Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California.
Breast J. 2020 Mar;26(3):406-413. doi: 10.1111/tbj.13499. Epub 2019 Aug 25.
Radioactive seed localization (RSL) and the Savi scout radar (SSR) are newer alternatives to wire-guided localization (WL) for nonpalpable breast lesions.
To compare three types of localization devices used in breast conserving surgery.
A total of 293 patients had a partial mastectomy (n = 194) or breast biopsy (n = 99) with preoperative image-guided localization of a single nonpalpable lesion between July 2017 to July 2018. Lesions were localized by WL, RSL, or SSR. Although all operations performed were outpatient, due to workflow differences at our institution, operations performed in the hospital operating rooms were defined as "hospital setting." Operations performed at an outpatient surgery facility without the capacity to admit patients were defined as "ambulatory." Delay in operating room start times and total perioperative times in both the hospital and ambulatory setting, localization time, explant of localization device, positive margins, volume of tissue excised, and 30-day complications were evaluated.
A total of 126 patients (43%) had WL; 59 patients (20%) had RSL; and 108 patients (37%) had SSR localization. SSR localization took longer to perform with an average time of 19 minutes, compared with 15 minutes for WL and 14 minutes for RSL (P = .020). In 93.52% of cases, the first specimen contained both the clip and localization device, which was similar among groups (P = .073). There was no difference in retained biopsy clip among the groups (average 3.4%, P = .173). For operations performed in the hospital, the time from patient arrival to the preoperative area and incision was significantly longer in the WL group with a median of 233 minutes (range 56-486), 130 minutes (range 64-294) in RSL, and 108 minutes (range 59-240) for SSR (P < .001). There was no difference in operative time among the groups with a median of 51 minutes (range 17-122) (P = .108). There was, however, significantly longer perioperative time of 469 minutes (range 210-926) in the WL group compared with 399 minutes (range 240-871) for RSL and 381 minutes (range 232-711) for SSR (P ≤ .001). For the ambulatory setting, although there was no difference in operating time among the groups (median 50 minutes, range 18-127, P = .715), only the RSL showed a decreased perioperative time compared to WL (WL 356 vs RSL 275, P < .001; SSR 279, p = NS). A total of 131 patients (44.7%) had same day localizations. Among operations with delayed start times, there was a longer average delay of 85 minutes (range 1-304) for WL group compared with 69 minutes (range 13-219) in RSL and 53 minutes (range 0-228) in SSR (P < .001). There was no difference among the three groups in positive margin rate, volume of tissue excised, and 30-day complications.
Nonwire localization devices are associated with reduced overall perioperative time compared to wire localization, with few complications.
放射性种子定位（RSL）和 Savi 导览雷达（SSR）是用于非可触及乳腺病变的导丝定位（WL）的较新替代方法。
比较三种用于保乳手术的定位设备。
共有 293 例患者于 2017 年 7 月至 2018 年 7 月接受了术前影像学引导下单个非可触及病变的部分乳房切除术（n=194）或乳房活检（n=99）。病变通过 WL、RSL 或 SSR 进行定位。尽管所有手术均为门诊手术，但由于我院工作流程的不同，我院手术室进行的手术被定义为“医院环境”。在没有住院能力的门诊手术设施进行的手术被定义为“门诊”。评估了手术室开始时间和医院及门诊环境的总围手术期时间、定位时间、定位装置取出、阳性切缘、切除组织的体积和 30 天并发症。
共有 126 例患者（43%）进行 WL；59 例患者（20%）进行 RSL；108 例患者（37%）进行 SSR 定位。SSR 定位时间较长，平均时间为 19 分钟，而 WL 为 15 分钟，RSL 为 14 分钟（P=0.020）。在 93.52%的病例中，第一个标本均包含夹和定位装置，各组之间无差异（P=0.073）。各组之间保留活检夹无差异（平均 3.4%，P=0.173）。对于在医院进行的手术，WL 组患者从到达术前区到切开的时间明显更长，中位数为 233 分钟（范围 56-486），RSL 组为 130 分钟（范围 64-294），SSR 组为 108 分钟（范围 59-240）（P<0.001）。各组之间的手术时间无差异，中位数为 51 分钟（范围 17-122）（P=0.108）。然而，WL 组的围手术期时间明显更长，中位数为 469 分钟（范围 210-926），而 RSL 组为 399 分钟（范围 240-871），SSR 组为 381 分钟（范围 232-711）（P≤0.001）。对于门诊环境，尽管各组之间的手术时间无差异（中位数 50 分钟，范围 18-127，P=0.715），但只有 RSL 与 WL 相比，围手术期时间减少（WL 356 比 RSL 275，P<0.001；SSR 279，p=NS）。共有 131 例患者（44.7%）当日定位。在延迟开始时间的手术中，WL 组的平均延迟时间延长 85 分钟（范围 1-304），而 RSL 组为 69 分钟（范围 13-219），SSR 组为 53 分钟（范围 0-228）（P<0.001）。三组之间阳性切缘率、切除组织体积和 30 天并发症无差异。
与 WL 相比，非导丝定位装置与总围手术期时间缩短相关，并发症较少。
