This study aims to validate radioactive seed localization (RSL) as an alternative to wire localization (WL) in the operative excision of nonpalpable breast lesions. Eligible patients were recruited sequentially. A sample of 99 patients treated with WL was compared to the next 383 patients treated with RSL. Margins were considered "negative" if > or =2 mm from in-situ and invasive disease. Pain and convenience scores were recorded on a 10-point scale. Patient characteristics and histology were similar. The lesion and localization device were retrieved in all patients. Margins of the first specimen were negative in 73% of RSL patients, versus 54% of WL patients (p < 0.001). A second operation was required in 8% of RSL patients to achieve negative margins, versus 25% of WL patients (p < 0.001). Pain scores were not statistically different. However, the RSL group had higher convenience scores (p = 0.015). RSL is safe, effective, and compared to WL, reduces the rates of intraoperative re-excision and reoperation for positive margins by 68%. Patient satisfaction is improved with RSL. We strongly favor RSL over WL.

MRI does not accurately predict extent of disease in patients with extensive DCIS. In patients with MRI tumor size < or = 2 cm, MRI may assist in surgical planning. MRI results in patients with DCIS should be interpreted with caution; decision for mastectomy should not be made on MRI findings alone.

Introduction: Accelerated partial breast irradiation (APBI) using high-dose rate (HDR) balloon catheter breast brachytherapy following wide segmental resection of the breast has been shown to be equivalent to whole breast irradiation (WB-XRT) in the treatment of stage-I breast carcinoma. Because the majority of all breast cancers recur in the same quadrant as the original tumor, the advantages of this treatment compared with WB-XRT include concentration of radiation in the area where cancer is most likely to recur, shorter treatment duration, and greater patient acceptance. This study examined the rate of local/regional recurrence in patients diagnosed with stage-0 breast cancer, specifically ductal carcinoma in-situ (DCIS), following wide segmental resection of the breast and treatment with APBI using HDR balloon catheter breast brachytherapy.Methods: An IRB-approved, single-institution, retrospective chart review was conducted identifying 40 patients diagnosed with stage-0 breast cancer between March, 2004 and April, 2008 who were treated with wide segmental resection of the breast followed by APBI using HDR MammoSite™ balloon catheter breast brachytherapy. Outcome measures included rates of same-quadrant recurrence, ipsilateral second-primary occurrence, and regional recurrence.Results: Patient age ranged from 44 to 89 years (median = 69 years) with a median follow-up of 40 months (range: 16 to 60 months). All 40 patients had DCIS. One patient of 40 (2.5%) had DCIS with an additional focus of lobular carcinoma in-situ. 29 of 40 patients (72.5%) were estrogen receptor (ER) positive. Of these 29 patients, 17 were also progesterone receptor (PR) positive. One patient (2.5%) at 38 months experienced a local recurrence of DCIS with micro-invasion and a synchronous focus of invasive ductal carcinoma in a separate quadrant. This was subsequently treated with total mastectomy, sentinel lymph node mapping, and axillary lymph node dissection. No other patients experienced local-regional recurrence or ipsilateral primary breast cancer occurrence.Conclusion: Patients with DCIS can be effectively treated with APBI/HDR balloon catheter breast brachytherapy following wide segmental breast resection. The rate of local-regional recurrence was 2.5% at a median follow-up time of 40 months. This is consistent with that of patients with DCIS treated with wide segmental breast resection followed by WB-XRT. Long-term follow-up will be required to assure these rates remain favorable. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2116.

Introduction: Molecular breast imaging (MBI), also referred to as breast specific gamma imaging (BSGI), utilizes nuclear medicine imaging with technetium 99-sestamibi to demonstrate metabolic activity of breast tissue. A focused gamma camera is used to assist in detecting lesions concerning for malignancy based on abnormal radiotracer uptake. MBI is performed with the patient in a sitting position and requires less breast compression than mammography. MBI is safe for patients with implanted metallic devices and renal disease. Facility charge for MBI is approximately $600 vs. $2500 for magnetic resonance imaging (MRI).Methods: IRB approval was obtained prior to study initiation. Forty four (44) patients underwent MBI with technetium 99-sestamibi after mammography and or ultrasound detected abnormalities for which biopsy was recommended.Results: Forty four (44) women ranging in age from 28 to 82 (median age 52) were found to have abnormal mammogram and or ultrasound findings requiring image guided biopsy. Prior to biopsy, MBI was performed. Fifteen MBI's were interpreted as demonstrating areas concerning for malignancy. Nine of the 44 patients (20.5%) demonstrated malignancy on biopsy pathology. Eight of these nine patients had positive MBI findings concerning for malignancy (88.9%). The patient whose MBI did not demonstrate findings consistent with malignancy had two sites of DCIS. The positive predictive value of these results was 53.3% and the negative predictive value was 96.55%.Conclusions: MBI shows promise in evaluating patients with abnormal mammogram or ultrasound findings. MBI is available at a much lower cost than MRI ($600 vs. $2500), which would have resulted in savings of $83,600 in this study alone. MBI can be used in patients for whom MRI is not an option such as claustrophobic patients, patients with renal disease limiting use of gadolinium contrast and patients who for other reasons such as body habitus and implanted metallic devices are not candidates for MRI. Further studies evaluating MBI are warranted to determine what role it may play in providing additional diagnostic data about patients with abnormal mammograms or ultrasounds. The role of MBI in settings where breast MRI is not available, is not technically feasible or is not an option due to cost also warrants further evaluation. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5014.