Bracketing Localization in Breast-Conserving Therapy: Indications and Success Rates from a Single, High Volume, Breast Cancer Center


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Presentation: 9:04

Mentor: Alliric Willis, MD, General Surgery, Thomas Jefferson University Hospital


Background: Bracketing localization is a technique used to help localize large or multifocal lesions for breast-conserving therapy (BCT). To date, there are no guidelines for when bracketing localization should be used in clinical practice. Based on our experience, we aim to provide criteria that should prompt surgeons to consider bracketing.

Methods: A single institution retrospective chart review was performed on patients who underwent bracketing localization for BCT between January 2015 and September 2021. Lesion characteristics were recorded including the span of the lesion on imaging, the number of lesions, histology type on core needle biopsy and surgical specimen, margin status, and if re-excision was performed.

Results: 113 cases were analyzed. Imaging showed an average mass or calcification size of 5.0 cm (range 2.2-17.0 cm). Multifocal lesions represented 45% of cases. Ductal carcinoma in situ (DCIS) was a histological component in 64% of core needle biopsies and 76% of surgical specimens. Negative margins were achieved in 82% of patients on the first excision. Additional surgery was performed in 17% of patients. Invasive lobular carcinoma had the highest additional surgery rate at 23%, followed closely by DCIS with 23%. The additional surgery rate for multifocal cases was 14%. Negative margins with BCS were achieved in 96% of cases, including those with successful re-excision.

Conclusions: This descriptive study shows that bracketed localization was most often employed for patients with large lesion spans, multifocality, and a DCIS or invasive lobular component. While these characteristics are typically associated with higher rates of positive margins, our cohort’s rate of additional surgery was comparable to the national average for all BCS operations. These results argue that surgeon utilization of bracketed localization may be beneficial in these clinical scenarios.



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