title: Systematic review of radioguided versus wire-guided localization in the treatment of non-palpable breast cancers.
abstract: One-third of breast cancers present as non-palpable lesions. The current gold standard treatment for these cancers is localized wide local excision using wire-guided localization (WGL). WGL has drawbacks including technical and scheduling issues resulting in the development of alternative radioguided techniques (RGL). A systematic review was performed to identify studies comparing RGL and WGL. The outcomes of surgical margin status, re-operation rates, surgical operative time, volume and excised specimen weight and successful sentinel lymph node biopsy (SLNB) rates were evaluated. Pooled odds ratios (ORs) and 95 % confidence intervals were estimated using fixed-effects analyses and random-effects analyses in case of statistically significant heterogeneity (p < 0.05). Seven randomized controlled trials (RCTs) matching the inclusion criteria were identified. The pooled ORs for involved surgical margin status were 0.78 (95 % CI, 0.52-1.17); for re-operations 0.74 (95 % CI, 0.49-1.11) and for successful SLNB 1.29 (95 % CI, 0.66-2.53). There was a significant difference in surgical operating time in favour of RGL (mean difference (MD), -2.95; 95 % CI, -4.43, -1.47) and a significant difference in excised specimen volume, favouring WGL (MD, 6.79; 95 % CI, 0.03, 13.56). The MD for a specimen weight of -3.00 (95 % CI, -15.15, 9.15) showed no significant difference between RGL and WGL. RGL has a reduced operating time, but larger volume excisions compared to WGL. There is insufficient evidence to support the uptake of RGL over WGL, and larger, adequately powered, multi-centre RCTs are required.
authors.affiliation: Department of Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK. muneer.ahmed@kcl.ac.uk
authors.forename: Muneer
authors.initials: M
authors.lastname: Ahmed
authors.forename: Mieke
authors.initials: M
authors.lastname: van Hemelrijck
authors.forename: Michael
authors.initials: M
authors.lastname: Douek
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D010173:Palpation / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome