E-viri
Recenzirano
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Pantiora, Eirini; Jazrawi, Allan; Hersi, Abdi-Fatah; Abdsaleh, Shahin; Ahlstedt, Hanna; Molnar, Eva; Wärnberg, Fredrik; Eriksson, Staffan; Karakatsanis, Andreas
JAMA surgery, 2023Journal Article
Importance Guidewires have been the standard for breast lesion localization but pose operative and logistic challenges. Paramagnetic seeds have shown promising results, but to the authors’ knowledge, no randomized comparison has been performed. Objective To determine whether the combination of a paramagnetic seed and superparamagnetic iron oxide (SPIO) is equivalent to guidewire and SPIO for breast cancer localization and sentinel lymph node detection (SLND). Design, Setting, and Participants This was a phase 3, pragmatic, equivalence, 2-arm, open-label, randomized clinical trial conducted at 3 university and/or community hospitals in Sweden from May 2018 to May 2022. Included in the study were patients with early breast cancer planned for breast conservation and SLND. Study data were analyzed July to November 2022. Interventions Participants were randomly assigned 1:1 to a paramagnetic seed or a guidewire. All patients underwent SLND with SPIO. Main Outcomes and Measures Re-excision rate and resection ratio (defined as actual resection volume / optimal resection volume). Results A total of 426 women (median IQR age, 65 56-71 years; median IQR tumor size, 11 8-15 mm) were included in the study. The re-excision rate was 2.90% (95% CI, 1.60%-4.80%), and the median (IQR) resection ratio was 1.96 (1.15-3.44). No differences were found between the guidewire and the seed in re-excisions (6 of 211 2.84% vs 6 of 209 2.87%; difference, −0.03%; 95% CI, −3.20% to 3.20%; P = .99) or resection ratio (median, 1.93; IQR, 1.18-3.43 vs median, 2.01; IQR, 1.11-3.47; P = .70). Overall SLN detection was 98.6% (95% CI, 97.1%-99.4%) with no differences between arms (203 of 207 98.1% vs 204 of 206 99.0%; difference, −0.9%; 95% CI, −3.6% to 1.8%; P = .72). More failed localizations occurred with the guidewire (21 of 208 10.1% vs 4 of 215 1.9%; difference, 8.2%; 95% CI, 3.3%-13.2%; P < .001). Median (IQR) time to specimen excision was shorter for the seed (15 10-22 minutes vs 18 12-30 minutes; P = .01), as was the total operative time (69 56-86 minutes vs 75.5 59-101 minutes; P = .03). The experience of surgeons, radiologists, and surgical coordinators was better with the seed. Conclusions and Relevance The combination of SPIO and a paramagnetic seed performed comparably with SPIO and guidewire for breast cancer conserving surgery and resulted in more successful localizations, shorter operative times, and better experience. Trial Registration ISRCTN.org Identifier: ISRCTN11914537
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Leto | Faktor vpliva | Izdaja | Kategorija | Razvrstitev | ||||
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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