Imaging Factors That Influence Surgical Margins After Preoperative ¹²⁵I Radioactive Seed Localization of Breast Lesions: Comparison With Wire Localization

Abstract

Objective The objective of this study was to compare the potential Influence of imaging variables on surgical margins after preoperative radioactive seed localization (RSL) and wire localization (WL) techniques. Materials and Methods A total of 565 women with 660 breast lesions underwent RSL or WL between May 16, 2012, and May 30, 2013. Patient age, lesion type (mass, calcifications, mass with associated calcifications, other), lesion size, number of seeds or wires used, surgical margin status (close positive or negative margins), and reexcision and mastectomy rates were recorded. Results Of 660 lesions, 127 (19%) underwent RSL and 533 (81%) underwent WL pre-operatively. Mean lesion size was 1.8 cm in the RSL group and 1.8 cm in the WL group (p = 0.35). No difference in lesion type was identified in the RSL and WL groups (p = 0.63). RSL with a single seed was used in 105 of 127 (83%) RSLs compared with WL with a single wire in 349 of 533 (65%) WLs (p = 0.0003). The number of cases with a close positive margin was similar for RSLs (26/127, 20%) and WLs (104/533, 20%) (p = 0.81). There was no difference between the RSL group and the WL group in close positive margin status (20% each, p = 0.81), reexcision rates (20% vs 16%, respectively; p = 0.36), or mastectomy rates (6% each, p = 0.96). Lesions containing calcifications were more likely to require more than one wire (odds ratio [OR], 4.44; 95% CI, 2.8–7.0) or more than one seed (OR, 7.03; 95% CI, 1.6–30.0) when compared with masses alone (p < 0.0001). Increasing lesion size and the presence of calcifications were significant predictors of positive margins, whereas the use of more than one wire or seed was not (OR, 0.9; 95% CI, 0.5–1.5) (p = 0.75). Conclusion Close positive margin, reexcision, and mastectomy rates remained similar in the WL group and RSL group. The presence of calcifications and increasing lesion size increased the odds of a close positive margin in both the WL and RSL groups, whereas the use of one versus more than one seed or wire did not.

Comparison of wire localization, radioactive seed, and Savi scout ® radar for management of surgical breast disease

“…In 2015, Sharek et al performed a retrospective cohort study of 232 cases comparing radioactive seed localization to wire localization and showed no differences in margins, re‐excision rate, reoperation rate, or cosmetic differences, while improving workflow for ease of scheduling biopsies and patient wait times. ii In 2016, Dryden et al retrospectively analyzed 565 women with similar results showing no difference in positive margin, re‐excision, and mastectomy rates in the wire compared with radioactive seed localization group . Zhang et al showed decreased costs, increased number of radiology appointments, and more rapid transport to the operating room for radioactive seed localization when compared to wire localization .…”

Beyond Wires and Seeds: Reflector-guided Breast Lesion Localization and Excision

“…Recently, 125 iodine ( 125 I) radioactive seed localization gained popularity by overcoming many of the disadvantages of wire localization; however, necessary radiation safety precautions limit implementation of radioactive seed localization at some institutions and outpatient centers (8)(9)(10)(11)(12)(13)(14).…”

Radioactive seed vs wire localization for nonpalpable breast lesions: A single institution review

“…Current studies support that RSL and WL are comparable in outcomes related to volume of tissue removed and margin positivity . In this single institution experience, there were no differences in complication rate, re‐excision rate, margin positivity on final pathology or volume of tissue removed between RSL and WL.…”