title: Radioactive seed localization for nonpalpable breast lesions: review of 1,000 consecutive procedures at a single institution.
abstract: BACKGROUND
  Radioactive seed localization (RSL) is an alternative to wire localization for nonpalpable breast lesions, with reported lower rates of positive surgical margins.
  
  
  METHODS
  A retrospective review of all consecutive RSL procedures performed at a single institution from 01/2003 through 10/2010 was conducted.
  
  
  RESULTS
  One thousand RSL breast procedures were performed in 978 patients. Indications for RSL included invasive carcinoma (52%), in situ carcinoma (22%), atypical hyperplasia (11%), and suspicious percutaneous biopsy findings (15%). A total of 1,148 seeds were deployed using image guidance, with 76% placed ≥1 day before surgery. Most procedures (86%) utilized one seed. A negative margin was achieved at the first operation in 97% of patients with invasive carcinoma and 97% of patients with ductal carcinoma in situ (DCIS). An additional 9% of patients with invasive carcinoma and 19% of patients with DCIS had close (≤2 mm) margins, and underwent re-excision. Sentinel lymph node biopsy was successfully performed in 99.8% of cases. Adverse events included 3 seeds (0.3%) not deployed correctly on first attempt and 30 seeds (2.6%) displaced from the breast specimen during excision of the targeted lesion. All seeds were successfully retrieved, with no radiation safety concerns. Local recurrence rates were 0.9% for invasive breast cancer and 3% for DCIS after mean follow-up of 33 months. There was no evidence of a learning curve.
  
  
  CONCLUSIONS
  RSL is a safe, effective procedure that is easy to learn, with a low incidence of positive/close margins. RSL should be considered as the method of choice for localization of nonpalpable breast lesions.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Phoenix, Arizona, USA.
authors.forename: Lee J
authors.initials: LJ
authors.lastname: McGhan
authors.forename: Sara C
authors.initials: SC
authors.lastname: McKeever
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Marina E
authors.initials: ME
authors.lastname: Giurescu
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Walton
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; 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; D006801:Humans; D007457:Iodine Radioisotopes; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010173:Palpation; D011379:Prognosis; D011877:Radionuclide Imaging; D012189:Retrospective Studies
chemical_list: D007457:Iodine Radioisotopes