title: A multicentered, randomized, controlled trial comparing radioguided seed localization to standard wire localization for nonpalpable, invasive and in situ breast carcinomas.
abstract: BACKGROUND
  Studies suggest radioguided seed localization (RSL) yields fewer positive margins than wire-guided localization (WL). The goal of this study is to determine whether RSL is superior to WL.
  
  
  METHODS
  Women with confirmed invasive or ductal carcinoma in situ (DCIS) undergoing localization and breast conserving surgery were enrolled. Outcomes measured include positive margin and reoperation rates, specimen weight, operative and localization times, and surgeon and radiologist ranking of procedural difficulty.
  
  
  RESULTS
  Randomization was centralized, concealed, and stratified by surgeon with 153 patients in the WL group and 152 in RSL group. Localizations were performed using either ultrasound (70%) or mammographic guidance (30%). Pathology was either DCIS (18%) or invasive carcinoma (82%). Procedures were performed at 3 sites, by 7 surgeons. Only difference found for patient and tumor characteristics was more multifocal disease in RSL group. Using intention-to-treat analysis, there were no differences in positive margins rates for RSL (10.5%) and WL (11.8%), (P=.99) or for positive or close margins (<1 mm) (RSL 19% and WL 22%; P=.61). Mean operative time (minutes) was shorter for RSL (RSL 19.4 vs WL 22.2; P<.001). Specimen volume, weight, reoperation and localization times were similar. Surgeons ranked the seed technique as easier (P=.008), while radiologists ranked them similarly. Patient's pain rankings during wire localization were higher (P=.038).
  
  
  CONCLUSIONS
  In contrast to other trials positive margin and reoperation rates were similar for RSL and WL. However, for RSL operative times were shorter, and the technique was preferred by surgeons, making it an acceptable method for localization.
authors.affiliation: Department of Surgery, McMaster University, and St. Joseph's Healthcare, Hamilton, ON, Canada. lovricsp@mcmaster.ca
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lovrics
authors.forename: Charlie H
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: Nicole
authors.initials: N
authors.lastname: Hodgson
authors.forename: David
authors.initials: D
authors.lastname: McCready
authors.forename: Gabriela
authors.initials: G
authors.lastname: Gohla
authors.forename: Colm
authors.initials: C
authors.lastname: Boylan
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cornacchi
authors.forename: Michael
authors.initials: M
authors.lastname: Reedijk
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D016217:Ultrasonography, Mammary
chemical_list: D007457:Iodine Radioisotopes