title: Systematic review of radioguided surgery for non-palpable breast cancer.
abstract: BACKGROUND
  This systematic review examines whether radioguided localization surgery (RGL) (radioguided occult lesion localization - ROLL and radioguided seed localization - RSL) for non-palpable breast cancer lesions produces lower positive margin rates than standard wire-guided localization surgery.
  
  
  METHODS
  We performed a comprehensive literature review to identify clinical studies using either ROLL or RSL. Included studies examined invasive or in situ BC and reported pathologically assessed margin status or specimen volume/weight. Two reviewers independently assessed study eligibility and quality and abstracted relevant data on patient and surgical outcomes. Quantitative data analyses were performed.
  
  
  RESULTS
  Fifty-two clinical studies on ROLL (n = 46) and RSL (n = 6) were identified. Twenty-seven met our inclusion criteria: 12 studies compared RGL to WGL and 15 studies were single cohorts using RGL. Ten studies were included in the quantitative analyses. Data for margin status and re-operation rates from 4 randomized controlled trials (RCT; n = 238) and 6 cohort studies were combined giving a combined odds ratio (OR) of 0.367 and 95% confidence interval (CI): 0.277 to 0.487 (p < 0.001) for margins status and OR 0.347, 95% CI: 0.250 to 0.481 (p < 0.001) for re-operation rates.
  
  
  CONCLUSIONS
  The results of this systematic review of RGL versus WGL demonstrate that RGL technique produces lower positive margins rates and fewer re-operations. While this review is limited by the small size and quality of RCTs, the odds ratios suggest that RGL may be a superior technique to guide surgical resection of non-palpable breast cancers. These results should be confirmed by larger, multi-centered RCTs.
authors.affiliation: Department of Surgery, McMaster University, Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. lovricsp@mcmaster.ca
authors.forename: P J
authors.initials: PJ
authors.lastname: Lovrics
authors.forename: S D
authors.initials: SD
authors.lastname: Cornacchi
authors.forename: R
authors.initials: R
authors.lastname: Vora
authors.forename: C H
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: K
authors.initials: K
authors.lastname: Kahnamoui
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005720:Gamma Rays; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D015201:Meta-Analysis as Topic; D018365:Neoplasm, Residual / Q000473:pathology*; D016017:Odds Ratio; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology; D010173:Palpation; D011859:Radiography; D019275:Radiopharmaceuticals; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000706:statistics & numerical data; D013668:Technetium Tc 99m Aggregated Albumin; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid