Eco-logistical comparison of non-radioactive seeds and the wire-guided localization for intraoperative detection of breast lesions

Stefan Lukac; Elena Leinert; Thorsten Kühn; Davut Dayan; Florian Ebner; Kerstin Pfister; Henning Schäffler; Kristina Veselinovic; Wolfang Janni; Michael Hiete; Visnja Fink

doi:10.1016/j.ejso.2024.108779

Eco-logistical comparison of non-radioactive seeds and the wire-guided localization for intraoperative detection of breast lesions

Eur J Surg Oncol. 2024 Oct 22;51(1):108779. doi: 10.1016/j.ejso.2024.108779. Online ahead of print.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany. Electronic address: stefan.lukac@uniklinik-ulm.de.
² Department of Obstetrics and Gynecology, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany.
³ Department of Obstetrics and Gynecology, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany; Department of Gynecology and Obstectrics, Die Filderklinik, Im Haberschlai 7, 70794, Filderstadt, Germany.
⁴ Institute of Theoretical Chemistry, Business Chemistry, Ulm University, Helmholtzstr. 18, 89081, Ulm, Germany.

PMID: 39489040
DOI: 10.1016/j.ejso.2024.108779

Abstract

Background: The current standard for the preoperative marking of non-palpable breast lesions is wire guided localization (WGL) which is associated with logistical efforts and patient discomfort. Non-radioactive seeds (NRS) recently challenged the use of WGL; but do they provide a better alternative from a logistical and environmental perspective?

Methods: WGL standard was compared with NRS available in Germany: Magseed®, Pintuition®, SAVI SCOUT ® and LOCalizer™ on a logistical and carbon-footprinting basis. In the logistical analysis the number of patient contacts with the healthcare system for lesion localization/removal and the number of breast punctures were evaluated in two different clinical scenarios (primary surgery and secondary surgery after neoadjuvant treatment). The carbon footprints of WGL and NRS (with exception of LOCalizer) were assessed based on their material compositions and operating energy in a streamlined approach.

Results: Application of NRS reduces the number of contacts by 33.3 % (2 vs. 3) in primary, by 50 % (2 vs. 4) in secondary surgery, and the number of breast punctures by 33.3 % (2 vs.3). Annual Germany-wide material- and energy-based carbon footprints of NRS (1.6-3.2 tons CO₂eq) are significantly lower in comparison to WGL (10.3 tons CO₂eq). The implementation of NRS would lead to a CO₂eq reduction by around 79 % compared to WGL.

Conclusions: The use of NRS for the localization of non palpable breast lesions is more favorable from the environmental and logistical perspective, when compared to WGL with possible benefits for patients, healthcare providers and the environment.

Keywords: Breast surgery; Carbon footprint; Logistics; Non-radioactive seeds; Wire-guided localization; Wireless localization.