Randomized Prospective Evaluation of a Novel Technique for Biopsy or Lumpectomy of Nonpalpable Breast Lesions: Radioactive Seed Versus Wire Localization

Abstract

RSL is as effective as WL for the excision of nonpalpable breast lesions and reduces the incidence of pathologically involved margins of excision. RSL also reduces scheduling conflicts and may allow elimination of intraoperative specimen mammography. RSL is an attractive alternative to WL.

A cosmesis outcome substudy in a prospective, randomized trial comparing radioguided seed localization with standard wire localization for nonpalpable, invasive, and in situ breast carcinomas

“…14,15 One randomized trial and 2 cohort studies have shown improved positive margin and reoperation rates with RSL compared with WL. 23,26,27 However, our prospective, multicentered randomized study comparing WL with RSL did not identify a difference in positive margin rate, reoperation rate, or specimen volume between WL and RSL. 30 In contrast to previous studies, our study included only patients with a preoperative diagnosis of in situ or invasive cancer, used a more conventional margin definition, and had an overall lower positive margin rate.…”

“…The surgeon has precise knowledge of the location of the target lesion, thereby improving incision placement. 25 Some studies of radioguided surgery have found lower positive margin rates and lower reoperation rates compared with WL, 23,26,27 and smaller volumes of excision. 28,29 These potential advantages of RSL over WL may translate into better cosmetic outcomes.…”

“…WL is also associated with high rates of positive margins, 20,21 resulting in high reoperation rates. 22,23 Furthermore, WL requires the surgeon to translate a 2-dimensional mammographic image into a 3-dimensional position of the wire within in the breast. 24 Without sufficient prior experience, this can be difficult, and can result in unnecessarily high volumes of normal breast tissue being excised, 24 thereby negatively impacting cosmesis.…”

Impact of radioguided occult lesion localization on the correct excision of malignant breast lesions: effect of histology and tumor size

“…Nevertheless, this technique is not without complications, which include infections, postpuncture bleeding, involuntary displacements of the harpoon, among others [15,16]. Besides the previously mentioned, the main inconvenience of this technique is the high incidence of residual disease at the biopsy site [8,9,[17][18][19].…”

Surgical margins in conservative surgery for breast cancer

“…Né anmoins, la faible ré solution de la technique rend, pour l'instant, difficile l'exploration de tumeurs de petite taille (moins de 1 cm) ; par ailleurs, la spé cificité n'est pas optimale, car les cellules inflammatoires peuvent ê tre marqué es [9,22]. Le repé rage radioguidé des lé sions occultes (ROLL), utilisant l'injection d'un radio-isotope dans la tumeur, ou encore une pastille d'iode 125, permettrait de faç on simple, rapide et sû re d'assurer l'exé rè se complè te de la lé sion [3,8]. Il pourrait occuper un rô le majeur dans l'obtention de marges saines dans le futur.…”