Surgeon seniority and performance in breast-conserving surgery for non-palpable lesions: evidence from a multicenter study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Breast-conserving surgery (BCS) for non-palpable lesions is technically demanding, often performed by surgical trainees under supervision. Despite extensive literature evaluating localization techniques, only few studies have directly examined the role of surgeon seniority in determining surgical performance in this specific setting. We conducted a retrospective multicenter analysis (LOCALIZATION01 study, NCT05942105) including 3,195 patients who underwent BCS for non-palpable breast lesions between 2016 and 2024 across 12 Breast Units. Four localization techniques were used: wire-guided (WGL), radioguided occult lesion localization (ROLL), magnetic seed localization (MSL), carbon localization (CL). Outcomes included margin status, calculated resection ratio (CRR), operative time, and complications, stratified by surgeon seniority (attending vs resident). Most procedures were performed by attending surgeons (89.3%, n = 2,855) compared to residents (10.7%, n = 340). Margin positivity rates didn't differ significantly across localization techniques (e.g., ROLL 3.7% vs 2.3%, p = 0.30; MSL 9.4% vs 4.4%, p = 0.11, WGL 2.7% vs 5.9 p = 0.16, CL 0% vs 9.6% p = 0.10). Residents achieved better CRR in ROLL procedures (2.0, IQR 3, [1-47] vs 2.8, IQR 5, [1-78], p = 0.006), but had longer operative times, particularly with SLNB (e.g., MSL 60 min, IQR 31, [37-98] vs 55 min, IQR 20, [18-180], p = 0.02). Complication rates were low and comparable between groups. In a supervised setting, surgeon seniority doesn't significantly impact margin status, complication rates, or overall oncologic safety in BCS for non-palpable breast lesions. Localization methods with high reproducibility, such as ROLL and MSL, may mitigate the influence of surgical inexperience. These findings support the safe involvement of trainees in BCS under adequate supervision.
Source: The Breast
Authors: Fabio Corsi, Maria Luisa Gasparri, Sara Albasini, Matilde Pelizzola, Carlo Morasso, Giulia Armatura, Alessandro Asaro, Virginia Casati, Corrado Chiappa, Virginia Coli, Francesca Combi, Andrea Cuccaro, Angelica Della Valle, Raimondo Di Giacomo, Secondo Folli, Massimo Maria Grassi, Stefano Mancini, Ilaria Maugeri, Andrea Papadia, Laura Roveda, Francesca Rovera, Silvia Segattini, Adele Sgarella, Claudio Siani, Norma Stefenelli, Francesco Valenti, Simone Zanotti
Institutions: University of Milan, Istituti Clinici Scientifici Maugeri, Ospedale regionale di Lugano, Ente Ospedaliero Cantonale, Università della Svizzera italiana, Provincia Autonoma di Trento, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Aziende Socio Sanitarie Territoriale dei Sette Laghi, Azienda Ospedaliero-Universitaria di Modena, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, Policlinico San Matteo Fondazione, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Fondazione IRCCS Istituto Nazionale dei Tumori, Humanitas Gavazzeni
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,200
OpenAlex ID: W7128495206