Guiding Breast-Conserving Surgery in Patients After Neoadjuvant Systemic Therapy for Breast Cancer: A Comparison of Radioactive Seed Localization with the ROLL Technique

Radioguided occult lesion localization (ROLL) with technetium-99 m colloid (ROLL-Tc-99m) is commonly used to perform breast-conserving surgery in patients with nonpalpable breast tumors. Radioactive seed localization is a relatively new technique that localizes the tumor with a radioactive iodine-125 (I-125) seed. The feasibility and outcome of these techniques after neoadjuvant systemic treatment has not been widely investigated. All patients treated with neoadjuvant systemic treatment between 2007 and 2010 in the Netherlands Cancer Institute who underwent breast-conserving surgery with the ROLL-Tc-99m technique (n = 83) or with I-125 seed localization (n = 71) were analyzed. The weight of the resected specimen, the margins, and the percentage of patients requiring a second surgical intervention as a result of positive margins were assessed. Patient and tumor characteristics and systemic treatment regimens were comparable between both groups. The median weight of the resected specimen (53 vs. 48 g), the median smallest margin (3.5 vs. 3.0 mm), and the risk for additional surgery for incomplete resections (7 vs. 8 %) did not differ significantly between patients treated with the ROLL-Tc-99m technique and I-125 seed localization. The ROLL-Tc-99m technique and I-125 seed localization demonstrate comparable results when used to perform breast-conserving surgery after neoadjuvant systemic treatment. Because I-125 seed localization does not require additional radiological localization shortly before surgery, it simplifies surgery scheduling. Therefore, we prefer I-125 seed localization to perform breast-conserving surgery after neoadjuvant systemic treatment.