Donna B Taylor1,2, Anita G Bourke1,3, Eliza Westcott4,5, John Burrage6, Bruce Latham7,8, Paul Riley3, Helen Ballal3, Roshi Kamyab3, Felicity Frost9, Deepthi Dissanayake2, Joanne Landman10, Michael Phillips11, Christobel Saunders1,2. 1. School of Surgery, University of Western Australia, Perth, Western Australia, Australia. 2. Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia. 3. Breast Centre, Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. 4. Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, QEII Medical Centre, Perth, Western Australia, Australia. 5. School of Physics, University of Western Australia, Perth, Western Australia, Australia. 6. Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, Australia. 7. PathWest Laboratory Medicine, Royal Perth Hospitial, Perth, Western Australia, Australia. 8. School of Medicine, Notre Dame University, Fremantle, Western Australia, Australia. 9. PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia. 10. Department of Nuclear Medicine, Royal Perth Hospital, Perth, Western Australia, Australia. 11. Harry Perkins Institute for Medical Research, University of Western Australia, Perth, Western Australia, Australia.
Abstract
INTRODUCTION: Approximately one-third of breast cancers are impalpable and require pre-operative image-guided localisation. Hook-wire localisation (HWL) is commonly used but has several disadvantages. Use of a low-activity radioactive iodine-125 seed is a promising alternative technique used in the USA and the Netherlands. This pilot study describes the first use of this in Australia. METHODS: In this prospective pilot study, 21 participants with biopsy-proven breast cancer underwent radioguided occult lesion localisation using iodine-125 seed(s) (ROLLIS) with insertion of a hook-wire for back up. Sentinel node biopsy was performed where indicated. Ease of hook-wire and seed insertion, duration of the procedure, dependence on the seed versus hook-wire during surgery, lesion location within the specimen, histopathology including size of radial margins, the ease of seed retrieval in pathology, and safe return of seeds for disposal were documented. Radiation dosimetry of staff was performed. RESULTS: All seeds were placed within 3.5 mm of the lesion. All lesions and seeds were removed. One participant needed re-excision for involved margins. Radiologists and surgeons both preferred ROLLIS. Surgeons were able to depend on the seed for localisation in all but one case. Sentinel node biopsy was successfully performed when required. Pathologists found seed retrieval quick and easy, with no detrimental effect on tissue processing. No radiation doses measurably above background were received by staff. CONCLUSION: ROLLIS is an easily learnt, safe and effective alternative technique to standard HWL.
INTRODUCTION: Approximately one-third of breast cancers are impalpable and require pre-operative image-guided localisation. Hook-wire localisation (HWL) is commonly used but has several disadvantages. Use of a low-activity radioactive iodine-125 seed is a promising alternative technique used in the USA and the Netherlands. This pilot study describes the first use of this in Australia. METHODS: In this prospective pilot study, 21 participants with biopsy-proven breast cancer underwent radioguided occult lesion localisation using iodine-125 seed(s) (ROLLIS) with insertion of a hook-wire for back up. Sentinel node biopsy was performed where indicated. Ease of hook-wire and seed insertion, duration of the procedure, dependence on the seed versus hook-wire during surgery, lesion location within the specimen, histopathology including size of radial margins, the ease of seed retrieval in pathology, and safe return of seeds for disposal were documented. Radiation dosimetry of staff was performed. RESULTS: All seeds were placed within 3.5 mm of the lesion. All lesions and seeds were removed. One participant needed re-excision for involved margins. Radiologists and surgeons both preferred ROLLIS. Surgeons were able to depend on the seed for localisation in all but one case. Sentinel node biopsy was successfully performed when required. Pathologists found seed retrieval quick and easy, with no detrimental effect on tissue processing. No radiation doses measurably above background were received by staff. CONCLUSION: ROLLIS is an easily learnt, safe and effective alternative technique to standard HWL.