Preoperative Radioactive Seed Localization for Nonpalpable Breast Lesions: Technique, Pitfalls, and Solutions

Iodine 125 ((125)I) radioactive seed localization has emerged as a reliable and safe alternative to wire localization for guidance during the surgical resection of nonpalpable breast lesions. The breast imager has a responsibility to be familiar with the general principles of this evolving technique, including its advantages and disadvantages as well as the technical differences involved in placement of seeds versus traditional wire localization. Although placement of (125)I seeds is conceptually similar to wire placement, there are additional technical considerations and safety measures that need to be addressed and implemented when radioactive seeds are used. We draw from our experience with more than 1000 cases of radioactive seed localization since inception of our program in 2009 to provide illustrative examples of not only the proper technique of radioactive seed localization, but also mishaps that may occur during this procedure, along with practical suggestions to prevent these problems. We examine some of the difficulties that we have encountered during radioactive seed localization at our institution, including bone wax mimicking the seed, the inadvertent deployment of seeds, the need for multiple seeds or supplemental wires, problematic seed locations, and difficulty in surgical retrieval of the seed. Recognizing the potential pitfalls of radioactive seed localization and understanding the appropriate guidelines and precautions for the safe, secure handling and placement of radioactive seeds is essential for a successful radioactive seed localization program.