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Annals of Surgical Oncology

, Volume 8, Issue 9, pp 711–715 | Cite as

Randomized Prospective Evaluation of a Novel Technique for Biopsy or Lumpectomy of Nonpalpable Breast Lesions: Radioactive Seed Versus Wire Localization

  • Richard J. Gray
  • Christopher Salud
  • Keoni Nguyen
  • Emilia Dauway
  • Jay Friedland
  • Claudia Berman
  • Eric Peltz
  • George Whitehead
  • Charles E. Cox
ORIGINAL ARTICLES

Abstract

Background: Standard wire localization (WL) and excision of nonpalpable breast lesions has several shortcomings.

Methods: Ninety-seven women with nonpalpable breast lesions were prospectively randomized to radioactive seed localization (RSL) or WL. For RSL, a titanium seed containing 125I was placed at the site of the lesion by using radiographical guidance. The surgeon used a handheld gamma detector to locate and excise the seed and lesion.

Results: Both techniques resulted in 100% retrieval of the lesions. Fewer RSL patients required resection of additional margins than WL patients (26% vs. 57%, respectively; P = .02). There were no significant differences in mean times for operative excision (5.4 vs. 6.1 minutes) or radiographical localization (13.9 vs. 13.2 minutes). There were also no significant differences in the subjective ease of the procedures as rated by surgeons, radiologists, and patients. All WLs were carried out on the same day as the excision, whereas RSL was performed up to 5 days before the operative procedure.

Conclusions: RSL is as effective as WL for the excision of nonpalpable breast lesions and reduces the incidence of pathologically involved margins of excision. RSL also reduces scheduling conflicts and may allow elimination of intraoperative specimen mammography. RSL is an attractive alternative to WL.

Key Words:

Wire localization Breast biopsy Radioguided surgery 

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Notes

References

  1. 1.
    Homer MJ. Transection of the localization hooked wire during breast biopsy. AJR Am J Roentgenol 1983; 141: 929–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Bristol JB, Jones PA. Transgression of localizing wire into the pleural cavity prior to mammography. Br J Radiol 1981; 54: 139–40.PubMedCrossRefGoogle Scholar
  3. 3.
    Davis PS, Wechsler RJ, Feig SA, et al. Migration of breast biopsy localization wire. AJR Am J Roentgenol 1988; 150: 787–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Homer MJ, Pile-Spellman ER. Needle localization of occult breast lesions with a curved-end retractable wire: technique and pitfalls. Radiology 1986; 161: 547–8.PubMedGoogle Scholar
  5. 5.
    Quercidella Rovere G, Benson JR, Morgan M, et al. Localization of impalpable breast lesions—a surgical approach. Eur J Surg Oncol 1996; 22: 478–82.CrossRefGoogle Scholar
  6. 6.
    Flanagan JJ, Conroy BG, Rubin G, et al. Short communication: prospective assessment of a new graduated hookwire for the localization of impalpable breast lesions. Br J Radiol 1996; 69: 341–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Jones MK, Vetto JT, Pommier RF, et al. An improved method of needle localized biopsy of nonpalpable lesions of the breast. J Am Coll Surg 1994; 178: 548–52.PubMedGoogle Scholar
  8. 8.
    Leeming R, Madden M, Levy L. An improved technique for needle localized biopsies of the breast. Surg Gynecol Obstet 1993; 177: 84–6.PubMedGoogle Scholar
  9. 9.
    Fornage BD. Recent advances in breast sonography. JBR-BTR 2000; 83: 75–80.PubMedGoogle Scholar
  10. 10.
    Gennari R, Galimberti V,De De Cicco C, et al. Use of technetium-99m-labeled colloid albumin for preoperative and intraoperative localization of nonpalpable breast lesions. J Am Coll Surg 2000; 190: 692–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Dauway EL, Saunders R, Friedland J, et al. Innovative Diagnostics for Breast Cancer: New Frontiers for the New Millennium Using Radioactive Seed Localization (Surgical Forum: 85th Annual American College of Surgeons Clinic Congress, vol 50). Chicago, IL: American College of Surgeons, 1999.Google Scholar
  12. 12.
    Hilaris BS. Techniques of interstitial and intracavitary radiation. Cancer 1968; 22: 745–51.PubMedCrossRefGoogle Scholar
  13. 13.
    Nath R, Melillo A. Dosimetric characteristics of a double wall 125I source for interstitial brachytherapy. Med Phys 1993; 20: 1475–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Cox CE, Haddad F, Bass S, et al. Lymphatic mapping in the treatment of breast cancer. Oncology 1998; 12: 1283–92.PubMedGoogle Scholar
  15. 15.
    Velanovich V,Lewis Lewis FR Jr, Nathanson SD, et al. Comparison of mammographically guided breast biopsy techniques. Ann Surg 1999; 229: 625–33.PubMedCrossRefGoogle Scholar
  16. 16.
    Cox CE, Reintgen DS, Nicosia SV, KuNN, Baekey P, Carey LC. Analysis of residual cancer after diagnostic breast biopsy: an argument for fine-needle aspiration cytology. Ann Surg Oncol 1995; 2: 201–6.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2001

Authors and Affiliations

  • Richard J. Gray
    • 1
  • Christopher Salud
    • 1
  • Keoni Nguyen
    • 1
  • Emilia Dauway
    • 1
  • Jay Friedland
    • 1
  • Claudia Berman
    • 1
  • Eric Peltz
    • 1
  • George Whitehead
    • 1
  • Charles E. Cox
    • 1
    • 2
  1. 1.Department of SurgeryComprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute at the University of South FloridaTampa
  2. 2.Breast Program, H. Lee Moffitt Cancer CenterTampa

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