Comparison of three new wireless non-radiation techniques for localisation of non-palpable breast cancer - An updated systematic review and pooled meta-analysis

With a logistical advantage, new wire-free procedures have simplified implantation and retrieval of non-palpable breast cancers with enhanced clinical outcomes. The objective of current systematic review and meta-analysis is to assess the clinical effectiveness between three new wireless non-radiation localisation techniques, such as Magseed, Radiofrequency identification TAG and Savi-scout reflector from published literature over the last 3 years. The study, following PRISMA guidelines, identified 26 studies from 2020 to 2022 involving 6275 innovative agents, analyzing three groups. Statistical analysis using Medcalc software showed a pooled positive margin rate of 12.28% (95% CI, 10 -15%) and a re-excision rate of 11.29% (95%CI, 9 -14%) for all three wireless group combined whereas studies that compare them with wire showed higher positive margin rate of 14.87% (95% CI, 12-18%) and re-excision rate of 16.23% (95% CI, 14-18%) for wire-guided localisation. Compared with odd's ratio, there was no statistical significance for margin involvement between WGL and novel agents OR 0.870 95% CI (0.707 -1.071); z=-1.310 p=0.190; however, there was a statistical significance with fewer re-excision for wireless group OR 0.791; 95% CI (0.648 – 0.965); z=-2.309 p=0.021 (Fig.6). In sub group analysis with kruskal-wallis test, there was no statistical significance between each group for both margin-positivity (p=0.797; Chi2 0.605) and re-excision rates (p=0.464; chi21.535). Consolidated insertion and retrieval success for wireless group were 98.13% and 99.13% respectively whereas WGL had a similar retrieval success rate of 99.63%. To establish the best localisation approach, future prospective randomised trials will be required to assess quantitative cost-effective analyses.