The Effect of Wire Versus Magnetic Seed Localization on Lumpectomy Cavity Size

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology Pub Date : 2024-07-01 DOI:10.1016/j.prro.2023.12.004

Michael Dykstra MD , Jessica Thompson MD , Jessica Aldous BS , Shannon Jiang MD , Tasha Hughes MD, MPH , James Hayman MD, MBA , Aleksandar Dragovic MD , Jennifer Shah MD , Alfred Chang MD , Corey Speers MD, PhD , Michael Sabel MD , Lesly Dossett MD, MPH , Matthew Schipper PhD , Reshma Jagsi MD, DPhil

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引用次数: 0

Abstract

Purpose

Our purpose was to assess whether an association exists between surgical localization technique and lumpectomy cavity size on radiation therapy planning computed tomography (CT) scan.

Methods and Materials

A single-institution retrospective review was conducted of women undergoing breast conserving surgery with wire or magnetic seed guided lumpectomy followed by adjuvant radiation therapy from 2018 to 2021. Patients of a surgeon only performing 1 localization technique or undergoing bracketed localization were excluded. The primary outcome was lumpectomy cavity size on simulation CT. Confounding due to imbalance in patient and tumor factors was addressed with overlap weights derived from a propensity score analysis and used in a weighted multivariable analysis. Secondary outcomes included positive margins, total pathologic volume, boost delivery, and boost modality.

Results

Of 617 women who received lumpectomy during the study period, 387 were included in final analysis. Tumors of patients undergoing seed localization were more likely unifocal, assessable by ultrasound, and smaller. Seed use rates ranged from 27.7% to 70.7% per surgeon. There was no difference in positive margins (6.4 vs 5.4%, P = .79) or second surgeries (9.4 vs 8.1%, P = .79) between groups. Close margin rates were similar for ductal carcinoma in situ (P = .35) and invasive carcinoma (P = .97). In unadjusted bivariable analyses, wire localization was associated with larger total pathology volume (P = .004), but localization technique showed no association with CT cavity volume (P = .15). After adjusting for potentially confounding variables, multivariable analysis failed to show an association between localization technique and either CT cavity (P = .35) or total path volume (P = .08). There was no difference in indicated-boost delivery (P = .15) or electron boost (P = .14) by localization technique.

Conclusions

There was no significant difference in CT cavity size by localization technique, suggesting choice between surgical techniques does not impede radiation therapy boost delivery.

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导线与磁性种子定位对腔镜切除术腔室大小的影响

目的评估手术定位技术与放疗计划 CT 扫描上的肿块切除术腔大小之间是否存在关联。方法和材料对 2018 年至 2021 年期间接受保乳手术并在导丝或磁性种子引导下进行肿块切除术后接受辅助放疗的女性进行了单机构回顾性研究。排除了外科医生只进行一种定位技术或进行括号定位的患者。主要结果是模拟 CT 上的肿块切除腔大小。通过倾向评分分析得出的重叠权重解决了患者和肿瘤因素不平衡造成的干扰，并在加权多变量分析（MVA）中使用。次要结果包括阳性边缘、总病理容积、助推剂输送和助推方式。接受种子定位的患者的肿瘤多为单灶、可通过超声评估且较小。每位外科医生的种子使用率从 27.7% 到 70.7% 不等。阳性边缘（6.4% 对 5.4%，P = 0.79）或二次手术（9.4% 对 8.1%，P = 0.79）在各组之间没有差异。DCIS（p = 0.35）和浸润癌（p = 0.97）的边缘关闭率相似。在未调整的二变量分析中，线定位与较大的病理总体积相关（p = 0.004），但定位技术与 CT 腔体积没有关联（p = 0.15）。在对方法中列出的潜在混杂变量进行调整后，MVA 未能显示定位技术与 CT 腔（p=0.35）或总病理容积（p=0.08）之间存在关联。结论定位技术与CT空腔大小无显著差异，表明手术技术的选择不会影响放疗的增量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

6.10%

发文量

177

审稿时长

34 days

期刊介绍： The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.

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