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Radioguided Localisation Techniques for Non-Palpable Breast Lesions: An Umbrella Review.

Marco Cuzzocrea1, Cesare Michele Iacovitti1, Nickolas Peradze2

  • 1Division of Nuclear Medicine, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland.

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Summary

Radioguided localisation techniques for non-palpable breast lesions offer superior or equivalent outcomes to wire-guided localisation (WGL), improving success rates and reducing positive margins. These methods enhance surgical workflow and patient outcomes.

Keywords:
ROLLSNOLLWGLbreast-conserving surgery (BCS)radioguided occult lesion localisationsentinel node and occult lesion localisationwire-guided localisation

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Area of Science:

  • Oncology
  • Radiology
  • Surgical Innovation

Background:

  • Accurate localization of non-palpable breast lesions is critical for successful breast-conserving surgery (BCS).
  • Wire-guided localization (WGL) is a traditional method, but radioguided techniques offer potential improvements.
  • Radioguided Occult Lesion Localisation (ROLL) and Radioactive Seed Localisation (RSL) aim to enhance margin clearance and reduce reoperations.

Purpose of the Study:

  • To critically appraise and synthesize evidence from systematic reviews and meta-analyses.
  • To compare radioguided localisation techniques with wire-guided localisation (WGL) for non-palpable breast lesions.
  • To evaluate efficacy, safety, margin positivity, re-excision rates, and patient outcomes.

Main Methods:

  • An umbrella review methodology was employed.
  • Literature search conducted in PubMed/Medline and Cochrane Library databases up to 2024.
  • Included systematic reviews and meta-analyses comparing radioguided techniques with WGL.

Main Results:

  • Radioguided methods demonstrated high localisation success rates (often >95%) and fewer positive margins than WGL.
  • Reoperation findings were mixed, but operative and localisation times were generally shorter with radioguided approaches.
  • Specimen characteristics were comparable, and safety profiles were favourable for radioguided techniques.

Conclusions:

  • Radioguided localisation techniques offer superior or equivalent outcomes compared to WGL, improving workflow efficiency.
  • Combined approaches like Sentinel Node and Occult Lesion Localisation (SNOLL) may facilitate simultaneous lesion and sentinel node evaluation.
  • Further high-quality, standardized comparative studies are needed to optimize protocols and cost-effectiveness.