Dados do Trabalho

Título

The radioactive seed localization and wire guided localization for impalpable breast cancer surgery: meta-analysis

Descrição sucinta do(s) objetivo(s)

The aim of this study was to develop a meta-analysis comparing the surgical efficiency of two intraoperative breast localization techniques, wire-guided localization (WGL) and radioactive seed localization (RSL).

Material(is) e método(s)

The systematic research was performed in databases such as Embase, LILACS, PubMed, SciELO, and Web of Science from the earliest available data to 30 November 2023. The selected studies in the screening process went through a standard form of data extraction. The ROBINS-1 and ROB-2 tool was applied to analyze the bias risk and methodological quality. The review manager 5.4 software was used to perform the meta-analysis by the random effects analysis model to calculate the relative risk considering a 95% confidence interval.

Resultados e discussão

Six randomized controlled trials and 32 cohort studies were identified, meeting the inclusion criteria. The evidence overall quality was high for randomized trials and moderate for cohort studies. The population consist of women with nonpalpable breast cancer, aged 22-92 years old, with single or bracketing markers, and neoadjuvant chemotherapy patients were included. The results demonstrated an RSL superiority over WGL for the rates of positive surgical margin (RR 0.78, 95% CI [0.70-0.88], 15085 patients), reoperation (RR 0.71, 95% CI [0.61-0.84], 13884 patients) and recurrence (RR 0.41, 95% CI [0.19-0.86], 1525 patients, followed up for a period of 13-109 months).

Conclusões

The results are promising because the conservative surgery success depends on the tumor’s complete removal with negative surgical margins, minimizing the need for reoperation and the disease recurrence risk. RSL is a valid localization method for surgical efficiency for patients with non-palpable breast cancer and can be applied in various indications for breast-conserving surgery with intraoperative localization, including neoadjuvant treatment. Furthermore, patients who underwent neoadjuvant chemotherapy can receive an RSL implant before neoadjuvant treatment and thus will not need to undergo another localization procedure before surgery. This is especially important for patients who achieve a complete pathological response, as the seed will continue to mark the tumor local even with tumor regression.

Palavras Chave

Breast cancer; Radioactive seed localization; Meta-analysis.

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