Title:Radioguided Surgery for Localization of Nonpalpable Breast Lesions A Mini-Review
VOLUME: 9 ISSUE: 2
Author(s):Linnea Langhans, Thomas Levin Klausen, Tove Filtenborg Tvedskov, Ilse Vejborg, Niels Kroman and Birger Hesse
Affiliation:Department of Breast Surgery, 2102, Copenhagen National Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Keywords:Nonpalpable breast lesions, radioactive seed localization, radioguided occult lesion localization, wire-guided
localization.
Abstract:The majority of patients with nonpalpable breast lesions are eligible for
breast conserving surgery guided by some kind of lesion localization. The current
standard is wire-guided localization (WGL) even though it has several disadvantages,
the most important one being the considerable proportion of patients with
insufficient resection margin. These patients require a reoperation. New methods in
the field of radioguided surgery (RGS) have been developed including radioguided
occult lesion localization (ROLL) and radioactive seed localization (RSL). Especially
RSL is a very promising technique. Guided by ultrasound a small titanium
seed containing typically 1-10 MBq of radioactive iodine-125 is placed in the centre
of the nonpalpable breast lesion. During the operation the seed is located with a
hand-held gamma probe. To date, only few cohort studies exist on the feasibility of RSL, and the
method has only been tested in one randomized trial. The results are either equal to or superior to those
obtained with WGL, with regards to achieving free margins and low reoperation rates. Additionally,
the RSL technique is less unpleasant for the patient and more flexible regarding preoperative logistics.
The seed can be placed a few days before surgery, in contrast to the wire used in WGL, which has to
be placed within few hours of surgery. RSL has quickly become popular in surgical and radiological
teams that have used the technique and will probably become an important tool for preoperative localization
of nonpalpable breast lesions in the near future.
