title: Radio-guided seed localization for breast cancer excision: an ex-vivo specimen-based study to establish the accuracy of a freehand-SPECT device in predicting resection margins.
abstract: OBJECTIVE
  Radioactive seed localization (RSL) uses an iodine-125 ((125)I) seed as a marker for tumour location. The (125)I seed is implanted into the tumour and enables intraoperative localization with a conventional gamma probe. However, specimen margins in relation to the (125)I seed are estimated on the basis of gamma-probe readings only. A novel device, freehand SPECT, is capable of measuring the distance from the resection plane to the (125)I seed. The aim of this feasibility study was to establish the accuracy of this device in predicting resection margins in ex-vivo tumour specimens excised with RSL guidance.
  
  
  METHODS
  In this feasibility study 10 patients with nonpalpable breast cancer scheduled for wide local excision with RSL were included. After surgery, the specimens containing the breast tumour and the (125)I seed were scanned using freehand SPECT. Measurements from five directions were taken and compared with distances measured by means of an ex-vivo computed tomographic (CT) scan and related to the pathology report.
  
  
  RESULTS
  The difference between freehand SPECT and CT measurements was 2.9±2.7 mm (mean±SD). One patient had a positive margin based on freehand SPECT. This specimen contained a focal irradical resection ventral of the tumour based on the pathology report. The smallest distance to the (125)I seed was 4 mm for the freehand SPECT and 5 mm for the CT scan.
  
  
  CONCLUSIONS
  Accurate ex-vivo measurements of the tumour resection margins using (125)I seeds and freehand SPECT are feasible in patients undergoing breast-conserving surgery. Incorporation of the freehand-SPECT device in RSL protocols may enable a real-time estimation of resection margins, which may be useful for surgeons to adjust resection planes.
authors: Departments of aNuclear Medicine bSurgical Oncology cPathology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Bas
authors: B
authors: Pouw
authors: Linda J
authors: LJ
authors: de Wit-van der Veen
authors: Jos A
authors: JA
authors: van der Hage
authors: Marie-Jeanne T F D
authors: MJ
authors: Vrancken Peeters
authors: Jelle
authors: J
authors: Wesseling
authors: Marcel P M
authors: MP
authors: Stokkel
authors: Renato A
authors: RA
authors: Valdés Olmos
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D007457:Iodine Radioisotopes; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D019736:Prostheses and Implants; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation*; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals