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

From the Departments of Surgery (RJG, CS, KN, ED, JF, EP, GW, LB, CEC) and Radiology (CB), Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, Florida.

Correspondence: Address correspondence and reprint requests to: Charles E. Cox, MD, Director, Breast Program, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612; Fax: 813-979-9779.

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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