title: Safety and efficacy of radioactive seed localization with I-125 prior to lumpectomy and/or excisional biopsy.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of pre-operative I-125 radioactive seed localization (RSL) as an alternative to wire localization (WL).
  
  
  METHODS
  A waiver was granted by the institutional review board for this HIPAA compliant study. Review of 356 consecutive single site nonpalpable mammographic and ultrasound guided I-125 RSLs done between November 2011 and April 2012 was conducted. Preoperative mammograms and specimen radiographs were reviewed for seed-target distance, lesion location, and target/seed removal. During a brief surgical training period, 35 of 356 women had both RSL and wire localization (WL) of the same lesion. Chi-square and single sample t-tests were used to compare margin status and duration of procedures.
  
  
  RESULTS
  Of the 356 RSLs, 303 (85.1%) were performed ≥ 1 day before surgery. Mammographic guidance was used in 330 (93%) and ultrasound in 26 (7%). Mean seed to target distance was 1mm (range 0-20mm); all targeted lesions were retrieved. In 31 women in whom mammographic guidance was used for both RSL and WL, median procedure time was not significantly different (RSL 9.0 min; WL 7.0 min; p=0.91), and median seed migration distance was <1mm (range 0-15 mm). No difference was detected between margin status with RSL alone versus WL (p=0.40 and p=0.65 for positive and <1mm margins, respectively). Two adverse events occurred requiring an additional wire/surgery.
  
  
  CONCLUSIONS
  RSL ≥ 1 day before surgery is a safe effective procedure for pre-operative localization, with few adverse events and surgical outcomes comparable to those achieved with wire localization.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States. sungj@mskcc.org
authors.forename: Janice S
authors.initials: JS
authors.lastname: Sung
authors.forename: Valencia
authors.initials: V
authors.lastname: King
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Thornton
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Brooks
authors.forename: Charles W
authors.initials: CW
authors.lastname: Fry
authors.forename: Mahmoud
authors.initials: M
authors.lastname: El-Tamer
authors.forename: Lawrence T
authors.initials: LT
authors.lastname: Dauer
authors.forename: Edi
authors.initials: E
authors.lastname: Brogi
authors.forename: Jean M
authors.initials: JM
authors.lastname: St Germain
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D007457:Iodine Radioisotopes; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals
keywords: Breast intervention; Mammography