Radioactive Seed Localization of Nonpalpable Breast Lesions in an Academic Comprehensive Cancer Program Community Hospital Setting

Abstract

Wire localized excision (WLE) has been a long-standing method for localization of nonpalpable breast lesions. Disadvantages of this method include difficulty locating the wire tip in relation to borders of the lesion, imprecise placement of the wire, and the need to place the wire shortly before scheduled surgery. These shortcomings may lead to a high positive margin rate requiring re-excision to obtain clear margins for breast cancer. Radioactive seed localized excision (RSLE) of nonpalpable breast lesions has been advocated as a safe and effective alternative to WLE. The primary endpoints of the study were to compare re-excision rates between WLE and RSLE of nonpalpable breast lesions and to determine if there were any differences in volume of tissue removed. One hundred three patients were included in a retrospective review of localized breast excisions done by a single surgeon. Forty-four patients underwent WLE between April 2007 and February 2009. Fifty-nine patients underwent RSLE between September 2009 and January 2012. Margins were considered to be clear if at least 1 mm of normal tissue was obtained from the circumferential periphery of the lesion in question. RSLE resulted in a re-excision rate of 17 versus 55 per cent re-excision rate for wire localization ( P < 0.001). Excision volume was greater for patients having wire localization ( P = 0.074). RSLE is an effective technique for excision of non-palpable breast lesions in the community setting. This technique allows for accurate localization and appears to allow for smaller volume of tissue to be excised.

Comparative Evaluation of Iodine-125 Radioactive Seed Localization and Wire Localization for Resection of Breast Lesions

“…Analysis of 254 consecutive lesions excised with 125 I radioactive seed localization showed the technique to be safe and easy, with no serious complications. We observed a rate of seed misplacement, defined as more than 1 cm from target on postprocedure mammography, of 2.4% (6 of 254), similar to other reports [29],[35],[36], and only 4 women required subsequent wire localization for lesion removal, a very low rate that confirms the stability of the seed after positioning into the breast [35]. There was no difference in technical success when comparing stereotactic and sonographic guidance for both RSL and WL.…”

“…Logically, observed re-excision rates in our study were also very low, at 6.1% and 6.4%, respectively, for RSL and WL, slightly greater to the 3% rates reported by Diego et al [16] after either technique; Sharek et al [30] reported higher reintervention rates, 21% for RSL and 26% for WL, but again there was no advantage of one technique over the other. Other studies reported decreased reintervention rates after RSL [23,24,28,29]. Perhaps it is in part the very low reintervention rates reported in this study for the WL cohort that make it difficult to show improved performance with RSL.…”

“…Ahmed and Douek [23], in their metaanalysis, calculated an improved risk ratio for margins of 0.51 with RSL compared with WL. Pouw et al [24] reported improved reoperation rates, from 56% with WL to 42% with RSL, and other authors have made similar observations [21,28,29]. Other authors did not observe these statistical differences between RSL and WL in terms of reintervention rates [3,17,18,30,31].…”

“…Again, some disparities exist regarding a possible improvement in the volume of tissue excised with RSL compared with WL, with some reporting no significant difference [3,11,18,23,29,30], whereas others [16] report smaller excised volumes with RSL. Finally, there is general agreement that, with RSL, marked improvements in operation times can be achieved [3,18], with reports of improved time allocation, scheduling, and biopsy wait times [30,32].…”

Radioactive seed localization compared with wire-guided localization of non-palpable breast carcinoma in breast conservation surgery— the first experience in the United Kingdom

“…12,13 RSL has been shown to be comparable to ROLL with regard to margin status and re-excision rates and has been shown to be equivalent or superior when compared with margin status and re-excision rates for GWL WLE. [14][15][16] A review of 100 consecutive procedures at a single institution by Meghan et al has shown RSL to be an effective safe procedure with just 3 seeds (0.3%) not being deployed correctly on first attempt. 17 RSL has also been shown to expose patients and staff to only minimal levels of radiation.…”