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Radioguided Localization of Nonpalpable Breast Cancer Lesions: Randomized Comparison With Wire Localization in Patients Undergoing Conservative Surgery and Sentinel Node Biopsy

¹ Department of Radiology, Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona, Carretera de Canyet s/n, E-08916, Badalona, Barcelona, Spain.
² Department of Nuclear Medicine, Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Barcelona, Spain.
³ Department of Radiology, Hospital Santa Caterina, Salt, Spain.
⁴ Department of General Surgery, Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Barcelona, Spain.

OBJECTIVE. The aim of this investigation was to determine whether radioguided occult lesion localization and routine wire localization differ in respect to the effectiveness of complete excision of nonpalpable breast cancer lesions.

SUBJECTS AND METHODS. This prospective randomized study included patients with breast cancer scheduled for conservative tumor excision and sentinel node biopsy. Patients were randomized to either radioguided localization or wire localization. Comparative radiologic, surgical, and pathologic data were collected and analyzed to establish the duration, ease of use, and accuracy of the two techniques for occult lesion localization. The effectiveness of sentinel node biopsy also was assessed. One radiologist and two surgeons participated in the study.

RESULTS. Among 134 patients, 68 were treated with wire localization and 66 with radioguided localization. The mean duration of radiologic localization was significantly shorter for radioguided localization (p < 0.001). No statistical differences were found for the other parameters studied. Radiography of the surgical specimen showed 100% lesion excision with both techniques. Complete tumor excision with tumor-free margins was achieved in 89.4% of patients who underwent radioguided localization group and 82.4% of patients who underwent wire localization. Pathologic examination showed the excised tissue volume was slightly larger (p = 0.371) and lesion concentricity slightly less (p = 0.730) with radioguided localization. The sentinel node detection rate was 91% with radioguided localization and 84% with wire localization.

CONCLUSION. The radioguided technique is as effective as the standard wire technique for localization and excision of nonpalpable breast cancer lesions and is somewhat faster and simpler to perform than wire localization.

Keywords: conservative tumor excision • nonpalpable breast cancer • radioguided localization • sentinel lymph node detection • wire localization

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