University of Twente Student Theses


Image guided localization of non-palpable breast lesions : a retrospective population-based cohort study

Simanowski, J. (2023) Image guided localization of non-palpable breast lesions : a retrospective population-based cohort study.

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Abstract:Background In 2020, in primary breast cancer 67% of all patients in the Netherlands received breast conserving surgery (BCS). Current standard-of-care for image-guided localization (IGL) of non-palpable breast cancer involves iodine seed, wire guidance, radio guided localization, ultrasound guidance, magnetic-marker and radiofrequency identification. However, comparative data regarding oncological safety, clear margins after surgery and number of re-excisions, is limited. Therefore, the aim of this retrospective population-based study is to compare IGL-techniques with respect to oncological safety in resection of non-palpable breast lesions. Methods All patients recorded by the Netherlands Cancer Registry, undergoing BCS with IGL between 2013 and 2022, were included in this study (n = 60.101). The status of resection margins (free, focally irradical, or more than focally irradical) was assessed according to the Dutch indications for re-excision. The correlation between image-guided localization and the status of tumor resection margins was assessed by a multinominal logistic regression analysis. The need for re-excision was assessed by logistic regression analysis. Both analyses were performed for invasive carcinoma and ductal carcinoma in situ (DCIS) separately. Iodine seed was taken as reference. Results There was a steady increase in the use of the iodine seed, magnetic-marker and radiofrequency identification (the latter two introduced in 2018), while wire-guided localization was decreasing. For patients with invasive carcinoma, there were no significant differences between the localization techniques regarding resection margin status. For patients with DCIS, the largest significant difference in the odds of a focally positive margin status was found between patients treated with magnetic-marker and iodine seed (OR = 1.94;1.13 – 3.34), while ultrasound guidance had the highest significant difference in the odds of a more than focally positive margin status compared to the iodine seed (OR = 1.80; 1.06 – 3.04). A significant difference in the odds of a re-excision was found between patients (both invasive carcinoma and DCIS) treated with wire guidance and iodine seed (OR = 1.37 and OR = 1.45 respectively). Conclusion With respect to resection margin status in treatment with image-guided localization, wire guided localization, ultrasound guided localization and the magnetic marker performed inferior to iodine seed for patients with DCIS. For patients with invasive carcinoma, no significant differences were revealed. Wire-guided localization has a higher occurrence of re-excisions compared to iodine seed for both patients with invasive carcinoma and patients with DCIS.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Health Sciences MSc (66851)
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