Radioactive seed localization and wire guided localization in breast cancer: A systematic review and meta-analysis.

PURPOSE: Classically, wire-guided localization (WGL) is used for the localization of non palpable breast lesions. On the other hand, many studies report a newer technique called radioactive seed localization (RSL). The purpose of our study was a systematic review and meta analysis of the two techniques regarding the rate of positive margins and the quantity of excised tissue. METHODS: Our study searched publications up to March 24th 2018 in Medline, Embase and Cochrane Library regarding studies comparing the two techniques of localization of subclinical lesions with WGL or RSL using technetium 99m as radioactive agent. The primary target was the rate of positive margins and the second was the rate of second surgery for reexcision. Revman5.3 and STATE12.0 were used for the statistics. RESULTS: Five randomized controlled trials (RCTs) and 13 cohort studies comprising 3879 breast cancer patients were included. RSL was significantly superior than WGL both in better margin status (RR=0.72, 95% CI 0.56-0.92, p=0.01) and reduced reoperation rate (RR=0.68, 95% CI 0.52-0.88, p=0.004). Subgroup analysis of RCTs showed no different ability of both techniques in terms of free margin status (RR=0.85, 95% CI 0.55-1.31, p=0.46) and reoperation rate (RR=0.80, 95% CI 0.48-1.32, p=0.38). Further subgroup analysis excluding three studies with different ductal carcinoma in situ (DCIS) proportion exhibited same efficacy in margin negativity (RR=0.83, 95% CI 0.69-1.01, p=0.07) and further operation rate (RR=0.85, 95% CI 0.71-1.01, p=0.07).

Preoperative assessment in endometrial cancer. Is triage for lymphadenectomy possible?

PURPOSE: We sought to examine whether a preoperative assessment with usual means, available in most hospitals (preoperative histology, pelvic MRI, serum CA-125) can confidently exclude from a full staging surgical procedure low-risk endometrial carcinoma (EC) patients according to ESMO-ESTRO-ESGO criteria (stage I endometrioid EC, grade 1 or 2, myometrial invasion <50% and negative lymphovascular space invasion). METHODS: We retrospectively identified all EC patients that underwent total hysterectomy with bilateral salpingo-oophorectomy (TH-BSO) plus lymph node dissection (LND) as primary treatment for endometrioid tumors from January, 2000 to December, 2010. Extensive review was made through patients' medical records. Having set the final pathology report as the "gold standard", we applied the ESMO-ESGO-ESTRO criteria to classify patients into risk categories (low-risk and non-low risk). We also evaluated preoperative risk status using combined data from preoperative biopsy, pelvic MRI and serum CA-125. We classified patients according to the following criteria: grade 1 or 2 on preoperative histology, myometrial invasion on MRI <50% and serum CA-125 <35 IU/ml, in low risk group. Receiver operating characteristic (ROC) curves were plotted. The area under the ROC curve (AUC), quantifying the overall ability of the combined preoperative assessment to discriminate between patients at low and non-low risk, was the primary outcome of our study. False negative rate was the secondary outcome. RESULTS: Preoperative data on histology, MRI and CA-125 levels were available for 292 patients. The sensitivity and specificity of combined preoperative assessment to discriminate between low- and non-low risk EC patients according to ESMO-ESTRO-ESGO criteria were 96.1% and 73.6% respectively. AUC of the corresponding ROC curve was 0.849. False negative rate was 3.8% (9/235). Among the 9 patients falsely classified as low-risk, one patient had nodal metastasis (1/9, 11.1%) after full staging. CONCLUSION: A selective LND strategy for EC patients based on preoperative assessment is possible and would probably be cost-effective, while not jeopardizing patients' survival or patient quality of life (QoL).