Radioactive seed localization breast biopsy and lumpectomy: can specimen radiographs be eliminated?
BACKGROUND
Wire localization (WL) is the current standard for surgical diagnosis of nonpalpable breast lesions. Many disadvantages inherent to WL are solved with radioactive seed localization (RSL). This trial investigated the ability of RSL to reduce the need for specimen radiographs and operating room delays associated with WL.


METHODS
A total of 134 women were entered onto an institutional review board-approved study. RSL was performed by placing a titanium seed containing.29 to 20 mCi of iodine-125 to within 1 cm of the suggestive breast lesion. The surgeon used a handheld gamma detector to locate and excise the iodine-125 seed and the lesion.


RESULTS
Specimen radiographs were eliminated in 98 (79%) of 124 patients. Surgical seed retrieval was 100% in 124 patients. No seed migration occurred after correct radiographical placement. A total of 26 (21%) of 124 patients required a specimen radiograph; 22 (85%) of these 26 were performed for microcalcifications.


CONCLUSIONS
After surgical removal, RSL can eliminate specimen radiographs when the radiologist accurately places the seed and the pathologist grossly identifies the lesion. If small microcalcifications are noted before surgery, then specimen radiographs may be necessary. RSL reduced requirements for specimen radiographs, decreased OR time, improved incision placement, and improved resections to clear margins.
Cox
Charles E
CE
Department of Surgery, Comprehensive Breast Cancer Program, H Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, Florida 33612, USA. coxce@moffitt.usf.edu
Furman
Ben
B
Stowell
Nicholas
N
Ebert
Mark
M
Clark
John
J
Dupont
Elizabeth
E
Shons
Alan
A
Berman
Claudia
C
Beauchamp
John
J
Gardner
Mary
M
Hersch
Marla
M
Venugopal
Priya
P
Szabunio
Margaret
M
Cressman
Joanne
J
Diaz
Nils
N
Vrcel
Vesna
V
Fairclough
Rita
R
D000328:Adult; D001706:Biopsy / Q000379:methods; D001918:Brachytherapy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D002114:Calcinosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D008327:Mammography / Q000379:methods; D015412:Mastectomy, Segmental; D012680:Sensitivity and Specificity; D014025:Titanium
D007457:Iodine Radioisotopes; D014025:Titanium