Comparison of the clinical efficacy of body surface mapping plus wire-guided localization and body surface mapping plus methylene blue-guided localization in occult breast lesions

Accurate preoperative and intra-operative localization of occult breast lesions is important. We aimed to compare the clinical efficacy of body surface mapping plus wire-guided localization (BWL) and body surface mapping plus methylene blue-guided localization (BML) in occult breast lesions. Patient samples were obtained from the Xuzhou Central Hospital from 01 January 2018 to 31 December 2020. A total of 315 patients with a single occult breast lesion were included, comprising 225 cases in the BWL group and 90 cases in the BML group, were eligible for this study. We found that the average localization time in the BWL group was significantly greater than in the BML group (2.9 min vs. 1.6 min), while no significant difference was observed in the degree of pain, which was mild, between the two groups (average score, 1.3 vs. 1.5, respectively). The localization success rate and surgical resection rate were 100%in both groups. In addition, no significant difference was observed between the BWL group and BML group in terms of the average time of surgery (8.5 min vs. 9.8 min), the subjective difficulty of surgery, which was easy in both groups (average score, 2.1 vs. 2.4), and the average volume of surgical specimens (1.8 mL vs. 2.4 mL). Further, in the follow-up 3 months after surgery, the resection rate of lesions was 100%, and both groups demonstrated similar cosmetic effect scores. These findings indicated that both BWL and BML have the advantages of accurate localization, high resection rate, few adverse reactions, and excellent cosmetic effects in patients with occult breast lesions. Although both localization methods might be suitable for hospitals in remote areas, our results indicated that BML might be relatively simpler and more economical.

Body surface mapping; Wire-guided localization; Methylene blue-guided localization; Occult breast lesions; Treatment

[1] van der Ploeg IM, Hobbelink M, van den Bosch MA, Mali WP, Borel Rinkes IH, van Hillegersberg R. ‘Radioguided occult lesion localisation’ (ROLL) for non-palpable breast lesions: a review of the relevant literature. European Journal of Surgical Oncology. 2008; 34: 1–5.

[2] Yamaguchi R, Tsuchiya S, Koshikawa T, Yokoyama T, Mibuchi K, Nonaka Y, et al. Evaluation of inadequate, indeterminate, false-negative and false-positive cases in cytological examination for breast cancer according to histological type. Diagnostic Pathology. 2012; 7: 53.

[3] Langhans L, Jensen M, Talman MM, Vejborg I, Kroman N, Tvedskov TF. Reoperation rates in ductal carcinoma in situ vs. invasive breast cancer after wire-guided breast-conserving surgery. JAMA Surgery. 2017; 152: 378.

[4] Lee C, Bhatt A, Felmlee JP, Trester P, Lanners D, Paulsen A, et al. How to safely perform magnetic resonance imaging-guided radioactive seed localizations in the breast. Journal of Clinical Imaging Science. 2020; 10: 19.

[5] Dauer LT, Thornton C, Miodownik D, Boylan D, Holahan B, King V, et al. Radioactive seed localization with 125I for nonpalpable lesions prior to breast lumpectomy and/or excisional biopsy. Health Physics. 2013; 105: 356–365.

[6] Bernardi S, Bertozzi S, Londero AP. Incidence and risk factors of the intraoperative localization failure of nonpalpable breast lesions by radio-guided occult lesion localization: a retrospective analysis of 579 cases: reply. World Journal of Surgery. 2013; 37: 478–478.

[7] Motta C, Turra A, Farina B, Ostan A, Ramella S, Cartia GL. Radioguided surgery of breast cancer: radiation protection survey. Tumori. 2000; 86: 372–374.

[8] Barentsz MW, van den Bosch MAAJ, Veldhuis WB, van Diest PJ, Pijnappel RM, Witkamp AJ, et al. Radioactive seed localization for non-palpable breast cancer. British Journal of Surgery. 2013; 100: 582–588.

[9] Rose A, Collins JP, Neerhut P, Bishop CV, Mann GB. Carbon localisation of impalpable breast lesions. The Breast. 2003; 12: 264–269.

[10] Alikhassi A, Saeed F, Abbasi M, Omranipour R, Mahmoodzadeh H, Najafi M, et al. Applicability of radioguided occult lesion localization for nonpalpable benign breast lesions, comparison with wire localization, a clinical trial. Asian Pacific Journal of Cancer Prevention. 2016; 17: 3185–3190.

[11] Zhou Y, Liang Y, Zhang J, Feng Y, Li X, Kong X, et al. Evaluation of carbon nanoparticle suspension and methylene blue localization for preoperative localization of nonpalpable breast lesions: a comparative study. Frontiers in Surgery. 2021; 8: 757694.

[12] Moss HA, Barter SJ, Nayagam M, Lawrence D, Pittam M. The use of carbon suspension as an adjunct to wire localisation of impalpable breast lesions. Clinical Radiology. 2002; 57: 937–944.

[13] Varghese P, Abdel-Rahman AT, Akberali S, Mostafa A, Gattuso JM, Carpenter R. Methylene blue dye-a safe and effective alternative for sentinel lymph node localization. The Breast Journal. 2008; 14: 61–67.

[14] Zakaria S, Hoskin TL, Degnim AC. Safety and technical success of methylene blue dye for lymphatic mapping in breast cancer. The American Journal of Surgery. 2008; 196: 228–233.

[15] Masannat YA, Shaaban AM, Speirs V, Coast G, Jackson P, Horgan K, et al. Adverse effects of dyes used in sentinel node biopsy on immunocytochemical determination of hormone receptors in breast cancer cells. Journal of Clinical Pathology. 2007; 60: 730–732.

[16] Nasrinossadat A, Ladan F, Fereshte E, Asieh O, Reza C, Akramossadat S, et al. Marking non-palpable breast masses with injected methylene blue dye, an easy, safe and low cost method for developing countries and resource-limited areas. Asian Pacific Journal of Cancer Prevention. 2011; 12: 1189–1192.

[17] Chen I, Wang C, Wang S, Cheng S, Yu T, Kuo S. Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer. BMC Women’s Health. 2020; 20: 101.

[18] de Roos MAJ, Welvaart WN, Ong KH. Should we abandon wire-guided localization for nonpalpable breast cancer? A plea for wire-guided localization. Scandinavian Journal of Surgery. 2013; 102: 106–109.

[19] Lantsberg L, Kirshtein B, Koretz M, Strano S. Role of wire-guided breast biopsy for diagnosis of malignant nonpalpable mammographic lesions. World Journal of Surgery. 1999; 23: 1279–1281.

[20] Povoski SP, Jimenez RE, Wang WP. Use of an intraoperative ultrasonography-guided localization and tissue fixation device demonstrates less margin positivity during breast-conserving surgery for invasive breast cancer than standard preoperative needle-wire localization: a retrospective comparative analysis in a consecutively treated case series. Clinical Breast Cancer. 2014; 14: 46–52.

[21] Rissanen TJ, Mäkäräinen HP, Mattila SI, Karttunen AI, Kiviniemi HO, Kallioinen MJ, et al. Wire localized biopsy of breast lesions: a review of 425 cases found in screening or clinical mammography. Clinical Radiology. 1993; 47: 14–22.

[22] Weyant M, Carroccio A, Tartter PI, Hermann G, Levykh R, Robenzadeh A, et al. Determinants of success with spot localization biopsy of the breast. Journal of the American College of Surgeons. 1995; 181: 521–524.

[23] Rappaport W, Thompson S, Wong R, Leong S, Villar H. Complications associated with needle localization biopsy of the breast. Surgery, Gynecology and Obstetrics. 1991; 172: 303–306.

[24] Bronstein AD, Kilcoyne RF, Moe RE. Complications of needle localization of foreign bodies and nonpalpable breast lesions. Archives of Surgery. 1988; 123: 775–779.