title: Localizing high-risk lesions for excisional breast biopsy: a comparison between radioactive seed localization and wire localization.
abstract: BACKGROUND
  Improved resolution and utilization of screening breast imaging has increased identification of nonpalpable high-risk lesions (HRL) and subsequent excisional breast biopsies (EBBs). Wire localization (WL), used most commonly for EBBs, may have shortcomings, including wire displacement, patient discomfort, limitations with incision planning and scheduling logistics. Radioactive seed localization (RSL) may overcome these drawbacks. The purpose of this study was to compare WL and RSL for EBBs for HRLs.
  
  
  METHODS
  All single-site EBBs for HRL performed by four breast surgeons were retrospectively reviewed over two consecutive 1-year periods. Patients with cancer on percutaneous core biopsy (CB) were excluded. Clinicopathologic information, operative time, targeted lesion retrieval rate, and upstage rate were collected.
  
  
  RESULTS
  A total of 324 EBBs for HRL were performed: 196 using WL and 128 using RSL. CB pathology was atypical hyperplasia in 56 % of WLs and 62 % of RSLs. The remaining pathologies were radial scar, papilloma, atypical papilloma or lobular carcinoma in situ. Mean age was 54 years. OR time was 27 ± 8 min for WL and 27 ± 7 min for RSL (p = 0.9). Upstage rate was 6 and 5 % for WLs and RSLs, respectively (p = 0.5). Targeted lesions were retrieved in 98 % of WL and 99 % of RSL (p = 0.5). SV was 37.2 ± 32.8 cm(3) and 25.7 ± 22.3 cm(3) for WL and RSL, respectively (p = 0.001).
  
  
  CONCLUSIONS
  RSL is comparable to WL for EBB of HRLs with similar OR times and upstage rates. SV is significantly decreased with RSL and may translate into improved cosmetic outcomes without sacrificing the diagnostic accuracy of the EBB.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee Womens Hospital of UPMC, Pittsburgh, PA, USA, diegoe@upmc.edu.
authors.forename: Emilia J
authors.initials: EJ
authors.lastname: Diego
authors.forename: Atilla
authors.initials: A
authors.lastname: Soran
authors.forename: Kandace P
authors.initials: KP
authors.lastname: McGuire
authors.forename: Corinne
authors.initials: C
authors.lastname: Costellic
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Johnson
authors.forename: Marguerite
authors.initials: M
authors.lastname: Bonaventura
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Ahrendt
authors.forename: Priscilla F
authors.initials: PF
authors.lastname: McAuliffe
mesh_terms: D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D057918:Fiducial Markers; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D007457:Iodine Radioisotopes; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D010212:Papilloma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals