The use of radioactive iodine-125 seed localization in patients with non-palpable breast cancer: a comparison with the radioguided occult lesion localization with 99m technetium.

Abstract

BACKGROUND:

Radioactive Seed Localization with a radioactive iodine-125 seed (RSL) and Radioguided Occult Lesion Localization with 99mTechnetium colloid (ROLL) are both attractive alternatives to wire localization for guiding breast conserving surgery (BCS) of non-palpable breast cancer. The aim of this study was to evaluate and compare the efficacy of RSL and ROLL.

METHODS:

We retrospectively analyzed 387 patients with unifocal non-palpable ductal carcinoma in situ (DCIS) or invasive carcinoma treated with BCS at the Netherlands Cancer Institute. In total 403 non-palpable lesions were localized either by RSL (N = 128) or by ROLL (N = 275). Primary outcome measures were positive margins and re-excision rates; the secondary outcome measure was weight of the specimen.

RESULTS:

Pre-operative mammography or ultrasound showed similar sizes of DCIS and invasive tumours in both RSL and ROLL groups. In the RSL group, more lesions were DCIS (58%) than in the ROLL group, where 32% of the lesions were pure DCIS. The proportions of focally positive margins (11% vs. 10%) and more than focally positive margins (9% vs. 9%) were comparable between the RSL and the ROLL group, resulting in the same re-excision rate in both RSL and ROLL groups (9% vs. 10%). For DCIS lesions, the specimen weight was significantly lower in the RSL group than in the ROLL group after adjusting for tumour size on mammography (12 g; 95% CI 2.6-21).

CONCLUSION:

Margin status and re-excision rates were comparable for RSL and ROLL in patients with non-palpable breast lesions. Because of the significant lower weight of the resected specimen in DCIS, the feasibility of position verification of the I-125 seed and more convenient logistics, we favour RSL over ROLL to guide breast-conserving therapy.

• Authors: M E M van der Noordaa, K E Pengel, E Groen, E van Werkhoven, E J Th Rutgers, C E Loo, W Vogel, M J T F D Vrancken Peeters
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 41 Issue 4 Pg. 553-8 (Apr 2015) ISSN: 1532-2157 [Electronic] England
• PMID: 25707349 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.

Chemical References

• Iodine Radioisotopes
• Radiopharmaceuticals
• Technetium Tc 99m Aggregated Albumin
• technetium Tc 99m nanocolloid

Topics

• Adult
• Aged
• Breast Neoplasms (diagnostic imaging, pathology, surgery)
• Carcinoma, Ductal, Breast (diagnostic imaging, pathology, surgery)
• Carcinoma, Intraductal, Noninfiltrating (diagnostic imaging, pathology, surgery)
• Female
• Humans
• Iodine Radioisotopes
• Mammography
• Mastectomy, Segmental
• Middle Aged
• Neoplasm, Residual
• Radionuclide Imaging
• Radiopharmaceuticals
• Reoperation
• Retrospective Studies
• Technetium Tc 99m Aggregated Albumin
• Tumor Burden
• Ultrasonography, Mammary