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

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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 2011

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Seeds
Breast
Carcinoma, Intraductal, Noninfiltrating
Carcinoma
Sentinel Lymph Node Biopsy
Learning Curve
Carcinoma in Situ
Ambulatory Surgical Procedures
Hyperplasia
Radiation
Biopsy
Safety
Recurrence
Incidence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Radioactive seed localization for nonpalpable breast lesions : Review of 1,000 consecutive procedures at a single institution. / McGhan, Lee J.; McKeever, Sara C.; Pockaj, Barbara A; Wasif, Nabil; Giurescu, Marina E.; Walton, Heidi A.; Gray, Richard J.

In: Annals of Surgical Oncology, Vol. 18, No. 11, 10.2011, p. 3096-3101.

Research output: Contribution to journalArticle

McGhan, Lee J. ; McKeever, Sara C. ; Pockaj, Barbara A ; Wasif, Nabil ; Giurescu, Marina E. ; Walton, Heidi A. ; Gray, Richard J. / Radioactive seed localization for nonpalpable breast lesions : Review of 1,000 consecutive procedures at a single institution. In: Annals of Surgical Oncology. 2011 ; Vol. 18, No. 11. pp. 3096-3101.
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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.",
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N2 - 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.

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