuum biopsy. Radiology. 1997;203:343–7.

    Article  CAS  PubMed  Google Scholar 

  82. Coles CE, Wilson CB, Cumming J, et al. Titanium clip placement to allow accurate tumour bed localisation following breast conserving surgery: audit on behalf of the IMPORT Trial Management Group. Eur J Surg Oncol. 2009;35:578–82.

    Article  CAS  PubMed  Google Scholar 

  83. Feggi L, Basaglia E, Corcione S, et al. An original approach in the diagnosis of early breast cancer: use of the same radiopharmaceutical for both non-palpable lesions and sentinel node localisation. Eur J Nucl Med. 2001;28(11):1589–96.

    Article  CAS  PubMed  Google Scholar 

  84. Cornfield J. A method for estimating comparative rates from clinical data. Applications to cancer of the lung, breast, and cervix. J Natl Cancer Inst. 1951;11:1269–75.

    CAS  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful to Alessandra Trocino, librarian at the National Cancer Institute “G. Pascale” of Naples, Italy, for bibliographic assistance.

Conflict of interest

The authors declare that they have no competing interests. The authors have no conflict of interest to be disclosed.

Author contribution

RF works on literature search, statistical analysis and drafting of the manuscript in collaboration with AP. OC,VG and SF participated in the drafting the manuscript. MS participated in the design of the study and performed the statistical analysis. MD, QP and MDA conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

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Correspondence to Antonella Petrillo.

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R. Fusco and A. Petrillo contributed equally to this work.

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Fusco, R., Petrillo, A., Catalano, O. et al. Procedures for location of non-palpable breast lesions: a systematic review for the radiologist. Breast Cancer 21, 522–531 (2014). https://doi.org/10.1007/s12282-012-0427-1

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  • DOI: https://doi.org/10.1007/s12282-012-0427-1

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