Randomized prospective evaluation of a novel technique for biopsy or lumpectomy of nonpalpable breast lesions: Radioactive seed versus wire localization

Background: Standard wire localization (WL) and excision of nonpalpable bre ast lesions has several shortcomings. Methods: Ninety-seven women with nonpalpable breast lesions were prospectiv ely randomized to radioactive seed localization (RSL) or WL. For RSL, a tit anium seed containing I-125 was placed at the site of the lesion by using r adiographical guidance. The surgeon used a handheld gamma detector to locat e and excise the seed and lesion. Results: Both techniques resulted in 100% retrieval of the lesions. Fewer R SL patients required resection of additional margins than WL patients (26% vs. 57%, respectively; P = .02). There were no significant differences in m ean times for operative excision (5.4 vs. 6.1 minutes) or radiographical lo calization (13.9 vs. 13.2 minutes). There were also no significant differen ces in the subjective ease of the procedures as rated by surgeons, radiolog ists, and patients. All WLs were carried out on the same day as the excisio n, whereas RSL was performed up to 5 days before the operative procedure. Conclusions: RSL is as effective as WL for the excision of nonpalpable brea st lesions and reduces the incidence of pathologically involved margins of excision. RSL also reduces scheduling conflicts and may allow elimination o f intraoperative specimen mammography. RSL is an attractive alternative to WL.