Our experience with the localization of non-palpable breast lesions using the radioactive seed Advantage™ I-125

Czech version

Authors: N. Harciníková ¹; K. Jágrová ¹; D. Engelová ¹; L. Večeřová ²; Z. Špůrková ³
Authors‘ workplace: Chirurgická klinika, 1. LF UK a FN Bulovka, Praha ¹; Ústav radiační onkologie, FN Bulovka, Praha ²; Oddělení patologické, anatomie, FN Bulovka, Praha ³
Published in: Rozhl. Chir., 2025, roč. 104, č. 3, s. 92-96.
Category: Original articles
doi: https://doi.org/10.48095/ccrvch202592

Overview

Introduction: Non-palpable breast lesions that are eligible for breast-conserving surgery require precise preoperative localization of the pathological site. Mammographic screening and modern diagnostic methods contribute to the increasingly early detection of these lesions.

Methods: We present our two-year practical experience with the marking of non-palpable breast lesions using the Advantage™ I-125 radioactive seed. This method was applied to 116 patients, 34 of whom had undergone successful neoadjuvant systemic therapy. The first 13 patients were marked using both the Frank wire method and radioactive seed application. The aim of our study was to evaluate the advantages and disadvantages of this method for both the patients and the entire multidisciplinary team.

Results: All pathological lesions were successfully removed during the primary procedure. In four patients, we observed seed displacement; however, the pathological lesion and the seed were always identified within the surgical field. Among the total number of patients, 73 underwent surgery for ductal carcinoma, 20 for lobular carcinoma, 8 for carcinoma associated with microcalcifications, 2 for invasive papillary carcinoma, and 13 for ambiguous biopsy findings. The method enables precise targeting of non-palpable lesions with minimal radiation exposure for both the patients and the surgical team. Additionally, the cosmetic outcomes of this method were assessed as clearly positive.

Conclusion: The Advantage™ I-125 radioactive seed localization proved to be a reliable method for detecting non-palpable breast lesions with minimal complications. Its main advantages lie in the overall comfort for patients and the ability to optimize incision placement from an aesthetic perspective. Our results confirm the high effectiveness of this method in breast-conserving surgery while achieving R0 resection.

Keywords:

breast carcinoma – non-palpable breast lesions – breast-conserving surgery – radioactive seed localization I-125

Sources

1. Coufal O, Schneiderová M, Fabian P et al. Iodine seed localisation of non-palpable lesions in breast surgery first experience. Rozhl Chir 2021; 100(6): 261–265. doi: 10.33699/PIS.2021.100.6.261-265.

2. Sánchez Sánchez R, González Jiménez AD, Rebollo Aguirre AC et al. 125I radioactive seed localization for non-palpable lesions in breast cancer. Rev Esp Med Nucl Imagen Mol 2019; 38(6): 343–347. doi: 10.1016/j.remn.2019.05.004.

3. Murphy JO, Moo TA, King TA et al. Radioactive seed localization compared to wire localization in breast-conserving surgery: initial 6-month experience. Ann Surg Oncol 2013; 20(13): 4121–4127. doi: 101245/s10434-013-3166.

4. Miodownik D, Bierman D, Thornton C et al. Radioactive seed localization is a safe and effective tool for breast cancer surgery: an evaluation of over 25,000 cases. J Radiol Prot 2024; 44(1): 10.1088/1361-6498/ad246a. doi: 10.1088/1361-6498/ad246a.

5. Aljohani B, Jumaa K, Kornecki A et al. Clinical utility of radioactive seed localization in nonpalpable breast cancer: a retrospective single institutional cohort study. Int J Surg 2018; 60: 149–152. doi: 10.1016/j.ijsu.2018.11.004.

6. Milligan R, Pieri A, Kritchley A et al. Radioactive seed localization compared with wire-guided localization of non-palpable breast carcinoma in breast corservation surgery – the first experience in the United Kingdom. Br J Radiol 2018; 91(1081): 20170268. doi: 10.1259/bjr.20170268.

7. Zhang Y, Seely J, Cordeiro E et al. Radioactive seed localization versus wire-guided localization for nonpalpable breast cancer: a cost and operating room efficiency analysis. Ann Surg Oncol 2017; 24(12): 3567–3573. doi: 10.1245/s10434-017-6084-z.

8. Bloomquist EV, Ajkay N, Patil S et al. A randomized prospective comparison of patient-assessed satisfaction and clinical outcomes with radioactive seed localization versus wire localization. Breast J 2016; 22(2): 151–157. doi: 10.1111/tbj.12564.

9. van der Noordaa ME, Pengel KE, Groen E et al. The use of radioactive iodine-125 seed localization in patients with non-palpable breast cancer: a comparison with the radioguided occult lesion localization with 99m technetium. Eur J Surg Oncol 2015; 41(4): 553–558. doi: 10.1016/j.ejso.2015.01.022.

10. Mendoza A, Sánches Sánches R, Casas Culiaňes M et al. Surgical clips vs. iodine-125I seeds for marking the location of nonpalpable malignant breast lesions: preliminary results. Radiologia 2020; 62(1): 38–45. doi: 10.1016/j.rx.2019.05.005.

11. Žatecký J, Heralt Z, Sekret D et al. Breast cancer localization by iodine seed 125I vs. wire-guided localization – retrospective case-control study. Rozhl Chir 2024; 103(7): 263–268. doi: 10.48095/ccrvch2024263.

12. Williams A, Richmond N, Thomay AA. Radioactive seed localization for non-breast tissue excision. Am Surg 2023; 89(9): 3933–3936. doi: 10.1177/00031348231177925.

13. Wright CM, Moorin RE, Saunders C et al. Cost-effectiveness of radioguided occult lesion localization using 125I seeds versus hookwire localization before breast-conserving surgery for non-palpable breast cancer. Br J Surg 2021; 108(7): 843–850. doi: 10.1093/bjs/znaa160.

14. Taylor DB, Bourke AG, Westcott EJ et al. Surgical outcomes after radiocative 125I seed versus hookwire localization of non-palpable breast cancer: a multicentre randomizes clinical trial. Br J Surg 2021; 108(1): 40–48. doi: 10.1093/bjs/znaa008.

15. Luiten JD, Beek MA, Voogd AC et al. Iodine seed- versus wire-guided localization in breast-conserving surgery for non-palpable ductal carcinoma in situ. Br J Surg 2015; 102(13): 1665–1669. doi: 10.1002/bjs.9946.

16. Zákony pro lidi. Zákon č. 263/2016 Sb., Atomový zákon. 2024 [online]. Dostupné z: https://www.zakonyprolidi.cz/cs/2016-263.

17. Guirguis MS, Checka C, Adrada BE et al. Bracketing with multiple radioactive seeds to achieve negative margins in breast conservation surgery: multiple seeds in breast surgery. Clin Breast Cancer 2022; 22(2): e158–e166. doi: 10.1016/j.clbc.2021.05.013.

MUDr. Natália Harciníková

Chirurgická klinika

1. LF UK a FN Bulovka

Budínova 2/67

180 81 Praha 8

natalia.harcinikova@gmail.com