title: Feasibility of magnetic marker localisation for non-palpable breast cancer.
abstract: OBJECTIVE
  Accurate tumour localisation is essential for breast-conserving surgery of non-palpable tumours. Current localisation technologies are associated with disadvantages such as logistical challenges and migration issues (wire guided localisation) or legislative complexities and high administrative burden (radioactive localisation). We present MAgnetic MArker LOCalisation (MaMaLoc), a novel technology that aims to overcome these disadvantages using a magnetic marker and a magnetic detection probe. This feasibility study reports on the first experience with this new technology for breast cancer localisation.
  
  
  METHODS
  Fifteen patients with unifocal, non-palpable breast cancer were recruited. They received concurrent placement of the magnetic marker in addition to a radioactive iodine seed, which is standard of care in our clinic. In a subset of five patients, migration of the magnetic marker was studied. During surgery, a magnetic probe and gammaprobe were alternately used to localise the markers and guide surgery. The primary outcome parameter was successful transcutaneous identification of the magnetic marker. Additionally, data on radiologist and surgeon satisfaction were collected.
  
  
  RESULTS
  Magnetic marker placement was successful in all cases. Radiologists could easily adapt to the technology in the clinical workflow. Migration of the magnetic marker was negligible. The primary endpoint of the study was met with an identification rate of 100%. Both radiologists and surgeons reflected that the technology was intuitive to use and that it was comparable to radioactive iodine seed localisation.
  
  
  CONCLUSIONS
  Magnetic marker localisation for non-palpable breast cancer is feasible and safe, and may be a viable non-radioactive alternative to current localisation technologies.
authors.affiliation: The Netherlands Cancer Institute, Department of Surgery, The Netherlands; University of Twente, MIRA Institute, The Netherlands. Electronic address: bramschermers@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Schermers
authors.affiliation: The Netherlands Cancer Institute, Department of Surgery, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: van der Hage
authors.affiliation: The Netherlands Cancer Institute, Department of Radiology, Division of Diagnostic Oncology, The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: Loo
authors.affiliation: The Netherlands Cancer Institute, Department of Surgery, The Netherlands.
authors.forename: M T F D
authors.initials: MTFD
authors.lastname: Vrancken Peeters
authors.affiliation: The Netherlands Cancer Institute, Department of Radiology, Division of Diagnostic Oncology, The Netherlands.
authors.forename: H A O
authors.initials: HAO
authors.lastname: Winter-Warnars
authors.affiliation: The Netherlands Cancer Institute, Department of Surgery, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van Duijnhoven
authors.affiliation: University of Twente, MIRA Institute, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Ten Haken
authors.affiliation: The Netherlands Cancer Institute, Department of Clinical Physics, The Netherlands.
authors.forename: S H
authors.initials: SH
authors.lastname: Muller
authors.affiliation: The Netherlands Cancer Institute, Department of Surgery, The Netherlands; University of Twente, MIRA Institute, The Netherlands.
authors.forename: T J M
authors.initials: TJM
authors.lastname: Ruers
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D007457:Iodine Radioisotopes; D059346:Magnets; D010173:Palpation; D019275:Radiopharmaceuticals
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals
keywords: Breast sparing surgery; Magnetism; Non-radioactive; Surgical localisation