Radioactive seed localization of nonpalpable breast lesions is better than wire localization

doi:10.1016/j.amjsurg.2004.06.023

The American Journal of Surgery

Volume 188, Issue 4, October 2004, Pages 377-380

Presented at the Fifth Annual Meeting of the American Society of Breast Surgeons, March 31–April 4, 2004, Las Vegas, Nevada

https://doi.org/10.1016/j.amjsurg.2004.06.023 Get rights and content

Abstract

Background

The current study sought to validate radioactive seed localization (RSL) as an alternative to wire localization (WL) to facilitate the operative excision of nonpalpable breast lesions.

Methods

One hundred consecutive patients underwent preoperative WL and the next 100 RSL. Margins were considered negative if ≥2 mm from in situ and invasive disease.

Results

RSL resulted in 100% retrieval of the seeds and lesions. Sixty-eight percent of patients underwent RSL at least 1 day before surgery. RSL resulted in a 35% relative improvement in the rate of negative margins in the first specimen (P = 0.01) and a 62% relative improvement in the rate of reoperation for positive margins (P = 0.01). The sentinel lymph node (SLN) identification rate was 100% in both groups.

Conclusions

RSL is effective and safe, and this procedure significantly improved the rate of negative margins in the first specimen and the rate of reoperation for positive margins compared to WL. We highly favor RSL over WL.

Section snippets

Materials and methods

The study was approved by the institutional review board and informed consent was obtained from all patients. Two hundred consecutive patients undergoing breast procedures after radiologic localization were included. The first 100 patients underwent WL and the subsequent 100 patients underwent RSL. Both WL and RSL were preferentially conducted under ultrasound guidance and were performed under mammographic guidance if the lesion was not sonographically visible. Patients underwent WL using a

Results

WL and RSL each resulted in the retrieval of the localization device and lesion in all operations. The histology of the lesions in each group was similar (Table 1). Excisional biopsy in 19 RSL patients and 26 WL patients was prompted by a percutaneous biopsy with findings of atypia, papillary lesion, or discordance, except for 1 patient who could not lie prone for stereotactic biopsy. Of these, 2 RSL patients (5%) and 5 WL patients (19%) were found to have malignancy on final histology. Risk

Comments

WL is a well-established, widely used procedure for the preoperative localization of nonpalpable breast lesions. The difficulties with WL are also well-established and widely known. An optimal localization procedure would provide precise identification of the site of the lesion and allow feedback on the width of all margins to the surgeon in order to limit the rate of positive margins. It would also be painless and convenient for patients and have no impact on operative suite scheduling. By

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Cited by (138)

Comparison of 3 Different Systems for Non-wire Localization of Lesions in Breast Cancer Surgery
2023, Clinical Breast Cancer
Localizing breast lesions by marking tumors and their detection using probes during surgery is a common part of clinical practice. Various nonwire localization systems were intended to be compared from different perspectives.
Various measurement experiments were performed. Localization techniques, including radioactive seed (RSLS), magnetically guided (MGLS), or radar (SLS), were compared in signal propagation in water and tissue environments, signal interference by surgical instruments, and the practical experience of surgeons. Individual experiments were thoroughly prospectively planned.
The RSLS signal was detectable at the largest evaluated distance, ie, 60 mm. The SLS and MGLS signal detection was shorter, up to 25 mm to 45 mm and 30 mm, respectively. The signal intensity and the maximum detection distance in water differed slightly depending on the localization marker orientation to the probe, especially for SLS and MGLS. Signal propagation in the tissue was noted to a depth of 60 mm for RSLS, 50 mm for SLS, and 20 mm for MGLS. Except for the expected signal interferences by approaching surgical instruments from any direction for MGLS, the signal interruption for RSLS and SLS was observed only by inserting instruments directly between the localization marker and probe. Moreover, the SLS signal interference by instrument touch was noted. Based on surgeons' results, individual systems did not differ significantly for most measurement condition settings.
Apparent differences noted among localization systems can help experts choose an appropriate system for a specific situation or reveal small nuances that have not yet been observed in clinical practice.
Radioactive and non-radioactive seeds as surgical localization method of non-palpable breast lesions
2022, Revista Espanola de Medicina Nuclear e Imagen Molecular
El diagnóstico cada vez más precoz de la enfermedad mamaria y el uso más extendido del tratamiento sistémico primario conlleva en la práctica clínica un creciente número de cirugías de lesiones mamarias no palpables (LMNP).
La cirugía conservadora de la mama requiere a menudo la utilización de un procedimiento de localización preoperatorio guiado por imagen, en el cual se coloca un dispositivo en el interior de la lesión a extirpar para guiar al cirujano durante la cirugía. Se trata de pacientes con tumores pequeños, no palpables, detectados en la mamografía de cribado poblacional, casos con significativa reducción de la lesión tras la quimioterapia neoadyuvante e incluso en ocasiones es necesario el marcaje de adenopatías axilares previo al tratamiento sistémico.
Durante décadas, la localización con arpón ha sido el estándar para el marcaje preoperatorio en cáncer de mama. Debido al componente externo del arpón, se debe extremar el cuidado de no alterar su posición antes de la cirugía, por lo que se coloca horas antes de la cirugía y conlleva una compleja y limitada flexibilidad de programación quirúrgica.
La ecografía intraoperatoria subsana este inconveniente, pero tiene la limitación de que únicamente va a poder realizarse en aquellas LMNP que tienen traducción ecográfica. La técnica Radioguided Ocult Lesión Localization (ROLL), si bien es otra alternativa adoptada por muchas instituciones, no está exenta de complicaciones, entre las que destaca la posibilidad de difusión del radiotrazador hacia el tejido sano.
Para solventar estos inconvenientes, más recientemente, se comenzaron a utilizar las semillas radiactivas de ¹²⁵I. Posteriormente, gracias a los avances tecnológicos, han surgido alternativas de semillas no radiactivas como los reflectores de radar, las semillas magnéticas y los marcadores por radiofrecuencia. Estos dispositivos de localización se pueden colocar días antes de la cirugía, evitando los problemas y complicaciones relacionados con los arpones. Se introducen por vía percutánea y se identifican intraoperatoriamente utilizando una sonda detectora.
No existe un método de localización intraoperatoria perfecto para la exéresis de las LMNP, pero afortunadamente disponemos de múltiples técnicas con distintas ventajas e inconvenientes que deben valorarse y adecuarse a los recursos propios del centro, el tipo de cirugía y siempre en beneficio del paciente.
The increasingly early diagnosis of breast disease and the more widespread use of primary systemic therapy leads to an increasing number of surgeries for non-palpable breast lesions (NPL) in clinical practice.
Breast-conserving surgery often requires the use of an image-guided preoperative localization procedure, in which a device is placed within the lesion to be removed to guide the surgeon during surgery. These are patients with small, non-palpable tumors detected in the population screening mammogram, cases with significant reduction of the lesion after neoadjuvant chemotherapy and sometimes it is even necessary to mark axillary lymphadenopathies prior to systemic treatment.
For decades, wire localization has been the standard for preoperative marking in breast cancer. Due to the external component of this device, extreme care must be taken not to alter its position before surgery, which is why it is placed hours before surgery and entails complex and limited flexibility in surgical programming.
Intraoperative ultrasound improves this drawback but has the limitation that it can only be performed in those NPLs that have ultrasound translation. The Radioguided Occult Lesion Localization (ROLL) technique, although it is another alternative adopted by many institutions, is not without complications, among which the possibility of diffusion of the radiotracer into healthy tissue stands out.
To overcome these problems, more recently, ¹²⁵I radioactive seeds began to be used. Subsequently, thanks to technological advances, non-radioactive seed alternatives such as radar reflectors, magnetic seeds and radio frequency markers have emerged. These locating devices can be placed days before surgery, avoiding wire-related problems and complications. They are introduced percutaneously and identified intraoperatively using a detector device.
There is no perfect intraoperative localization method for NPL excision, but fortunately, we have multiple techniques with different advantages and disadvantages that must be assessed and adapted to the center's own resources, the type of surgery, and always to the benefit of the patient.
Use of wire-guided and radio-guided occult lesion localization for non-palpable breast lesions: A systematic literature review and meta-analysis of current evidence
2022, Asian Journal of Surgery
Breast cancer screening has seen an increase in the detection of non-palpable breast lesions. Wire guided localisation (WGL) and Radio-guided occult lesion localisation (ROLL) are well established modalities of localisation of non-palpable breast lesions in the UK. We aimed to compare the outcomes of WGL and ROLL in this updated meta-analysis. We searched Cochrane Central Register of Controlled Trials (CENTRAL), and LILACS using free text search words as well as relevant MESH-terms. We also searched Medline (02/03/2021), Embase and registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Outcomes considered were re-excision rates, margin involvement, specimen volume and weight, accurate localisation of lesions and operative time. We assessed the risk of bias in included studies and performed random effects meta-analyses using Review Manager (version 5.3). Heterogeneity was estimated using the I²-statistic. Nine included studies enrolled 1096 patients undergoing localization in breast surgery (534 in WGL and 562 in ROLL). There was a statistically significant benefit in favour of ROLL for non-involved resection margins (OR 0.60; 95% CI, 0.44–0.97); based on seven studies. Nine trials assessed operative time favouring ROLL (OR 1.95; 95% CI, 0.27–3.63). No significant difference in re-excision rates was reported (OR 1.42; 95% CI, 0.83–2.43) based on seven studies. Current evidence favourably supports ROLL, compared to WGL, with respect to margin involvement, localisation and operative time in the treatment of non-palpable breast lesions.
A Review of Options for Localization of Axillary Lymph Nodes in the Treatment of Invasive Breast Cancer
2019, Academic Radiology
Invasive breast cancer is a common disease, and the most common initial site of metastatic disease are the axillary lymph nodes. As the standard of care shifts towards less invasive surgery in the axilla for patients with invasive breast cancer, techniques have been developed for axillary node localization that allow targeted dissection of specific lymph nodes without requiring full axillary lymph node dissection. Many of these techniques have been adapted from technologies developed for localization of lesions within the breast and include marker clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive seeds, magnetic seeds, radar reflectors, and radiofrequency identification devices.The purpose of this article is to summarize these methods and describe benefits and drawbacks of each method for performing localization of lymph nodes in the axilla.
Comparison of Radioactive Seed Localized Excision and Wire Localized Excision of Breast Lesions: A Community Hospital's Experience
2019, Clinical Breast Cancer
Most data comparing wire localized excision (WLE) and radioactive seed localized excision (RSLE) derive from academic institutions with limited data from community hospitals. This study aimed to compare positive margin rates between WLE and RSLE and to determine if there were any differences in specimen volume and operation time.
A retrospective cohort study was conducted on patients who underwent WLE or RSLE at a Canadian community hospital. Group characteristics were compared as appropriate. Multivariable logistic regression was used determine if the localization techniques were independently associated with having a positive margin. Statistical significance was set as P < .05.
The cohort consisted of 747 (WLE) and 577 (RSLE) patients. Both groups had similar mean age, mean tumor (invasive and ductal carcinoma-in-situ) size, histologic grade distribution, presence of lymphovascular invasion, and extensive intraductal component, nodal status, and hormone receptor and HER2 status. Compared to WLE, patients who underwent RSLE had significantly lower invasive positive margin rates (8.1% vs. 12.3%, P = .03), shorter operation time (39.5 minutes vs. 68.7 minutes, P = .0001), and smaller surgical specimens (21.4 cm³ vs. 30.2 cm³, P = .008). Ductal carcinoma-in-situ positive margin rates were not different between the groups. However, the localization technique was not independently associated with having a positive margin (odds ratio = 1.55; 95% confidence interval, 0.99-2.44).
RSLE led to a shorter operation time and smaller surgical specimens compared to WLE, but there was no difference in positive margin rates. RSLE is an effective technique to excise nonpalpable breast lesions in the community setting.
Advances in Breast Localization Techniques: An Opportunity to Improve Quality of Care and Patient Satisfaction
2018, Seminars in Roentgenology

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Scientific paperRadioactive seed localization of nonpalpable breast lesions is better than wire localization

Abstract

Background

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Comments

J Am Coll Surg

Am J Surg

J Am Coll Surg

Localization of impalpable breast lesions—a surgical approach

Eur J Surg Oncol

Short communication: prospective assessment of a new graduated hookwire for the localization of impalpable breast lesions

Br J Radiol

An improved method of needle localized biopsy of nonpalpable lesions of the breast

J Am Coll Surg

Scientific paper
Radioactive seed localization of nonpalpable breast lesions is better than wire localization