Radioactive seed localization and wire guided localization in breast cancer: A systematic review and meta-analysis.

PURPOSE: Classically, wire-guided localization (WGL) is used for the localization of non palpable breast lesions. On the other hand, many studies report a newer technique called radioactive seed localization (RSL). The purpose of our study was a systematic review and meta analysis of the two techniques regarding the rate of positive margins and the quantity of excised tissue. METHODS: Our study searched publications up to March 24th 2018 in Medline, Embase and Cochrane Library regarding studies comparing the two techniques of localization of subclinical lesions with WGL or RSL using technetium 99m as radioactive agent. The primary target was the rate of positive margins and the second was the rate of second surgery for reexcision. Revman5.3 and STATE12.0 were used for the statistics. RESULTS: Five randomized controlled trials (RCTs) and 13 cohort studies comprising 3879 breast cancer patients were included. RSL was significantly superior than WGL both in better margin status (RR=0.72, 95% CI 0.56-0.92, p=0.01) and reduced reoperation rate (RR=0.68, 95% CI 0.52-0.88, p=0.004). Subgroup analysis of RCTs showed no different ability of both techniques in terms of free margin status (RR=0.85, 95% CI 0.55-1.31, p=0.46) and reoperation rate (RR=0.80, 95% CI 0.48-1.32, p=0.38). Further subgroup analysis excluding three studies with different ductal carcinoma in situ (DCIS) proportion exhibited same efficacy in margin negativity (RR=0.83, 95% CI 0.69-1.01, p=0.07) and further operation rate (RR=0.85, 95% CI 0.71-1.01, p=0.07).