A major new study led by researchers at Wake Forest University School of Medicine and Atrium Health Levine Cancer finds that a modern technique for marking breast tumors before surgery, called radioactive seed localization (RSL), is as effective as the traditional wire method—while being easier and more comfortable for patients.
Published in Annals of Surgery, the study is the largest U.S. randomized trial comparing RSL with wire localization (WL) for breast-conserving surgery. Each year, thousands of women undergo surgery to remove tumors that cannot be felt by hand, and precise tumor localization is critical for successful treatment.
Traditionally, surgeons have used wires to mark tumors, a method that can be uncomfortable and stressful. RSL, a newer approach, uses a tiny radioactive seed to mark the tumor, simplifying the process and reducing patient anxiety.
“Improving the patient experience during breast cancer treatment is a top priority,” said Dr. Lejla Hadzikadic-Gusic, the study’s lead investigator and surgical oncologist at Atrium Health Levine Cancer. “Our study shows that radioactive seed localization is a safe, effective alternative that patients and providers prefer.”
Between July 2015 and January 2021, the research team conducted a randomized trial at Atrium Health Levine Cancer involving 400 women with nonpalpable malignant breast tumors. Participants were randomly assigned to receive either RSL or WL before surgery.
The study looked at how often surgeons could remove the tumor with clear margins (no cancer cells at the edges), while also assessing patient anxiety, pain, satisfaction, procedure cost, and the experience of surgeons, radiologists, and pathologists.
Key Findings
Both RSL and WL were equally effective at helping surgeons remove tumors with clear margins.
Patients who received RSL reported less pain, lower anxiety, and higher satisfaction with their procedure.
Surgeons and radiologists found RSL more convenient and satisfying to perform.
RSL cost roughly $600 more per patient than WL, though this refers to the procedure itself, not out-of-pocket expenses.
“Our results confirm that radioactive seed localization should be considered a favorable option for breast tumor localization,” said Hadzikadic-Gusic. “Patients felt less anxious and more comfortable, and our surgical teams appreciated the flexibility and convenience of the technique.”
The study supports RSL as a patient-centered alternative to wire localization, with the potential to improve both clinical outcomes and quality of life for women undergoing breast-conserving surgery.
Researchers plan to continue exploring ways to make breast cancer surgery even safer and more comfortable. Future studies may examine long-term outcomes, cost-effectiveness, and broader integration of RSL in hospitals and surgical centers.
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