Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
University Hospitals, Cleveland Medical Center, Cleveland, OH, USA.
Ann Surg Oncol. 2021 Jun;28(6):3223-3229. doi: 10.1245/s10434-020-09311-x. Epub 2020 Nov 10.
As an alternative to traditional wire localization, an inducible magnetic seed system can be used to identify and remove nonpalpable breast lesions and axillary lymph nodes intraoperatively. We report the largest single-institution experience of magnetic seed placement for operative localization to date, including feasibility and short-term outcomes.
Patients who underwent placement of a magnetic seed in the breast or lymph node were identified from July 2017 to March 2019. Imaging findings, core needle biopsy, surgical pathology results, and type of surgery were collected. Outcomes included procedural complications, magnetic seed and biopsy clip retrieval rates, and need for additional surgery.
A total of 842 magnetic seeds were placed by nine radiologists in 673 patients and retrieved by six surgeons at six operative locations. The majority of breast lesions were malignant (395/659, 59.9%); 136 seeds were placed for lymph node localization. The overall magnetic seed retrieval rate was 98.6%, whereas the biopsy clip retrieval rate was 90.9%. Only six patients (0.7%) experienced a complication from magnetic seed placement. Reexcision was performed in 15.2% of patients with breast cancer; 9.6% of benign/high risk lesions were upgraded to malignancy at surgical excision.
The magnetic seed technique is safe, effective, and accurate for localization of breast lesions and lymph nodes, and importantly uncouples surgery from the localization procedure. The high magnetic seed retrieval rate and low reexcision rate may reflect the accuracy of magnetic marker placement as a "second chance" localization procedure, especially in cases with biopsy clip migration.
作为传统金属丝定位的替代方法，可诱导磁性种子系统可用于术中识别和切除不可触及的乳房病变和腋窝淋巴结。我们报告了迄今为止最大的单一机构磁性种子放置用于手术定位的经验，包括可行性和短期结果。
从 2017 年 7 月至 2019 年 3 月，确定了在乳房或淋巴结中放置磁性种子的患者。收集了影像学发现、核心针活检、手术病理结果和手术类型。结果包括手术并发症、磁性种子和活检夹的取出率以及是否需要额外手术。
共有 9 名放射科医生在 673 名患者中放置了 842 个磁性种子，并由 6 名外科医生在 6 个手术部位取出。大多数乳房病变为恶性（395/659，59.9%）；136 个种子用于淋巴结定位。总体磁性种子取出率为 98.6%，而活检夹取出率为 90.9%。仅 6 名患者（0.7%）经历了磁性种子放置的并发症。15.2%的乳腺癌患者行再次切除术；9.6%的良性/高危病变在手术切除时升级为恶性。
磁性种子技术安全、有效、准确，可用于定位乳房病变和淋巴结，重要的是将手术与定位过程分开。高磁性种子取出率和低再次切除率可能反映了磁性标记放置作为“第二次机会”定位程序的准确性，尤其是在活检夹迁移的情况下。
