Advertisement

Preoperative localization of breast lesions: Comparing digital breast tomosynthesis-guided radioactive seed localization versus standard 2D stereotactic radioactive seed localization

      Highlights

      • Pre-operative radioseed localizations can be performed using a digital breast tomosynthesis guided method.
      • Preliminary data suggest DBT-guided preoperative radioseed localization has statistically significant time and dose savings compared to traditional stereotactic radioseed localization.
      • No significant difference in margin outcomes for patients undergoing DBT-guided preoperative seed localization compared to 2D radioseed localization.

      Abstract

      Purpose

      To compare single seed digital breast tomosynthesis-guided radioseed localization (DBT-L) to standard 2D stereotactic-guided radioseed localization (SGL) of the breast.

      Methods

      A retrospective review of a large tertiary cancer center's database yielded 68 women who underwent preoperative DBT-L from March 2019–December 2019 and a matched cohort of 65 women who underwent SGL during the same period. The electronic medical record and radiology were reviewed for patient characteristics including breast density, exam technique, pre- and post-operative pathology, exam duration, and radiation dose to the patient. To compare margin outcomes between the groups, the chi-square test of independence was used; to compare continuous outcomes such as exam duration and total dose, the Wilcoxon rank sum test was used.

      Results

      DBT-L and SGL localization targets included biopsy marker (62/68, 91% vs 55/65, 85%), distortion (4/68, 6% vs 2/65, <3%), focal asymmetry (1/68 and 1/65, < 2% for both), calcifications (1/68, <2% vs 4/65, 6%), and anatomic landmarks (0% vs 3/65, 5%). 72% and 71% of localizations were performed for malignant pathology in the DBT-L and SGL groups, respectively. The median duration of DBT-L was 8.3 min vs 10.3 min for SGL, representing statistically significant time savings (p = 0.003). The median total organ dose of DBT-L was 8.6 mGy vs 10.4 mGy for SGL, representing statistically significant dose savings (p = 0.018). The incidence of positive margins at surgery was not statistically different between the groups (p = 0.26).

      Conclusion

      DBT-L demonstrates both time and dose savings for the patient compared to SGL without compromising surgical outcome.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gøtzsche P.C.
        • Nielsen M.
        Screening for breast cancer with mammography.
        Cochrane Database Syst Rev. 2011; Cd001877
        • Tardioli S.
        • Ballesio L.
        • Gigli S.
        • DIP F.
        • D'Orazi V.
        • Giraldi G.
        Wire-guided localization in non-palpable breast cancer: results from monocentric experience.
        Anticancer Res. 2016; 36: 2423-2427
        • Kopans D.B.
        • Swann C.A.
        Preoperative imaging-guided needle placement and localization of clinically occult breast lesions.
        AJR Am J Roentgenol. 1989; 152: 1-9
        • Owen A.W.
        • Kumar E.N.
        Migration of localizing wires used in guided biopsy of the breast.
        Clin Radiol. 1991; 43: 251
        • Kaul D.
        • Fallenberg E.
        • Diekmann F.
        • Budach V.
        • Maurer M.
        Dislocability of localization devices for nonpalpable breast lesions: experimental results.
        Radiol Res Pract. 2014; 2014425823
        • Tingen J.S.
        • McKinley B.P.
        • Rinkliff J.M.
        • Cornett W.R.
        • Lucas C.
        Savi scout radar localization versus wire localization for breast biopsy regarding positive margin, complication, and reoperation rates.
        Am Surg. 2020; 86: 1029-1031
        • Acosta J.A.
        • Greenlee J.A.
        • Gubler K.D.
        • Goepfert C.J.
        • Ragland J.J.
        Surgical margins after needle-localization breast biopsy.
        Am J Surg. 1995; 170 (discussion 5–6): 643-645
        • Jakub J.W.
        • Gray R.J.
        • Degnim A.C.
        • Boughey J.C.
        • Gardner M.
        • Cox C.E.
        Current status of radioactive seed for localization of non palpable breast lesions.
        Am J Surg. 2010; 199: 522-528
        • Mayo III, R.C.
        • Kalambo M.J.
        • Parikh J.R.
        Preoperative localization of breast lesions: current techniques.
        Clin Imaging. 2019; 56: 1-8
        • Lovrics P.J.
        • Goldsmith C.H.
        • Hodgson N.
        • McCready D.
        • Gohla G.
        • Boylan C.
        • et al.
        A multicentered, randomized, controlled trial comparing radioguided seed localization to standard wire localization for nonpalpable, invasive and in situ breast carcinomas.
        Ann Surg Oncol. 2011; 18: 3407-3414
        • Saphier N.
        • Kondraciuk J.
        • Morris E.
        • Bernard-Davila B.
        • Mango V.
        Preoperative localization of breast MRI lesions: MRI-guided marker placement with radioactive seed localization as an alternative to MRI-guided wire localization.
        J Breast Imaging. 2020; 2: 250-258
        • Lamb L.R.
        • Gilman L.
        • Specht M.
        • D'Alessandro H.A.
        • Miles R.C.
        • Lehman C.D.
        Retrospective review of preoperative radiofrequency tag localization of breast lesions in 848 patients.
        AJR Am J Roentgenol. 2021; 217: 605-612
        • Kasem I.
        • Mokbel K.
        Savi Scout® radar localisation of non-palpable breast lesions: systematic review and pooled analysis of 842 cases.
        Anticancer Res. 2020; 40: 3633-3643
        • Price E.R.
        • Khoury A.L.
        • Esserman L.J.
        • Joe B.N.
        • Alvarado M.D.
        Initial clinical experience with an inducible magnetic seed system for preoperative breast lesion localization.
        AJR Am J Roentgenol. 2018; 210: 913-917
        • Cheang E.
        • Ha R.
        • Thornton C.M.
        • Mango V.L.
        Innovations in image-guided preoperative breast lesion localization.
        Br J Radiol. 2018; 9120170740
        • Choudhery S.
        • Simmons C.
        • Harper L.
        • Lee C.U.
        Tomosynthesis-guided needle localization of breast and axillary lesions: our initial experience.
        AJR Am J Roentgenol. 2019; 212: 943-946
        • Madeley C.
        • Kessell M.
        • Madeley C.
        • Taylor D.
        A comparison of stereotactic and tomosynthesis-guided localisation of impalpable breast lesions.
        J Med Radiat Sci. 2019; 66: 170-176
        • Goudreau S.H.
        • Joseph J.P.
        • Seiler S.J.
        Preoperative radioactive seed localization for nonpalpable breast lesions: technique, pitfalls, and solutions.
        Radiographics. 2015 Sep-Oct; 35 (Epub 2015 Aug 14. PMID: 26274097): 1319-1334https://doi.org/10.1148/rg.2015140293
        • R Development Core Team
        Vienna, Austria: R Foundation for Statistical Computing.
        2022
        • Waldherr C.
        • Berclaz G.
        • Altermatt H.J.
        • Cerny P.
        • Keller P.
        • Dietz U.
        • et al.
        Tomosynthesis-guided vacuum-assisted breast biopsy: a feasibility study.
        Eur Radiol. 2016; 26: 1582-1589
        • American College of Radiology
        ACR statement on FDA radiation reduction program.
        • Brouwer de Koning S.G.
        • Vrancken Peeters M.
        • Jóźwiak K.
        • Bhairosing P.A.
        • Ruers T.J.M.
        Tumor resection margin definitions in breast-conserving surgery: systematic review and meta-analysis of the current literature.
        Clin Breast Cancer. 2018; 18: e595-e600
        • Conant E.F.
        • Zuckerman S.P.
        • McDonald E.S.
        • Weinstein S.P.
        • Korhonen K.E.
        • Birnbaum J.A.
        • et al.
        Five consecutive years of screening with digital breast tomosynthesis: outcomes by screening year and round.
        Radiology. 2020; 295: 285-293