Document Type : Original Article(s)
Authors
1 Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
2 Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
3 Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Abstract
Background: Preoperative marking of impalpable breast lesions is crucial for limiting false negative results and reducing the size of the resected breast tissue, thus improving cosmesis. The aim of this study was to evaluate wire localization versus intralesional methylene blue marking for surgical excision of impalpable breast lesions regarding the success of localization, cost, and limitations of both techniques.
Method: This prospective cohort study included 50 patients with impalpable breast lesions or an area of suspicious microcalcification who were scheduled for surgical excision in the period between June 2020 and December 2021. Patients were randomly allocated into two groups: group I included 25 patients for surgical excision after preoperative ultrasound-guided methylene blue marking. Group II included 25 patients scheduled for surgical excision after preoperative guide wire localization under radiological guidance.
Results: Localization by methylene blue injection has been associated with significantly shorter time of operation with mean duration (P = 0.018) and much reduced cost in comparison with guide wire (P < 0.001). Postoperative pain, reactions, ecchymosis, accuracy of localization, margin status, and patient satisfaction did not vary significantly between both groups.
Conclusion: Localization by methylene blue injection is not only equally successful to guide wire in locating and identifying impalpable breast lesions for surgical excision, but also is significantly less costly and associated with a shorter duration of operation.
Highlights
Rabie Ramadan (Google Scholar)
Keywords
How to cite this article:
Ramadan R, El-Fayoumy T, Ibrahim RM, Saifeldin H, Fayed H. Wire localization versus intralesional methylene blue marking for surgical excision of impalpable breast lesions. Middle East J Cancer. 2023; 14(4):559-69. doi: 10.30476/mejc.2023.95919.1796.
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi: 10.3322/caac.21492. Erratum in: CA Cancer J Clin. 2020;70(4):313.
- Ahmed M, Rubio IT, Klaase JM, Douek M. Surgical treatment of nonpalpable primary invasive and in situ breast cancer. Nat Rev Clin Oncol. 2015;12(11):645-63. doi: 10.1038/nrclinonc.2015.161.
- Nasrinossadat A, Ladan F, Fereshte E, Asieh O, Reza C, Akramossadat S, et al. Marking non-palpable breast masses with injected methylene blue dye, an easy, safe and low cost method for developing countries and resource-limited areas. Asian Pac J Cancer Prev. 2011;12(5):1189-92.
- Tang J, Wang X, Wu YP, Wang X, Lian ZQ, Fu JH, et al. Significance of methylene blue dye for localization biopsy of nonpalpable breast lesions. Ai Zheng. 2009;28(1):79-81.
- Tromberg BJ, Pogue BW, Paulsen KD, Yodh AG, Boas DA, Cerussi AE. Assessing the future of diffuse optical imaging technologies for breast cancer management. Med Phys. 2008;35(6):2443-51. doi: 10.1118/1.2919078.
- Cheang E, Ha R, Thornton CM, Mango VL. Innovations in image-guided preoperative breast lesion localization. Br J Radiol. 2018;91(1085):20170740. doi: 10.1259/bjr.20170740.
- Masannat YA, Shaaban AM, Speirs V, Coast G, Jackson P, Horgan K, et al. Adverse effects of dyes used in sentinel node biopsy on immunocytochemical determination of hormone receptors in breast cancer cells. J Clin Pathol. 2007;60(6):730-2. doi: 10.1136/jcp.2006.044974.
- Fusco R, Petrillo A, Catalano O, Sansone M, Granata V, Filice S, et al. Procedures for location of non-palpable breast lesions: a systematic review for the radiologist. Breast Cancer. 2014;21(5):522-31. doi: 10.1007/s12282-012-0427-1.
- Surry KJ, Mills GR, Bevan K, Downey DB, Fenster A. Stereotactic mammography imaging combined with 3D US imaging for image guided breast biopsy. Med Phys. 2007;34(11):4348-58. doi: 10.1118/1.2794175.
- Alikhassi A, Saeed F, Abbasi M, Omranipour R, Mahmoodzadeh H, Najafi M, et al. Applicability of radioguided occult lesion localization for nonpalpable benign breast lesions, comparison with wire localization, a clinical trial. Asian Pac J Cancer Prev. 2016;17(7):3185-90.
- Coca KP, Amir LH, Alves M, Barbieri M, Marcacine KO, de Vilhena Abrão ACF. Measurement tools and intensity of nipple pain among women with or without damaged nipples: A quantitative systematic review. J Adv Nurs. 2019;75(6):1162-72. doi: 10.1111/jan.13908.
- Joe BN, Sickles EA. The evolution of breast imaging: past to present. Radiology. 2014;273(2S):S23-S44. doi: 10.1148/radiol.14141233.
- Postma EL, Koffijberg H, Verkooijen HM, Witkamp AJ, van den Bosch MA, van Hillegersberg R. Cost-effectiveness of radioguided occult lesion localization (ROLL) versus wire-guided localization (WGL) in breast conserving surgery for nonpalpable breast cancer: results from a randomized controlled multicenter trial. Ann Surg Oncol. 2013;20(7):2219-26. doi: 10.1245/s10434-013-2888-7.
- Siegmann-Luz KC, Bahrs SD, Preibsch H, Hattermann V, Claussen CD. Management of breast lesions detectable only on MRI. Rofo. 2014;186(01):30-6. doi: 10.1055/s-0033-1335972.
- Gerrard AD, Shrotri A. Surgeon-led intraoperative ultrasound localization for nonpalpable breast cancers: results of 5 years of practice. Clin Breast Cancer. 2019;19(6):e748-e52. doi: 10.1016/j.clbc.2019.05.008.
- Ahmed M, Douek M. Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancers: systematic review and meta-analysis. Breast Cancer Res Treat. 2013;140(3):435-46. doi: 10.1007/s10549-013-2639-2.
- Filho WMNE, de Medeiros Neto AM, de Melo Rodrigues RM, Alves ACBR, Vieira SC. Use of the patent blue and air in the preoperative marking of impalpable breast lesions. Eur J Breast Health. 2018;15(1):7-12. doi: 10.5152/ejbh.2018.4321.
- Ko K, Han BK, Jang KM, Choe YH, Shin JH, Yang JH, et al. The value of ultrasound-guided tattooing localization of nonpalpable breast lesions. Korean J Radiol. 2007;8(4):295-301. doi: 10.3348/kjr.2007.8.4.295.
- Zhou Y, Liang Y, Zhang J, Feng Y, Li X, Kong X, et al. Evaluation of carbon nanoparticle suspension and methylene blue localization for preoperative localization of nonpalpable breast lesions: a comparative study. Front Surg. 2021;8:757694. doi: 10.3389/fsurg.2021.757694.
- Athanasiou C, Mallidis E, Tuffaha H. Comparative effectiveness of different localization techniques for non-palpable breast cancer. A systematic review and network meta-analysis. Eur J Surg Oncol. 2022;48(1):53-9. doi: 10.1016/j.ejso.2021.10.001.
- Tong M, Guo W. Indocyanine green fluorescence-guided lumpectomy of nonpalpable breast cancer versus wire-guided excision: A randomized clinical trial. Breast J. 2019;25(2):278-81. doi: 10.1111/tbj.13207.
- Cox CE, Russell S, Prowler V, Carter E, Beard A, Mehindru A, et al. A prospective, single arm, multi-site, clinical evaluation of a nonradioactive surgical guidance technology for the location of nonpalpable breast lesions during excision. Ann Surg Oncol. 2016;23(10):3168-74. doi: 10.1245/s10434-016-5405-y.
- Mango VL, Wynn RT, Feldman S, Friedlander L, Desperito E, Patel SN, et al. Beyond wires and seeds: reflector-guided breast lesion localization and excision. Radiology. 2017;284(2):365-71. doi: 10.1148/radiol.2017161661.
- Falcon S, Weinfurtner RJ, Mooney B, Niell BL. SAVI SCOUT® localization of breast lesions as a practical alternative to wires: Outcomes and suggestions for trouble-shooting. Clin Imaging. 2018;52:280-6. doi: 10.1016/j.clinimag.2018.07.008.
- Pouw B, de Wit-van der Veen LJ, Stokkel MP, Loo CE, Vrancken Peeters MJ, Valdés Olmos RA. Heading toward radioactive seed localization in non-palpable breast cancer surgery? A meta-analysis. J Surg Oncol. 2015;111(2):185-91. doi: 10.1002/jso.23785.
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