Radioactive seed localization for non-palpable breast cancer

Barentsz, Maarten W.; Bosch, Maurice A.A.J. van den; Veldhuis, Wouter B.; Diest, Paul J. van; Pijnappel, Ruud M.; Witkamp, Arjen J.; Verkooijen, Helena M.

doi:10.1002/bjs.9068

Cited by 66 publications

(33 citation statements)

References 37 publications

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“…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).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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Purpose To evaluate outcomes of Savi Scout (Cianna Medical, Aliso Viejo, Calif) reflector-guided localization and excision of breast lesions by analyzing reflector placement, localization, and removal, along with target excision and rates of repeat excision (referred to as re-excision). Materials and Methods A single-institution retrospective review of 100 women who underwent breast lesion localization and excision by using the Savi Scout surgical guidance system from June 2015 to May 2016 was performed. By using image guidance 0-8 days before surgery, 123 nonradioactive, infrared-activated, electromagnetic wave reflectors were percutaneously inserted adjacent to or within 111 breast targets. Twenty patients had two or three reflectors placed for bracketing or for localizing multiple lesions, and when ipsilateral, they were placed as close as 2.6 cm apart. Target and reflector were localized intraoperatively by one of two breast surgeons who used a handpiece that emitted infrared light and electromagnetic waves. Radiographs of the specimen and pathologic analysis helped verify target and reflector removal. Target to reflector distance was measured on the mammogram and radiograph of the specimen, and reflector depth was measured on the mammogram. Pathologic analysis was reviewed. Re-excision rates and complications were recorded. By using statistics software, descriptive statistics were generated with 95% confidence intervals (CIs) calculated. Results By using sonographic (40 of 123; 32.5%; 95% CI: 24.9%, 41.2%) or mammographic (83 of 123; 67.5%; 95% CI: 58.8% 75.1%) guidance, 123 (100%; 95% CI: 96.4%, 100%) reflectors were placed. Mean mammographic target to reflector distance was 0.3 cm. All 123 (100%; 95% CI: 96.4%, 100%) targets and reflectors were excised. Pathologic analysis yielded 54 of 110 malignancies (49.1%; 95% CI: 39.9%, 58.3%; average, 1.0 cm; range, 0.1-5 cm), 32 high-risk lesions (29.1%; 95% CI: 21.4%, 38.2%), and 24 benign lesions (21.8%; 95% CI: 115.1%, 30.4%). Four of 54 malignant cases (7.4%; 95% CI: 2.4%, 18.1%) demonstrated margins positive for cancer that required re-excision. Five of 110 radiographs of the specimen (4.5%; 95% CI: 1.7%, 10.4%) demonstrated increased distance between the target and reflector distance of greater than 1.0 cm (range, 1.1-2.6 cm) compared with postprocedure mammogram the day of placement, three of five were associated with hematomas, two of five migrated without identifiable cause. No related postoperative complications were identified. Conclusion Savi Scout is an accurate, reliable method to localize and excise breast lesions with acceptable margin positivity and re-excision rates. Bracketing is possible with reflectors as close as 2.6 cm. Savi Scout overcomes many limitations of other localization methods, which warrants further study. RSNA, 2017.

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Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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“…47 Concern over migration and subsequent loss of inserted seeds has been raised in RSL procedures, but clinically relevant seed migration is rare and has been reported in less than 1% of patients. 48 Another potential advantage of RSL is that 125 I emits 27-keV gamma rays compared with 140-keV rays emitted by the 99m Tc used in ROLL. This difference means that by altering the sensitivity of the gamma probe, differentiation between radioactive emissions from the localized lesion and the sentinel lymph nodes is possible, irrespective of the site of the primary lesion.…”

Section: Limitationsmentioning

confidence: 99%

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

et al. 2015

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Breast cancer is the most-common cancer among women worldwide, and over one-third of all cases diagnosed annually are nonpalpable at diagnosis. The increasingly widespread implementation of breast-screening programmes, combined with the use of advanced imaging modalities, such as magnetic resonance imaging (MRI), will further increase the numbers of patients diagnosed with this disease. The current standard management for nonpalpable breast cancer is localized surgical excision combined with axillary staging, using sentinel-lymph-node biopsy in the clinically and radiologically normal axilla. Wire-guided localization (WGL) during mammography is a method that was developed over 40 years ago to enable lesion localization preoperatively; this technique became the standard of care in the absence of a better alternative. Over the past 20 years, however, other technologies have been developed as alternatives to WGL in order to overcome the technical and outcome-related limitations of this technique. This Review discusses the techniques available for the surgical management of nonpalpable breast cancer; we describe their advantages and disadvantages, and highlight future directions for the development of new technologies.

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“…It is unclear whether factors such as lesion type (mass vs calcifications vs architectural distortion), lesion size, or method of preoperative localization influence the success of localization, with success determined by the incidence of single-step surgical excision of the targeted lesion [4, 6, 7, 10]. Therefore, we undertook this retrospective study to investigate whether lesion-specific and technical factors such as lesion type, lesion size, and the number of seeds or wires used in the localization procedure had an impact on the surgical margins.…”

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confidence: 99%

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

Dryden

Dogan

Fox

et al. 2016

American Journal of Roentgenology

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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.

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Radioactive seed localization for non-palpable breast cancer

Abstract: Available scientific evidence suggests that RSL is a safe and accurate technique for localization of non-palpable breast lesions.

Cited by 66 publications

References 37 publications

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

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

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

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

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Radioactive seed localization for non-palpable breast cancer

Abstract: Available scientific evidence suggests that RSL is a safe and accurate technique for localization of non-palpable breast lesions.

Cited by 66 publications

References 37 publications

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

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

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

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

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