ABSTRACT
Background/Objectives: De-escalation of axillary surgery is made possible by advancements in both neoadjuvant systemic therapy (NST) and in localisation technology for breast lesions. Magseed®, developed in 2013 by Dr. Michael Douk of Cambridge, United Kingdom, is a wire-free localisation technology that facilitates the localisation and retrieval of lymph nodes for staging. Targeted axillary dissection (TAD), which entails marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB), has emerged as the preferred method to assess residual disease in post-NST node-positive patients. This systematic review and pooled analysis evaluate the performance of Magseed® in TAD. Methods: The search was carried out in PubMed and Google Scholar. An assessment of localisation, retrieval rates, concordance between MLNB and SLNB, and pathological complete response (pCR) in clinically node-positive patients post NST was undertaken. Results: Nine studies spanning 494 patients and 497 procedures were identified, with a 100% successful deployment rate, a 94.2% (468/497) [95% confidence interval (CI), 93.7-94.7] localisation rate, a 98.8% (491/497) retrieval rate, and a 68.8% (247/359) [95% CI 65.6-72.0] concordance rate. pCR was observed in 47.9% (220/459) ) [95% CI 43.3-52.6] of cases. Subgroup analysis of studies reporting the pathological status of MLNB and SLNB separately revealed an FNR of 4.2% for MLNB and 17.6% for SLNB (p = 0.0013). Mean duration of implantation was 37 days (range: 0-188). Conclusions: These findings highlight magnetic seed localisation's efficacy in TAD for NST-treated node-positive patients, aiding in accurate axillary pCR identification and safe de-escalation of axillary surgery in excellent responders.
ABSTRACT
Background Maintaining ear projection and preservation of cephaloauricular sulcus from obliteration following graft contracture is a challenge following staged microtia reconstruction. Authors have designed simple, effective, and easy-to-use splints to ensure improved aesthetic outcomes and patient compliance. Materials and Methods This is a prospective study over 3 years including 8 patients of both sexes aged 6 to 12 years. Custom-made ear splints were designed separately for females and males and used to maintain ear projection. Projection of the ear was measured postoperatively and at follow-up using goniometer and photographic records. Outcome was assessed in terms of cephaloauricular angle, conchal depth, pain, cost-effectiveness, splint retention period, and aesthetics. Results and Conclusion Maximal follow-up was 2 years. The splint effectively maintained ear projection of more than 30 degrees. Patient compliance was optimal, and no major complications were associated with its prolonged use.
