Hookwire Guided Breast Conserving Surgery at Charlotte Maxeke Johannesburg Academic Hospital Breast Unit

Abstract

Background: Breast cancer is the most common cancer diagnosed in SA women and is one of the leading causes of cancer related deaths. Historically SA patients have presented with more advanced disease, however with improved radiological technology and screening, the number of impalpable cancers detected can be expected to increase. The current gold standard of treatment for impalpable cancers is BCS, which requires a method of pre-operative localization. Although newer technologies exist, WGL remains the only technology available for use at our institution. This study will aim to assess whether our practice of hookwire guided localization is in keeping with the current international standards of wire guided localization as well as assess factors that influence disease recurrence in these patients. Methods: Records of all patients undergoing hookwire guided excision of a breast carcinoma from the period of 1 January 2016 to 31 May 2024 were retrospectively reviewed using the Charlotte Maxeke Johannesburg Academic Hospital database. Results: A total of 119 patients were eligible for inclusion, with 55 patients meeting criteria as having had a malignancy excised via hookwire guidance. 76.7% of patients presented with a self-palpated mass, with 14.5% picked up at screening. The majority of those (50.9%) had primary NAC in order to downsize the lesion. On imaging the median size of masses was 19mm (IQR 12 – 28). Of patients undergoing WGL excision, 58.18% had received radiation during the study period. Of these, the median (IQR) number of days from surgery to radiation was 216 (175 – 357). Our rates of margin positivity/inadequacy and re-excision were 10.9% and 12.7% respectively. Our recurrence rate was 25.5%, higher than internationally acceptable standards. Having a TNBC compared to any other molecular subtype of cancer as well as having received NAC were the 2 variables found to significantly increase your chances of recurrence in this study. Conclusion: Patients undergoing hookwire guided BCS at CMJAH have acceptable rates of margin adequacy and re-excision when compared to international rates. Our study showed higher rates of recurrence when compared to international data, which is likely related to our inadequate access to timeous radiation following BCS. TNBC was shown to be a tumour specific factor that significantly increases your risk of recurrence.