30 Accuracy and Operational Efficiency of the MOLLI Marker Compared to Needle Localization in Breast Surgery

Background

Needle localization has traditionally been the standard for localizing impalpable breast lesions. Given potential workflow inefficiencies, patient discomfort, and concerns regarding accuracy, newer technologies such as the magnetic occult lesion localization instrument (MOLLI) were designed to offer potential accuracy and workflow advantages.

Methods

We conducted a retrospective analysis of breast lesion localizations performed by 4 surgeons practicing across both a community and an academic medical center. All MOLLI cases that were included were from the earliest adoption period, providing a real-world evaluation of the learning curve. The primary outcome assessed was the rate of missed biopsy clips, with a secondary outcome addressing operating room (OR) delays. Secondary outcomes included rates of operating room delays, defined as the percentage of operations that were delayed compared with their scheduled time, and total surgery duration.

Results

A total of 301 lesions were analyzed, with 143 undergoing MOLLI localization and 161 undergoing needle localization. While 100% of the MOLLI markers were retrieved, the MOLLI group trended toward fewer missed biopsy clips compared with needle localization (0.7% vs 3.7%; P = .172). Importantly, MOLLI cases demonstrated a markedly reduced OR delay rate compared with needle localization (60.1% vs 86.8%; P <.001), most likely due to the MOLLI markers being placed several days before surgery, while needle localization needed to be placed by radiology on the day of surgery. On average, the delay time was 48 minutes for a breast case. Surgery times were comparable between groups (121.9 ± 79.2 vs 119.2 ± 71.5; P = .767), despite accounting for the learning curve associated with adapting to a new localization device.

Conclusions

Early adoption of the MOLLI wireless localization system demonstrated a rapid learning curve for community- and academic-based surgeons, lower rates of missed clips, and a significant reduction in OR delays compared with needle localization.