Radioactive Seed Versus Wire-Guided Localization for Ductal Carcinoma in Situ of the Breast: Comparable Resection Margins

Abstract

Background There are currently two widely used methods for preoperative localization of ductal carcinoma in situ (DCIS) of the breast: wire-guided localization (WGL) and radioactive seed localization (RSL). Several studies compared these localization techniques in small cohorts. Objective The aim of this study was to compare the surgical resection margin status between RSL and WGL in a large national cohort of patients with DCIS. Patients and Methods We included patients from the Dutch Pathology Registry who underwent breast-conserving surgery for DCIS by either RSL (n = 1851) or WGL (n = 2187) between 2009 and 2019. Several clinicopathological characteristics were compared between these two groups, including resection margin status and number of re-excisions. Results Patients undergoing RSL were younger (p = 0.014) and were more often diagnosed with a large DCIS (p = 0.013), high grade DCIS (p < 0.001) and comedonecrosis (p < 0.001) compared with patients undergoing WGL. There was no significant difference in resection margin status between both groups (p = 0.089) and the number of re-excisions (p = 0.429). However, in case of re-excision, patients in the RSL group were more often treated with breast-conserving surgery (p = 0.029). Conclusion In this large national cohort study of patients with DCIS, we demonstrated that there was no difference in resection margin status between both procedures, or in the number of re-excisions, but patients in the RSL group were more often treated with breast-conserving therapy in case of a re-excision.

Exploiting the advantages of a wireless seed localization system that differentiates between the seeds: Breast cancer resection following neoadjuvant chemotherapy

“…Studies published that examine resection margin status in using wire‐guided localizations, RSL and SSR, Magseed® and RFID appear to be comparable or slightly improved over wire localization in obtaining negative margins on excision. 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 The technical difficulties in placing these seeds are similar to tissue marker placement, with the risk of seed migration, failure of seed placement, and inadvertent deployment of seed. 29 , 30 , 31 Given similar methods of deployment, it is not surprising that the similar technical difficulties result.…”

Usefulness of 3-Dimensional-Printed Breast Surgical Guides for Undetectable Ductal Carcinoma In Situ on Ultrasonography: A Report of 2 Cases

“…There are two generally used localization methods for DCIS: wire-guided and radioactive seeding localization. Although previous studies have reported the utility of these localization methods [ 4 5 ], the mean rate of re-excision associated with positive resection margins is 30% [ 6 ], and re-excision may lead to potential complications, as well as stress and additional costs, for patients. The sensitivity of MRI in detecting DCIS is higher than that of mammography or ultrasonography [ 2 3 ], and MRI is often performed for patients with DCIS.…”

“…Magnetic resonance imaging (MRI) is more sensitive than mammography or ultrasonography in detecting DCIS [ 2 3 ], and lesions are often not detectable using imaging modalities other than MRI. However, conventional localization methods, such as hook wire or radioactive seeding techniques, are generally performed under ultrasonographic or mammography guidance and are rarely performed with MRI guidance in current clinical practice [ 4 5 ].…”

Radioactive Seed Localization for Nonpalpable Breast Lesions: Systematic Review and Meta-Analysis

“…Reoperation rates were reported by 27 studies [29,35,[38][39][40][41][42][44][45][46][47][48][49][50][51][52][53][54][55][56][57][60][61][62][63][64][65][66][67]69,70], with a relevant heterogeneity (I 2 = 61%). The reoperation risk after conservative surgery with RSL was lower than with WGL (RR = 0.71, 95% CI = 0.61-0.84; 13884 patients; 27 studies; see Figure 8).…”