Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 18:2023:4082501.
doi: 10.1155/2023/4082501. eCollection 2023.

Effectiveness of Carbon Localization for Invasive Breast Cancer: An Institutional Experience

Etienne El-Helou  1 , Christine Eddy  1 , Simona Picchia  2 , Carine Van de Merckt  2 , Magali Radermeker  2 , Michel Moreau  3 , Filip De Neubourg  1 , Denis Larsimont  4 , Isabelle Veys  1 , C Florin Pop  1
Affiliations

Effectiveness of Carbon Localization for Invasive Breast Cancer: An Institutional Experience

Etienne El-Helou et al. Breast J. .

Abstract

Introduction: The final oncological and aesthetic results of breast-conserving surgery (BCS) are influenced by the precise localization of breast cancer (BC) tumors and by the quality of the intraoperative margin assessment technique. This study aimed to assess the effectiveness of the carbon localization (CL) technique by determining the success rate of BC identification and the proportion of adequate complete resection of BC lesions.

Methods: We conducted a cross-sectional retrospective study of patients treated with primary BCS for invasive BC who underwent CL of their BC lesion at the Jules Bordet Institute between January 2015 and December 2017. Descriptive statistics with categorical and continuous variables were used. The success rate of tumor identification and the rate of adequate excision were calculated using the test of percentages for independent dichotomous data.

Results: This study included 542 patients with 564 nonpalpable BC lesions. The median pathological tumor size was 12 mm. Of these, 460 were invasive ductal carcinomas. Most of the tumors were of the luminal subtype. CL was performed using ultrasound guidance in 98.5% of cases. The median delay between CL and surgery was 5 days, with 46% of the patients having CL one day before surgery. The lumpectomy weighed 38 g on average, with a median diameter of the surgical sample at 6 cm and a median volume of 44 cm3 (6-369). One-stage complete resection was successfully performed in 93.4% of cases. In 36% of cases, an intraoperative re-excision was performed, based on intraoperative macroscopic pathological margin evaluation. The tumor was identified in 98.9% of cases in the breast surgical specimen.

Conclusion: This study demonstrated high success rates for BC tumor identification (99%) and one-stage complete resection (93.4%) after BCS and CL. These results show that CL is an effective, simple, and inexpensive localization technique for successful excision of BC lesions during BCS.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Procedural aspects of ultrasound-guided carbon localization of breast cancer lesions. The breast cancer (BC) lesion is first identified with the ultrasound (US) probe (a), and the dimensions of the tumor as well as the distance of the tumor to the skin and the position in relation to the nipple are measured (b). A syringe with an 18-gauge needle is inserted vertically (a) around the lesion usually with freehand US guidance (c), and approximately 1 mL of sterile 4% charcoal suspension is slowly injected, while the needle is withdrawn towards the skin entry point (d, f, g). Care is taken to avoid excessive carbon injection (g) just under the skin and unnecessary residual skin tattooing (h). A schematic representation (d) of the BC lesion and trace marking is made and added to the radiological report.
Figure 2
Figure 2
Surgical and pathological aspects of carbon localization in breast cancer tumors. During breast-conserving surgery, an incision is made over the carbon injection site (yellow arrow (a)) whenever possible. After carbon identification (b, c, e), the breast tumor lesion is excised with a macroscopic surgical margin (d). The breast surgical specimen is oriented (f, g) in a standardised way and sent to the pathology department for intraoperative gross pathological margin evaluation (h). The red arrow (h) shows the peritumoral carbon marking on the sliced surgical specimen.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kashyap D., Pal D., Sharma R., et al. Global increase in breast cancer incidence: risk factors and preventive measures. BioMed Research International . 2022;2022:1–16. doi: 10.1155/2022/9605439.9605439 - DOI - PMC - PubMed
    1. Siegel R. L., Miller K. D., Fuchs H. E., Jemal A. Cancer statistics. CA: A Cancer Journal for Clinicians . 2022;72(1):7–33. doi: 10.3322/caac.21708. - DOI - PubMed
    1. Ghoncheh M., Pournamdar Z., Salehiniya H. Incidence and mortality and epidemiology of breast cancer in the world. Asian Pacific Journal of Cancer Prevention . 2016;17(3):43–46. doi: 10.7314/apjcp.2016.17.s3.43. - DOI - PubMed
    1. Davey M. G., O’Donnell J. P. M., Boland M. R., et al. Optimal localization strategies for non-palpable breast cancers-A network meta-analysis of randomized controlled trials. The Breast . 2022;62:103–113. doi: 10.1016/j.breast.2022.02.004. - DOI - PMC - PubMed
    1. Li W., Li X. Development of intraoperative assessment of margins in breast conserving surgery: a narrative review. Gland Surgery . 2022;11(1):258–269. doi: 10.21037/gs-21-652. - DOI - PMC - PubMed