Abstract
Purpose: To compare the positive margin rates for women with nonpalpable breast tumors who underwent breast conserving surgery with wire localization versus those with radioactive seed localization in a small community hospital and to compare the size of the corresponding breast specimens.Introduction: Wire localization (WL) has been the standard technique to assist in the removal of nonpalpable breast tumors for the past three decades for patients undergoing breast conserving surgery. Radioactive seed localization (RSL) is an alternative technique that provides advantages of patient comfort and scheduling convenience. There are numerous studies from large academic centers, but little information on how successfully this technique can be implemented in community hospitals.Methods: Thirty-five patients who underwent WL between September 18, 2013 and December 10, 2014 were compared to 110 patients who underwent RSL between February 12, 2014 and December 16, 2015. Results: Three of the 35 WL patients (8.5%) had a positive margin compared to 14 of the 110 RSL patients (12.7%), but this difference was not statistically significant (p-value 0.763). The breast specimen weight had a geometric mean of 30.26 g for the WL patients and 32.78 g for the RSL patients, a difference of 8.3%, which was not statistically significant. Positive margin rates did not depend on the surgeon or the radiologist placing the I-125 localization seed.Conclusion: The RSL technique can be implemented in community hospitals with the expectation of having the same positive margin rates as reported from academic centers.
Highlights
Wire localization (WL) has been the standard technique to assist in the removal of nonpalpable breast tumors for the past three decades for patients undergoing breast conserving surgery
The breast specimen weight had a geometric mean of 30.26 g for the WL patients and 32.78 g for the Radioactive seed localization (RSL) patients, a difference of 8.3%, which was not statistically significant
The RSL technique can be implemented in community hospitals with the expectation of having the same positive margin rates as reported from academic centers
Summary
Wire localization (WL) has been the standard technique to assist in the removal of nonpalpable breast tumors for the past three decades for patients undergoing breast conserving surgery. Wire localization has been the standard radiologic technique to assist in the removal of nonpalpable breast tumors for the past three decades (Homer & Pile-Spellman, 1986). Wire localization (WL) uses a needle-wire assembly under image guidance to place the tip of the marker wire in the tumor for subsequent surgical removal. The need to avoid patient delay for her scheduled arrival in the operating room places pressure on the radiology team. The problem of potential wire migration between the time it is inserted in the radiology suite and subsequent surgical removal in the operating room has been known for over 25 years (Davis, Wechsler, Feig, & March, 1988). The surgeon may remove the lesion in continuity with the localization wire rather than choose a better position of skin entry, with resultant unnecessary loss of normal breast tissue remote from the tumor
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