Radioactive seed localization for nonpalpable breast lesions: Review of 1,000 consecutive procedures at a single institution

Lee J. McGhan, Sara C. McKeever, Barbara A. Pockaj, Nabil Wasif, Marina E. Giurescu, Heidi A. Walton, Richard J. Gray

Research output: Contribution to journalArticle

77 Scopus citations

Abstract

Introduction. 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.

Original languageEnglish (US)
Pages (from-to)3096-3101
Number of pages6
JournalAnnals of surgical oncology
Volume18
Issue number11
DOIs
StatePublished - Oct 1 2011

ASJC Scopus subject areas

  • Surgery
  • Oncology

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