Surgical outcomes after radioactive 125I seed versus hookwire localization of non-palpable breast cancer: a multicentre randomized clinical trial.
D B Taylor, A G Bourke, E J Westcott, M L Marinovich, C Y L Chong, R Liang, R L Hughes, E Elder, C M Saunders
Journal: The British journal of surgery
2021;108(1):40-48
PMID: 33640932
Abstract
[{"label":"BACKGROUND","text":"Previous studies have suggested improved efficiency and patient outcomes with 125I seed compared with hookwire localization (HWL) in breast-conserving surgery, but high-level evidence of superior surgical outcomes is lacking. The aim of this multicentre pragmatic RCT was to compare re-excision and positive margin rates after localization using 125I seed or hookwire in women with non-palpable breast cancer."},{"label":"METHODS","text":"Between September 2013 and March 2018, women with non-palpable breast cancer eligible for breast-conserving surgery were assigned randomly to preoperative localization using 125I seeds or hookwires. Randomization was stratified by lesion type (pure ductal carcinoma in situ (DCIS) or other) and study site. Primary endpoints were rates of re-excision and margin positivity. Secondary endpoints were resection volumes and weights."},{"label":"RESULTS","text":"A total of 690 women were randomized at eight sites; 659 women remained after withdrawal (125I seed, 327; HWL, 332). Mean age was 60.3\u00a0years in the 125I seed group and 60.7\u00a0years in the HWL group, with no difference between the groups in preoperative lesion size (mean 13.2\u00a0mm). Lesions were pure DCIS in 25.9 per cent. The most common radiological lesion types were masses (46.9 per cent) and calcifications (28.2 per cent). The localization modality was ultrasonography in 65.5 per cent and mammography in 33.7 per cent. The re-excision rate after 125I seed localization was significantly lower than for HWL (13.9 versus 18.9 per cent respectively; P\u2009=\u20090.019). There were no significant differences in positive margin rates, or in specimen weights and volumes."},{"label":"CONCLUSION","text":"Re-excision rates after breast-conserving surgery were significantly lower after 125I seed localization compared with HWL. Registration number: ACTRN12613000655741 (http:\/\/www.ANZCTR.org.au\/)."},{"copyright":"\u00a9 The Author(s) 2020. Published by Oxford University Press on behalf of BJS Society Ltd."}]
Address:
Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia.; Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.; BreastScreen WA, Perth, Western Australia, Australia.; Breast Centre, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia.; Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia.; School of Physics, University of Western Australia, Crawley, Perth, Western Australia, Australia.; School of Public Health, Curtin University, Bentley, Perth, Western Australia, Australia.; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, New South Wales, Australia.; Monash Health School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia.; Department of Surgery, Gold Coast Hospital and Health Service, Robina, Queensland, Australia.; Radiology Department, Waikato District Health Board, Hamilton, New Zealand.; Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.; Breast Centre, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia.; Department of Surgery, St John of God Hospital, Subiaco, Perth, Western Australia, Australia.
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MeSH Terms:
Breast Neoplasms,
Carcinoma, Intraductal, Noninfiltrating,
Female,
Humans,
Iodine Radioisotopes,
Margins of Excision,
Mastectomy, Segmental,
Middle Aged,
Surgery, Computer-Assisted,
Treatment Outcome
