Radioactive Seed Localization Research Articles

Evolution of localization methods for non-palpable breast lesions: a literature review from a translational medicine perspective.

With an increasing number of non-palpable breast lesions detected due to improved screening, accurate localization of these lesions for surgery is crucial. This literature review explores the evolution of localization methods for non-palpable breast lesions, highlighting the translational journey from concept to clinical practice. A comprehensive search of PubMed, Embase, and Scopus databases until September 2023 was conducted. Multiple methods have been developed throughout the past few decades. (I) Wire-guided localization (WGL) introduced in 1966, has become a reliable method for localization. Its simplicity and cost-effectiveness are its key advantages, but challenges include logistical constraints, patient discomfort, and potential wire migration. (II) Intraoperative ultrasound localization (IOUS) has shown promise in ensuring complete lesion removal with higher negative margin rates. However, its utility is limited to lesions visible on ultrasound (US) imaging. (III) Breast biopsy marker localization: the use of markers has improved the precision of localization without the need for wire. However, marker visibility remains a challenge despite improvements in their design. (IV) Radioactive techniques: radio-guided occult lesion localization (ROLL) and radioactive seed localization (RSL) offer flexibility in scheduling and improved patient comfort. However, they require close multidisciplinary collaboration and specific equipment due to radioactive concerns. (V) Other wireless non-radioactive techniques: wireless non-radioactive techniques have been developed in recent three decades to provide flexible and patient-friendly alternatives. It includes magnetic seed localization, radar techniques, and radiofrequency techniques. Their usage has been gaining popularity due to their safety profile and allowance of more flexible scheduling. However, their high cost and need for additional training remain a barrier to a wider adoption. The evolution of breast lesion localization methods has progressed to more patient-friendly techniques, each with its unique advantages and limitations. Future research on patient-reported outcomes, cosmetic outcomes, breast biopsy markers and integration of augmented reality with breast lesion localization are needed.

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

This study is a systematic review with meta-analysis comparing radioactive seed localization (RSL) versus radio-guided occult lesion localization (ROLL) and wire-guided localization (WGL) for patients with impalpable breast cancer undergoing breast-conserving surgery and evaluating efficacy, safety, and logistical outcomes. The protocol is registered in PROSPERO with the number CRD42022299726. A search was conducted in the Embase, Lilacs, Pubmed, Scielo, Web of Science, and clinicaltrials.gov databases, in addition to a manual search in the reference list of relevant articles, for randomized clinical trials and cohort studies. Studies selected were submitted to their own data extraction forms and risk of bias analysis according to the ROB 2 and ROBINS 1 tools. A meta-analysis was performed, considering the random effect model, calculating the relative risk or the mean difference for dichotomous or continuous data, respectively. The quality of the evidence generated was analyzed by outcome according to the GRADE tool. Overall, 46 articles met the inclusion criteria and were included in this systematic review; of these, 4 studies compared RSL and ROLL with a population of 1550 women, and 43 compared RSL and WGL with a population of 19,820 women. The results showed that RSL is a superior method to WGL in terms of surgical efficiency in the impalpable breast lesions' intraoperative localization, and it is at least equivalent to ROLL. Regarding security, RSL obtained results equivalent to the already established technique, the WGL. In addition to presenting promising results, RSL has been proven to be superior to WGL and ROLL technologies.

Radioactive seed localization is a safe and effective tool for breast cancer surgery: an evaluation of over 25,000 cases.

Radioactive seed localization (RSL) provides a precise and efficient method for removing non-palpable breast lesions. It has proven to be a valuable addition to breast surgery, improving perioperative logistics and patient satisfaction. This retrospective review examines the lessons learned from a high-volume cancer center's RSL program after 10 years of practice and over 25 000 cases. We provide an updated model for assessing the patient's radiation dose from RSL seed implantation and demonstrate the safety of RSL to staff members. Additionally, we emphasize the importance of various aspects of presurgical evaluation, surgical techniques, post-surgical management, and regulatory compliance for a successful RSL program. Notably, the program has reduced radiation exposure for patients and medical staff.

Radiofrequency localization of nonpalpable breast cancer in a multicentre prospective cohort study: feasibility, clinical acceptability, and safety

PurposeIn breast conserving surgery, accurate lesion localization is essential for obtaining adequate surgical margins. Preoperative wire localization (WL) and radioactive seed localization (RSL) are widely accepted methods to guide surgical excision of nonpalpable breast lesions but are limited by logistical challenges, migration issues, and legislative complexities. Radiofrequency identification (RFID) technology may offer a viable alternative. The purpose of this study was to evaluate the feasibility, clinical acceptability, and safety of RFID surgical guidance for localization of nonpalpable breast cancer.MethodsIn a prospective multicentre cohort study, the first 100 RFID localization procedures were included. The primary outcome was the percentage of clear resection margins and re-excision rate. Secondary outcomes included procedure details, user experience, learningcurve, and adverse events.ResultsBetween April 2019 and May 2021, 100 women underwent RFID guided breast conserving surgery. Clear resection margins were obtained in 89 out of 96 included patients (92.7%), re-excision was indicated in three patients (3.1%). Radiologists reported difficulties with the placement of the RFID tag, partially related to the relatively large needle-applicator (12-gauge). This led to the premature termination of the study in the hospital using RSL as regular care. The radiologist experience was improved after a manufacturer modification of the needle-applicator. Surgical localization involved a low learning curve. Adverse events (n = 33) included dislocation of the marker during insertion (8%) and hematomas (9%). The majority of adverse events (85%) occurred using the first-generation needle-applicator.ConclusionRFID technology is a potential alternative for non-radioactive and non-wire localization of nonpalpable breast lesions.

Response in axillary lymph nodes to neoadjuvant chemotherapy for breast cancers: correlation with breast response, pathologic features, and accuracy of radioactive seed localization

ObjectivesThis study examined the accuracy of radioactive seed localization (RSL) of lymph nodes (LNs) following neoadjuvant chemotherapy (NAC) for invasive breast carcinoma, recorded pathologic features of LNs following NAC, evaluated concordance of response between breast and LNs, and identified clinicopathologic factors associated with higher risk of residual lymph node involvement.MethodsClinical records, imaging, and pathology reports and slides were retrospectively reviewed for 174 breast cancer patients who received NAC. Chi-square and Fisher’s exact tests were used to compare differences in risk of residual lymph node disease.ResultsRetrieval of biopsied pre-therapy positive LN was confirmed in 86/93 (88%) cases overall, and in 75/77 (97%) of cases utilizing RSL. Biopsy clip site was the best pathologic feature to confirm retrieval of a biopsied lymph node. Pre-therapy clinical N stage > 0, positive pre-therapy lymph node biopsy, estrogen and progesterone receptor positivity, Ki67 < 50%, HR + /HER2− tumors, and residual breast disease had higher likelihood of residual lymph node disease after NAC (p < 0.001).ConclusionsRSL-guided LN excision improves retrieval of previously biopsied LNs following NAC. The pathologist can use histologic features to confirm retrieval of targeted LNs, and tumor characteristics can be used to predict a higher risk of residual LN involvement.

Can axillary lymph node dissection (ALND) be omitted in patients with breast cancer with persistent axillary disease after neoadjuvant chemotherapy?

e12624 Background: Axillary lymph node dissection (ALND) is the standard of care for patients (pts) with persistent node-positive (N+) disease after neoadjuvant chemotherapy (NAC). In those with a clinical response to NAC, it is appropriate to perform limited axillary surgery to evaluate axillary status, with ALND reserved for those who remain N+. We define the directed-sentinel node biopsy (dSLNB) as pre-operative localization of the previously positive lymph node combined with dual-tracer sentinel node biopsy. We hypothesize that omission of ALND in those that have residual N+ disease after NAC, is associated with less morbidity, without impacting outcomes. Methods: This is a single-institution, retrospective analysis of consecutive pts with N+ breast cancer (BC) who received NAC and dSLNB +/- ALND from 2014-2021. A clip was placed in the positive node at the time of biopsy and excised using radioactive seed localization (RSL) with an I-125 seed. Only those with persistent disease in the RSL on pathology were included (RSL+). We assessed the impact of extent of axillary surgery on primary outcomes, including recurrence, disease-free survival (DFS) and overall survival (OS), and secondary outcomes, including location of recurrence and lymphedema. Results: 156 female pts with N+ BC received NAC, underwent dSLNB +/- ALND with RSL+. Mean age was 52.1 years (SD 12.2). Median follow-up was 32.5 months (IQR 22.9-51.6). Phenotype distribution was 55.8% luminal, 21.2% HER2 positive, and 23.1% triple negative, with no difference between ALND or dSLNB. Pts who had ALND had a higher nodal stage at presentation compared to dSLNB (N1: 72.9% vs. 91.8%, N2: 20.6% vs. 8.2%, N3: 6.5% vs. 0%, p = 0.016). 90.4% received adjuvant radiation with no difference between ALND and dSLNB. Lymphedema rates were higher in the ALND group (47.7% vs. 16.3%, p &lt; 0.001). Fifteen patients died with no difference between ALND and dSLNB in overall mortality rates (9.3% vs. 10.2%, p = 1.000). Nineteen pts recurred with 73.7% occurring at distant sites (ALND 76.5% vs. dSLNB 50%, p = 0.468). There was a higher recurrence rate after ALND (15.9% vs. 4.1%, p = 0.038) as well as higher rates of extracapsular LN extension (46.7% vs. 14.9%, p &lt; .001) and breast lymphovascular invasion (49% vs. 30.4%, p = 0.035). Comparing ALND to dSLNB, there was no difference in DFS (30 months vs. 37 months, p = 0.650) or OS (36.4 months vs. 36.2 months, p = 0.982). Conclusions: For pts with persistent N+ disease in the RSL node after NAC, there was no difference in DFS or OS regardless of extent of axillary surgery. ALND led to higher rates of morbidity, namely lymphedema, but did not contribute to better outcomes. Most recurrences were distant, suggesting aggressive tumor biology as the driver for poor oncologic outcomes rather than the extent of axillary surgery. In this light, the results of the Alliance 11202 are awaited as it answers the question on a randomized, multi-institutional level.

Radioactive Seed Localization for Non-Breast Tissue Excision.

Lymph nodes are common basins for cancer recurrence; however, during surgery, lymphatic tissue is often indistinguishable from surrounding tissue making local excision difficult. Novel breast surgery techniques have utilized radioactive seed localization (RSL) to preoperatively tag tissue so it can be identified intraoperatively with a gamma probe. Our goal was to assess the use of RSL in non-breast tissues. This was a retrospective case series of non-breast cancer patients undergoing RSL. Overall, 42 patients met inclusion criteria. Pathology results indicated benign findings in 20 patients (47.62%), toxoplasma in 1 patient (2.38%), non-necrotizing granulomatous disease in 2 patients (4.76%), and malignant progression in 19 patients (45.24%). Two patients had non-lymphatic tissue removed: one in the abdominal wall and one in the lower lumbar region. Radioactive seed localization is an effective technique to localize and excise non-palpable lymph nodes and masses identified on imaging, highlighting its wide variety of uses in non-breast cancer cases.

Comparative analysis between radioactive seed localization and wire-guided for non-palpable breast cancer surgery

The conservative surgery for impalpable breast cancer requires an intraoperative localization method that guides the identification and correct excision of the lesion. The aim of this study is to comparatively analyze two intraoperative breast localization technologies, wire guided localization (WGL) and radioactive seed localization (RSL), regarding their surgical efficacy through the outcomes of surgical margins, intraoperative re-excision, reoperation and recurrence. To this end, a systematic search was realized in databases for clinical trials that match with the study eligibility criteria. The selected studies were evaluated for their methodological quality; the data were then collected and quantitatively synthesized. The results comprised thirty-eight studies that match the eligibility criteria. The main outcomes reported demonstrating that the RSL is at least equivalent to the WGL in efficiency rates. These results confirm the method applicability for impalpable breast lesions surgery in an effective way, in addition to presenting organizational optimization of radiology and surgery services by allowing the surgery to be performed up to two months after seed implantation.

PD30 Radioactive Seed Localization And Radio-Guided Occult Lesion Localization For Non-Palpable Breast Cancer Surgery: A Meta-Analysis

IntroductionNon-palpable breast cancers require intraoperative localization to guide the surgical procedure. The radio-guided occult lesion localization (ROLL) and radioactive seed localization (RSL) techniques use radioactive material (technetium-99m labeled macroaggregated albumin and iodine-125 seeds, respectively) implanted at the lesion site. The success of conservative surgery depends on complete tumor excision with negative surgical margins. The objective of this study was to perform a meta-analysis of the surgical effectiveness of the ROLL and RSL techniques with respect to rates of positive surgical margins, reoperation, and recurrence.MethodsA systematic search of the PubMed, Embase, LILACS, SciELO, and Web of Science databases was performed on 2 August 2021. A standard form was used to extract data from the studies selected in the screening process. The ROBINS-I tool was used to analyze risk of bias and RevMan 5.4 software was used to perform the meta-analysis.ResultsFour observational studies met the inclusion criteria. The overall evidence quality was moderate. The studies included women aged from 28 to 91 years with non-palpable breast cancer. The results demonstrated similar effectiveness between RSL and ROLL for rates of positive surgical margins (risk ratio [RR] 0.83, 95% confidence interval [CI]: 0.50, 1.39; 763 patients) and reoperation (RR 1.14, 95% CI: 0.75, 1.74; 1,550 patients). Regarding the rate of disease recurrence, RSL was superior to ROLL (RR 0.50, 95% CI: 0.29, 0.87; 939 patients).ConclusionsThe results demonstrate that the ROLL and RSL techniques are equivalent with respect to rates of positive surgical margins and reoperation, although patients undergoing RSL had lower rates of disease recurrence. However, there is a tendency to favor the RSL technique because of the longer interval between implantation and surgery, which is possible due to the longer half-life of iodine-125 (59.4 days). This also means that radioactive seed implantation can occur before neoadjuvant chemotherapy, so the tumor bed remains marked if further interventions are required, obviating the need for another invasive procedure before surgery.

Clinical Outcomes Using Magnetic Seeds as a Non-wire, Non-radioactive Alternative for Localization ofNon-palpable Breast Lesions.

Nonpalpable breast lesions require precise preoperative localization to facilitate negative margins with breast-conserving therapy. The traditional use of wires has several challenges including patient discomfort, wire migration, and coordination of schedules between radiology and the operating room. Radioactive seed localization overcomes some of these challenges, but radiation safety requirements have limited adoption of this technology. The authors examined their institutional experience with Magseed as an alternative technology for localization and compared outcomes with those of wire and radioactive seed localization. An institutional review board (IRB)-approved retrospective study was performed to evaluate patients who underwent excisional biopsy or segmental mastectomy after wire-guided localization (WGL), radioactive seed localization (RSL), or Magseed localization (ML). The clinical and pathologic factors of the three groups were assessed with a negative margin rate as the primary outcome measure. Of the 1835 patients in the study, 825 underwent WGL, 449 underwent RSL, and 561 underwent ML. For the patients with either multiple lesions or a large lesion that required bracketing, multiple localization devices were placed in 31% of the WGL patients, 28% of the RSL patients, and 23% of the ML patients (p = 0.006). Negative margins were achieved in 91% of the WGL patients, 89% of the RSL patients, and 89% of the ML patients (p = 0.4). Localization of non-palpable breast lesions using Magseed is a safe and effective alternative to WGL and RSL that overcomes radiation safety limitations and increases radiology and surgery scheduling efficiency.

Radioactive Seed Localization for Conservative Surgery of Nonpalpable Breast Cancer: Recommendations for Technology Implantation Program

The radioactive seed localization (RSL) is used in impalpable breast cancer conservative surgery to assist the surgeon in accurately locating and excising the lesion site. This study aims to present recommendations about the RSL program implementation in health institutions that perform breast cancer conservative surgery with intraoperative localization. An extensive literature review was performed. It comprehends: the committee responsible for implementation of the program actions; description of the necessary multidisciplinary team; the radiological safety committee role; the facility licensing; professionals training; material and instrumentation associated with the technique; and seed tracking system. 13 topics are presented. The Program Implementation Committee must be formed by leaders from each department. The committee assumes responsibility for evaluating the necessary processes and presenting the schedule for program implementation. Since the procedure is classified as a nuclear medicine procedure it requires licensing. The Professional Team Formation, Education, and Training is a priority and simulation exercises are necessary. The Materials and Instrumentation Associated with the Technique must be well-know by the team and they should practice using radiation detectors. The seed must be always tracked, from moment they are received to discard. An Inventory for Tracking Seeds is provided. The Radiological Safety Aspects such as the ALARA principle are presented. A full description for the Radiological Procedure for Placing the seeds, the surgical removal and the Specimen Handling in Pathology focusing on how to locate the seed and retrieve them. After removed, the seeds can be placed in storage to wait for full radioactive decay or be returned to the manufacturer. The procedure has the advantage to increase to 2 months the time between insertion of the seed and the surgical removal. Regular multidisciplinary team meetings during program development are important to create a realistic timeline, having briefing meetings after the first 1-5 RSL cases and having annual or biannual follow-up meetings to discuss any issues or incidents. Abstract Graphic ImageCreated by Macrovector, obtained in Freepik at https://br.freepik.com/fotos-vetores-gratis/oncologia.This graphical abstract shows everything that is necessary to implement the RSL technique and are discussed in this paper. This study present recommendations for RSL program implementation in hospitalsWas performed by an extensive descriptive and qualitative literature reviewTopics 1: Implementation Committee, Professional Team Training, InstrumentationTopics 2: Radiological Safety, Patient Consent, Radiological ProcessTopics 3: Surgical Procedure, Pathology, Seeds Disposal Completion.

Nationwide registry study on trends in localization techniques and reoperation rates in non-palpable ductal carcinoma in situ and invasive breast cancer.

There is a transition from wire-guided localization (WGL) of non-palpable breast cancer to other localization techniques. Multiple prospective studies have sought to establish superior clinical outcomes for radioactive-seed localization (RSL), but consistent and congruent evidence is missing. In this study, female patients with breast cancer operated with breast-conserving surgery after tumour localization of a non-palpable breast cancer or ductal carcinoma in situ (DCIS) were included. The cohort was identified from the nationwide Netherlands Breast Cancer Audit conducted between 2013 and 2018. Trends in localization techniques were analysed. Univariable and multivariable analyses were performed to assess the association between the localization technique and the probability of a reoperation. A total of 28 370 patients were included in the study cohort. The use of RSL increased from 15.7 to 61.1 per cent during the study years, while WGL decreased from 75.4 to 31.6 per cent. The localization technique used (RSL versus WGL) was not significantly associated with the odds of a reoperation, regardless of whether the lesion was DCIS (odds ratio 0.96 (95 per cent c.i. 0.89 to 1.03; P = 0.281)) or invasive breast cancer (OR 1.02 (95 per cent c.i. 0.96 to 1.10; P = 0.518)). RSL is rapidly replacing WGL as the preoperative localization technique in breast surgery. This large nationwide registry study found no association between the type of localization technique and the odds of having a reoperation, thus confirming the results of previous prospective cohort studies.

Use of an Introducer for Radioactive Seed Localization of Targets Beyond the Length of Available Preloaded Needles.

Use of an Introducer for Radioactive Seed Localization of Targets Beyond the Length of Available Preloaded NeedlesAsha A. Bhatt, MD1, Genevieve A. Woodard, MD, PhD1 and Christine U. Lee, MD, PhD1Audio Available | Share

Therapeutic applications of radioactive sources: from image-guided brachytherapy to radio-guided surgical resection.

It is well known nowadays that radioactivity can destroy the living cells it interacts with. It is therefore unsurprising that radioactive sources, such as iodine-125, were historically developed for treatment purposes within radiation oncology with the goal of damaging malignant cells. However, since then, new techniques have been invented that make creative use of the same radioactivity properties of these sources for medical applications. Here, we review two distinct kinds of therapeutic uses of radioactive sources with applications to prostate, cervical, and breast cancer: brachytherapy and radioactive seed localization. In brachytherapy (BT), the radioactive sources are used for internal radiation treatment. Current approaches make use of real-time image guidance, for instance by means of magnetic resonance imaging, ultrasound, computed tomography, and sometimes positron emission tomography, depending on clinical availability and cancer type. Such image-guided BT for prostate and cervical cancer presents a promising alternative and/or addition to external beam radiation treatments or surgical resections. Radioactive sources can also be used for radio-guided tumor localization during surgery, for which the example of iodine-125 seed use in breast cancer is given. Radioactive seed localization (RSL) is increasingly popular as an alternative tumor localization technique during breast cancer surgery. Advantages of applying RSL include added flexibility in the clinical scheduling logistics, an increase in tumor localization accuracy, and higher patient satisfaction; safety measures do however have to be employed. We exemply the implementation of RSL in a clinic through our experiences at the Netherlands Cancer Institute.

Adequacy of invasive and in situ breast carcinoma margins in radioactive seed and wire-guided localization lumpectomies.

Image-guided preoperative localizations help surgeons to completely resect nonpalpable breast cancers. The objective of this study is to compare the adequacy of specimen margins for both invasive breast cancer (IBC) and ductal carcinoma in situ (DCIS) after radioactive seed localization (RSL) vs wire-guided localization (WGL). We retrospectively reviewed 600 cases at a single Canadian academic center from January 2014 to September 2017, comparing surgical margins, re-excisions and reoperations, localization accuracy and major complications (migration, accidental deployment, vasovagal reaction), as well as operative duration between RSL and WGL cases. IBC margins were positive in 7% of RSL and 6% of WGL cases (P=.57). Tumor size (P =.039) and association with DCIS (P=.036) predicted positive margins in invasive carcinoma. DCIS margins were positive in 6% and 8%, and close (≤2mm) in 37% and 36% of cases (P = .45) for RSL and RSL cases respectively. The presence of extensive intraductal component predicted positive DCIS margins (P <.0001). There was no significant difference between intraoperative re-excisions (P=.54), localization accuracy (P=.34), and operation duration (P=.81). Reoperation for lumpectomies and mastectomies was marginally higher for WGL than RSL (P=.049). There were 11 (4%) WGL and no RSL complications (P=.03). Overall, positive margins for IBC, close or positive margins for DCIS, intraoperative re-excision, localization accuracy, and operation duration were similar between RSL and WGL. The reoperation rate was higher in WGL than RSL, which may reflect practice changes over time. RSL was safer than WGL with lower complication rates.

Comparison of Multiple Wire, Radioactive Seed, and Savi Scout® Radar Localizations for Management of Surgical Breast Disease

Radioactive seed localization (RSL) and the Savi Scout® radar (SSR) are newer alternatives to wire-guided localization (WL) for nonpalpable breast lesions. The aim of this study was to compare three localization devices when multiple devices were used for preoperative localization for breast surgery. Between July 2017 and July 2018, 68 patients had a partial mastectomy (n=54) or breast biopsy (n=14) with preoperative image-guided localization using multiple wires or device placement for nonpalpable lesions. Operative timing, outcomes, and 30-day complications were evaluated. Overall, 41 patients (60%) had WL, 11 patients (16%) had RSL, and 16 patients (24%) had SSR localization. Fifty-four patients (79.4%) had localization of two lesions and 13 patients (19.1%) had localization of three lesions. Twenty-three patients (33.8%) had a lesion that was bracketed. There was no difference in retained biopsy clip among the groups (average 7.4%; p=0.962). For operations performed in the hospital, there was no difference in operative time among the groups, with a median of 77.5 min (p=0.705) or total perioperative time of 508 min (p=0.210). Among operations with delayed start times, there was a longer average delay of 95.5 min in WL, compared with 42 min in SSR (p=0.004). A greater volume of tissue was excised in the WL group (29.5g WL vs. 15.9g RSL vs. 12.1g SSR; p=0.022). There was no difference in positive margin rate and 30-day complications among groups. SSR and RSL can be used to localize multiple breast lesions, with no difference in positive margin rates or complications and less tissue excised compared with WL.

Budget Impact Analysis of Preoperative Radioactive Seed Localization.

This study models costs in implementing a radioactive seed localization (RSL) program for nonpalpable breast lesions at a large Canadian tertiary hospital to replace existing wire-guided localization (WGL). All direct and indirect operating costs of localization per lesion from the hospital's perspective were determinedby retrospectively reviewing patient data and costs from January 2014to December 2016. A budget impact analysis and sensitivity analysis were performed to calculate the mean cost per lesion, the minimum and maximum cost per lesion, operational costs, and initial costs. There were 265 WGL lesions in 2014 and 170 RSL lesions in 2016 included in cost calculation. The mean cost per localization was $185 CAD for WGL ($148-$311) and $283 CAD ($245-$517) for RSL using preloaded seeds, adjusted to 2016 Canadian dollars. The annual operational expenditure including all localizations and overhead costs was $49,835 for WGL and $80,803 for RSL. Initial costs for RSL were $22,000, including external training and new equipment purchases. Our budget impact analysis shows that RSL using preloaded radioactive seeds was more expensive than WGL when considering per-lesion localization costs and specific costs related to radiation safety. Manually loading radioactive seed could be a cost-saving alternative to purchasing preloaded seeds.Our breakdown of costs can provide a framework for other centres to determine which localization method best suit their departments.

125I radioactive seed localization (RSL) in surgery of cervical metastasis of thyroid cancer

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

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

BackgroundThere 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.ObjectiveThe 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 MethodsWe 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.ResultsPatients 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).ConclusionIn 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.

Early budget impact analysis on magnetic seed localization for non-palpable breast cancer surgery.

IntroductionCurrent localization techniques used in breast conserving surgery for non-palpable tumors show several disadvantages. Magnetic Seed Localization (MSL) is an innovative localization technique aiming to overcome these disadvantages. This study evaluated the expected budget impact of adopting MSL compared to standard of care.MethodsStandard of care with Wire-Guided Localization (WGL) and Radioactive Seed Localization (RSL) use was compared with a future situation gradually adopting MSL next to RSL or WGL from a Dutch national perspective over 5 years (2017–2022). The intervention costs for WGL, RSL and MSL and the implementation costs for RSL and MSL were evaluated using activity-based costing in eight Dutch hospitals. Based on available list prices the price of the magnetic seed was ranged €100-€500.ResultsThe intervention costs for WGL, RSL and MSL were respectively: €2,617, €2,834 and €2,662 per patient and implementation costs were €2,974 and €26,826 for MSL and RSL respectively. For standard of care the budget impact increased from €14.7m to €16.9m. Inclusion of MSL with a seed price of €100 showed a budget impact of €16.7m. Above a price of €178 the budget impact increased for adoption of MSL, rising to €17.6m when priced at €500.ConclusionMSL could be a cost-efficient localization technique in resecting non-palpable tumors in the Netherlands. The online calculation model can inform adoption decisions internationally. When determining retail price of the magnetic seed, cost-effectiveness should be considered.