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Bracketing with Multiple Radioactive Seeds to Achieve Negative Margins in Breast Conservation Surgery

Multiple Seeds in Breast Surgery

      Highlights

      • Breast conservation surgery is the treatment of choice for unifocal breast cancer.
      • Breast conservation is less feasible with locally advanced tumors or extensive ductal carcinoma in situ.
      • Radioactive seed localization may allow breast conservation in this population.
      • An approach using multiple radioactive seeds is validated in our study.

      Abstract

      Introduction

      Breast conservation surgery (BCS) is the treatment of choice for unifocal, early-stage breast cancer. The ability to offer BCS to a wider subset of patients, including those with multifocal/multicentric cancer as well as extensive ductal carcinoma in situ, has emerged over time, especially in those undergoing joint oncoplastic reconstruction and those treated with neoadjuvant therapy. However, localization techniques using multiple radioactive seeds for bracketing in this patient subset have not been validated.

      Materials and Methods

      A single-institution retrospective review was conducted of all patients with breast cancer who underwent BCS, guided by multiple bracketed iodine I 125 radioactive seeds between January 2014 and April 2017.

      Results

      Bracketing of breast cancer using 2 or more radioactive seeds was performed in 157 breasts in 156 patients. Negative margins were achieved in 124 of 157 (79%) breasts, including 33 cases (21%) that underwent targeted margin reexcision at the time of surgery after intraoperative, multidisciplinary margin assessment. Thirty-three cases (21%) resulted in close or positive margins, of which 11 (7%) and 10 (6.4%) underwent completion mastectomy or repeat lumpectomy, respectively. Twelve patients (7.6%) did not undergo reexcision. En bloc resection was successful in 134 of 157 (85.4%) lumpectomies. Eighty-nine percent of the procedures were coupled with oncoplastic reconstruction.

      Conclusion

      Bracketing techniques using multiple radioactive seeds expands the indications for breast conservation therapy in patients who would have traditionally required mastectomy. Intraoperative margin assessment improves surgical and pathologic success. Larger defects created by multifocal resection are optimally managed in concert with oncoplastic reconstruction to minimize asymmetries and aesthetic defects.

      Keywords

      Abbreviations:

      BCS (breast conservation surgery), BCT (breast conservation therapy), DCIS (ductal carcinoma in situ), IDC (invasive ductal carcinoma), ILC (invasive lobular carcinoma), MCBC (multicentric breast cancer), MFBC (multifocal breast cancer), NWL (nonwire localization), pCR (pathologic complete response), WL (wire localization)
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