Radioactive Seed Localization for Nonpalpable Breast Lesions: Review of 1,000 Consecutive Procedures at a Single Institution

Abstract

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.

ROLL versus RSL: toss of a coin?

“…However, the clinical relevance of this greater volume of excision remains questionable [6]. The two largest cohort series [7][8][9] each composed of approximately 1,000 patients supports the excellent outcomes achievable with RGL. The economical assessment has also demonstrated no disadvantage for RGL [7,[9][10][11].…”

“…The two largest cohort series [7-9] each composed of approximately 1,000 patients supports the excellent outcomes achievable with RGL. The economical assessment has also demonstrated no disadvantage for RGL [7,[9][10][11]. In view of the mounting evidence supporting RGL, the question no longer remains that of the previous decade in terms of deciding between RGL and WGL, but rather the clinically relevant issue has now progressed to deciding between ROLL and RSL in the treatment of non-palpable breast cancers.…”

“…Great variation exists in the radiation dose administered for ROLL, with the literature quoting anywhere between 5 and 123 MBq, [12,13] whilst for RSL it is between 3.7 and 10.7 MBq [14,15]. ROLL requires localization to be performed within 24 h of surgery due to the short 6 h half-life of 99m Tc-labelled colloid and RSL typically is performed 0-5 days prior to surgery [7,[14][15][16][17]. In the primary systemic therapy (PST) setting RSL can be undertaken several months before surgery because the half-life of 125 I is 60 days [18].…”

“…Concern has been raised at the issue of migration and subsequent loss of inserted seeds, but clinically relevant seed migration is rare and has been reported in \1 % of RSL procedures [19]. In the eight published studies [7,[14][15][16][17][18]20] on RSL, 2 studies [11,17] have failed to demonstrate 100 % successful intraoperative localization for RSL, with failure rates of 2 % [11] and 7.9 %. [17] The largest published series of RSL with 978 patients recorded a 100 % successful localization rate [7].…”

“…In the eight published studies [7,[14][15][16][17][18]20] on RSL, 2 studies [11,17] have failed to demonstrate 100 % successful intraoperative localization for RSL, with failure rates of 2 % [11] and 7.9 %. [17] The largest published series of RSL with 978 patients recorded a 100 % successful localization rate [7]. However, this remains an important issue requiring the establishment of a defined protocol to allow the safe handling of the seeds from intake in the nuclear medicine department, through sterilization, implantation, excision and removal.…”