Evaluation of Carbon Nanoparticle Suspension and Methylene Blue Localization for Preoperative Localization of Nonpalpable Breast Lesions: A Comparative Study

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Abstract

Background: The resection of nonpalpable breast lesions (NPBLs) largely depends on the preoperative localization technology. Although several techniques have been used for the guidance of NPBL resection, more comfortable and effective methods are needed. This aim of this study was to evaluate the use and feasibility of carbon nanoparticle suspension (CNS) and methylene blue (MB)-guided resection of NPBL, to introduce alternative techniques.

Methods: A total of 105 patients with 172 NPBLs detected by breast ultrasound were randomized to CNS localization (CNSL) group and MB localization (MBL) group. The injection times of the two groups were divided into 2, 4, 6, 12, 16, and 20 h before surgery. In this study, localization time, stained area, operation time, total resection volume (TRV), calculated resection ratio (CRR), and pathological diagnosis were assessed.

Results: All of the 172 lesions were finally confirmed benign. Dye persisted in all cases in the CNSL group (109/109, 100%), while that persisted in only 53 cases in the MBL group (53/63, 84.1%) ( P < 0.001). There was a significant correlation between dyeing time and dyeing area in the MBL group ( r = −0.767, P < 0.001); however, there was no significant correlation in the CNSL group ( r = −0.154, P = 0.110). The operation time was 11.05 ± 3.40 min in the CNSL group and 13.48 ± 6.22 min in the MBL group ( P < 0.001). The TRV was 2.51 ± 2.42 cm3 in the CNSL group and 3.69 ± 3.24 cm3 in the MBL group ( P = 0.016). For CRR, the CNSL group was lower than the MBL group (7.62 ± 0.49 vs. 21.93 ± 78.00, P = 0.018). There is no dye remained on the skin in the MBL group; however, dye persisted in 12 patients (19.4%) in the CNSL group ( P = 0.001).

Conclusion: Carbon nanoparticle suspension localization and MBL are technically applicable and clinically acceptable procedures for intraoperatively localizing NPBL. Moreover, given the advantages of CNSL compared to MBL, including the ability to perform this technique 5 days before operation and smaller resection volume, it seems to be a more attractive alternative to be used in intraoperative localization of NPBL.

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Most cited references 35

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Intraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial.

Henk van Steenbergen, Sybren Meijer, Ludmila Cardozo … (2012)

Breast-conserving surgery for palpable breast cancer is associated with tumour-involved margins in up to 41% of cases and excessively large excision volumes. Ultrasound-guided surgery has the potential to resolve both of these problems, thereby improving surgical accuracy for palpable breast cancer. We aimed to compare ultrasound-guided surgery with the standard for palpable breast cancer-palpation-guided surgery-with respect to margin status and extent of healthy breast tissue resection. In this randomised controlled trial, patients with palpable T1-T2 invasive breast cancer were recruited from six medical centres in the Netherlands between October, 2010, and March, 2012. Eligible participants were randomly assigned to either ultrasound-guided surgery or palpation-guided surgery in a 1:1 ratio via a computer-generated random sequence and were stratified by study centre. Patients and investigators were aware of treatment assignments. Primary outcomes were surgical margin involvement, need for additional treatment, and excess healthy tissue resection (defined with a calculated resection ratio derived from excision volume and tumour diameter). Data were analysed by intention to treat. This trial is registered at http://www.TrialRegister.nl, number NTR2579. 134 patients were eligible for random allocation. Two (3%) of 65 patients allocated ultrasound-guided surgery had tumour-involved margins compared with 12 (17%) of 69 who were assigned palpation-guided surgery (difference 14%, 95% CI 4-25; p=0·0093). Seven (11%) patients who received ultrasound-guided surgery and 19 (28%) of those who received palpation-guided surgery required additional treatment (17%, 3-30; p=0·015). Ultrasound-guided surgery also resulted in smaller excision volumes (38 [SD 26] vs 57 [41] cm(3); difference 19 cm(3), 95% CI 7-31; p=0·002) and a reduced calculated resection ratio (1·0 [SD 0·5] vs 1·7 [1·2]; difference 0·7, 95% CI 0·4-1·0; p=0·0001) compared with palpation-guided surgery. Compared with palpation-guided surgery, ultrasound-guided surgery can significantly lower the proportion of tumour-involved resection margins, thus reducing the need for re-excision, mastectomy, and radiotherapy boost. By achieving optimum resection volumes, ultrasound-guided surgery reduces unnecessary resection of healthy breast tissue and could contribute to improved cosmetic results and quality of life. Dutch Pink Ribbon Foundation, Osinga-Kluis Foundation, Toshiba Medical Systems. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancers: systematic review and meta-analysis.

M. Ahmed, M Douek (2013)

The current standard of treatment for non-palpable breast cancers is wire-guided localization (WGL). WGL has its drawbacks and alternatives such as radio-guided surgery (RGL) and intra-operative ultrasound (IOUS) have been developed. The clinical effectiveness of all forms of RGL has been assessed against WGL in previous systematic reviews and meta-analyses. We performed the first systematic review and meta-analysis of IOUS in the management of non-palpable breast cancers.

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A comparison of three methods for nonpalpable breast cancer excision.

Michela De Maria, Seline Meijer, Barbara Zonderhuis … (2011)

To evaluate the efficacy of three methods of breast-conserving surgery (BCS) for nonpalpable invasive breast cancer in obtaining adequate resection margins and volumes of resection. A total of 201 consecutive patients undergoing BCS for nonpalpable invasive breast cancer between January 2006 and 2009 in four affiliated institutions was retrospectively analysed. Patients with pre-operatively diagnosed primary or associated ductal carcinoma in situ (DCIS), multifocal disease, or a history of breast surgery or neo-adjuvant treatment were excluded from the study. The resections were guided by wire localisation (WL), ultrasound (US), or radio-guided occult lesion localisation (ROLL). The pathology reports were reviewed to determine oncological margin status, as well as tumour and surgical specimen sizes. The optimal resection volume (ORV), defined as the spherical tumour volume with an added 1.0-cm margin, and the total resection volume (TRV), defined as the corresponding ellipsoid, were calculated. By dividing the TRV by the ORV, a calculated resection ratio (CRR) was determined to indicate the excess tissue resection. Of all 201 excisions, 117 (58%) were guided by WL, 52 (26%) by US, and 32 (16%) by ROLL. The rate of focally positive and positive margins for invasive carcinoma was significantly lower in the US group (N = 2 (3.7%)) compared to the WL (N = 25 (21.3%)) and ROLL (N = 8 (25%)) groups (p = 0.023). The median CRRs were 3.2 (US), 2.8 (WL) and 3.8 (ROLL) (WL versus ROLL, p < 0.05), representing a median excess tissue resection of 3.1 times the optimal resection volume. US-guided BCS for nonpalpable invasive breast cancer was more accurate than WL- and ROLL-guided surgery because it optimised the surgeon's ability to obtain adequate margins. The excision volumes were large in all excision groups, especially in the ROLL group. Copyright © 2010 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Xiaoyan Li: URI : http://loop.frontiersin.org/people/975300/overview

Qifeng Yang: URI : http://loop.frontiersin.org/people/693595/overview

Journal

Journal ID (nlm-ta): Front Surg

Journal ID (iso-abbrev): Front Surg

Journal ID (publisher-id): Front. Surg.

Title: Frontiers in Surgery

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2296-875X

Publication date (Electronic): 23 November 2021

Publication date Collection: 2021

Volume: 8

Electronic Location Identifier: 757694

Affiliations

[1] ¹Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University , Jinan, China

[2] ²Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai, China

[3] ³Pathology Tissue Bank, Qilu Hospital of Shandong University , Jinan, China

[4] ⁴Research Institute of Breast Cancer, Shandong University , Jinan, China

Author notes

Edited by: Damiano Caputo, Campus Bio-Medico University, Italy

Reviewed by: Alessandro Rossetta, University of Genoa, Italy; Luca Digiacomo, Sapienza University of Rome, Italy

*Correspondence: Qifeng Yang qifengy_sdu@ 123456163.com

This article was submitted to Surgical Oncology, a section of the journal Frontiers in Surgery

†These authors have contributed equally to this work

Article

DOI: 10.3389/fsurg.2021.757694

PMC ID: 8651243

PubMed ID: 34888344

SO-VID: 36b5d0e3-babe-4851-81d1-e042726a9877

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 12 August 2021

Date accepted : 18 October 2021

Page count

Figures: 6, Tables: 4, Equations: 0, References: 35, Pages: 10, Words: 5614

Funding

Funded by: National Key Research and Development Program of China, doi 10.13039/501100012166;

Award ID: 2018YFC0114705

Award ID: 2020YFA0712400

Funded by: Taishan Scholar Foundation of Shandong Province, doi 10.13039/501100010029;

Award ID: ts20190971

Funded by: National Natural Science Foundation of China-China Academy of General Technology Joint Fund for Basic Research, doi 10.13039/501100019492;

Evaluation of Carbon Nanoparticle Suspension and Methylene Blue Localization for Preoperative Localization of Nonpalpable Breast Lesions: A Comparative Study

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Karger: Oncology

Most cited references 35

Intraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial.

Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancers: systematic review and meta-analysis.

A comparison of three methods for nonpalpable breast cancer excision.

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