Jacky Luiten

Iodine seed ‐ versus wire ‐ guided localization in breast ‐ conserving surgery for non ‐ palpable DCIS | 91 6 Discussion This single ‐ center retrospective cohort study compared I ‐ 125 GL with WGL of non ‐ palpable DCIS during BCS. Patients who had I ‐ 125 GL had a significantly lower risk of extensively involved resection margins than those whose lesions were localized by WGL. This resulted in fewer patients requiring additional surgical treatment. Although WGL is a commonly used localization technique, it has several limitations. 13 Exact placement of the guidewire can be more demanding for radiologists, especially as the hook of the wire precludes repositioning. Consequently, the procedure can be hampered by the fact that the surgeon cannot exactly define the location of the lesion in relation to the tip of the wire during the surgery. 14 Finding the tip of the guidewire can also be challenging. Furthermore, guidewires may dislocate or can be lost before or during surgery, leaving the surgeon without any reliable tool to locate the lesion. Wires placed under ultrasound or stereotactic guidance may sometimes also enter the breast at a considerable distance from the lesion, which renders the surgical procedure rather cumbersome, requiring extensive dissection to follow the tract of the wire towards the tip. 15 It has also been reported by breast surgeons familiar with both techniques that the surgical procedure with iodine ‐ 125 seeds is easier to perform. 16 In contrast to guidewires, an iodine ‐ 125 seed can be localized exactly in three dimensions using a hand ‐ held γ‐ probe. This allows the surgeon to navigate accurately towards the lesion. An additional advantage of this technique is the possibility of using two or more seeds, which makes it possible to mark the exact location and diameter of the lesion. 17 This allows surgeons to extend BCS to even larger DCIS lesions. Finally, iodine ‐ 125 seeds can be used not only for non ‐ palpable breast lesions, including both invasive breast cancer and DCIS, but also several months before surgery to mark original tumor borders in patients who will subsequently be treated with neoadjuvant chemotherapy. 8 , 18 Apart from the surgical technique, patient comfort is also of importance when judging the quality of healthcare. In patient ‐ reported outcomes, insertion of the hook wire used in WGL has been reported as uncomfortable and painful. 6 The wire sticks out of the breast and has to be secured by tape to keep it in place until surgery. This procedure not only causes discomfort, but also the wire is at risk of dislocation or being lost. 7 Wires are placed by a radiologist and the procedure can be time ‐ consuming, potentially disturbing operating theatre scheduling as it is preferably carried out immediately preceding surgery. A weakness of this study is its retrospective nonrandomized design. However, it reflects the real ‐ world experience of these localization techniques among surgeons