Breast conservative surgery after neoadjuvant chemotherapy in breast cancer patients: Comparison of two tumor localization methods

Aims The key to surgical planning for breast conservative treatment (BCT) after neoadjuvant chemotherapy (NAC) is tumor localization. Tumor marking can be performed using either skin tattoo or metallic marker. The objective of this study is to compare both types of tumor localization markers and to assess which techniques improve BCT in achieving a complete resection without compromise margins. Methods 149 patients between 1999 and 2009 were eligible for the study. The skin tattoo group (TG) included 118 patients and the metallic marker group (MG) included 31 patients. Both markers were placed before starting NAC. Results Median clinical tumor volume was 10.3 cm3 in the TG and 22.4 cm3 in the MG (p = 0.051). After NAC treatment, there were no significant statistically differences in both groups regarding complete clinical response, partial clinical response, and complete and partial pathological response. Median pathological tumor volume was: 0.8 cm3 in the TG and 0.69 cm3 in the MG (p = 0.8). Lumpectomy volume was bigger in the TG (268 cm3) than MG (143 cm3); p < 0.004. There were no statistically significant differences when comparing margin status. Conclusions Lumpectomy guided with metallic marker after NAC allows lower excision of breast tissue without compromising margins. Having similar pathologic response between groups, skin tattoo leads to excise larger volume of tissue adding no benefits to the surgery. With the increasing pathologic complete responses to NAC, patients who are candidates for BCT after NAC will benefit from marking the tumor with metallic markers.