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Bracketed Localization in Breast-Conserving Surgery: Indications and Success Rates From a Single, High Volume,

Walker Lyons1, Ryan Lamm1, Emily R Duffner2

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The American Surgeon
|June 27, 2022
PubMed
Summary

Bracketed localization aids breast-conserving surgery (BCS) for large or multifocal lesions. This technique, particularly for ductal carcinoma in situ (DCIS), achieved good outcomes, suggesting its clinical benefit in select cases.

Keywords:
breastsurgical oncology

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Area of Science:

  • Surgical Oncology
  • Breast Surgery
  • Radiology

Background:

  • Bracketed localization is a technique for localizing breast lesions during breast-conserving surgery (BCS).
  • Current clinical practice lacks established guidelines for its use.
  • This study aimed to define criteria for employing bracketed localization.

Purpose of the Study:

  • To establish criteria for surgeons to consider bracketed localization in breast-conserving surgery.
  • To evaluate the effectiveness of bracketed localization in achieving negative margins.

Main Methods:

  • Retrospective chart review of 113 patients undergoing bracketed localization for BCS (2015-2021).
  • Analysis of lesion characteristics: span, number, histology (core biopsy and specimen).
  • Assessment of margin status and need for re-operation.

Main Results:

  • Average lesion span was 5.0 cm; 45% of cases involved multifocal lesions.
  • Ductal carcinoma in situ (DCIS) was present in 64% of core biopsies and 76% of specimens.
  • 82% achieved negative margins initially; 17% required additional surgery, with invasive lobular carcinoma having the highest rate (23%).

Conclusions:

  • Bracketed localization was frequently used for large, multifocal lesions, and those with DCIS or invasive lobular components.
  • Despite associated challenges, the rate of additional surgery in this cohort was comparable to national averages for BCS.
  • Surgeon use of bracketed localization appears beneficial for specific challenging clinical scenarios.