Radiofrequency identification tag localization of nonpalpable breast lesions: a systematic review and meta-analysis.

OBJECTIVE: Preoperative localization of nonpalpable breast lesions has traditionally been performed by wire-guided localization (WGL). Radiofrequency identification (RFID) tag localization provides a less invasive alternative. The aim of this systematic review and meta-analysis was to investigate outcomes of RFID in terms of clinical utility, efficacy, and safety, also in comparison with WGL. MATERIALS AND METHODS: Following PRISMA guidelines, studies reporting on outcomes post-RFID tag localization, and comparing outcomes post-RFID tag localization and WGL were included. Positive margins and re-excision rates were estimated using meta-analyses of proportions. Further meta-analyses compared positive margins and re-excision rates between RFID tag localization and WGL. Random effects models were used. RESULTS: Nineteen studies involving 3,234 patients were included. Localization was performed for 497 benign and 2,741 malignant lesions. No study reported failure to retrieve an inserted RFID tag. Failed localization rates ranged from 0.0 to 60.7% across studies. After RFID tag localization, the pooled rate of positive margins was 12% (95% confidence interval (CI) 10-15%) and the pooled re-excision rate was 13% (95% CI 10-16%) in 14 and 16 studies, respectively; heterogeneity was high, I2 = 54.6% and 54.9, respectively. In three comparative studies, RFID tag localization was associated with significantly lower rates of positive margins than WGL, odds ratio (OR) 0.71 (95% CI 0.54-0.95), p = 0.021; however, no difference was observed in re-excision rates, OR 1.13 (95% CI 0.88-1.45), p = 0.346. Heterogeneity was low in both analyses, I2 = 0.0%. Moderate bias was reported in 16/19 studies, serious bias in 3/19. CONCLUSION: RFID tag localization provides an effective alternative to WGL. RELEVANCE STATEMENT: This systematic review shows that RFID tag localization of nonpalpable breast lesions provides a less invasive, safe and effective alternative to WGL-guided localization for selected patients, considering its higher cost. Randomized trials are required to elucidate the benefit of RFID tag localization over WGL and other non-wire localization techniques. KEY POINTS: The pooled rates of positive margins and re-excision after RFID tag localization were 12% and 13%, respectively. RFID localization had significantly lower positive margin rates than wire-guided localization (WGL); however, no difference was observed in re-excision rate. RFID localization provides an effective alternative to WGL and may be of benefit in selected patients. Randomized trials are required to better elucidate the benefit of RFIS tag localization.