Hamza Aziz *,Randall Scheri ,Jay Baker ,E Shelley Hwang
Introduction: Axillary lymph node biopsy in an irradiated or previously operated axilla can be technically challenging. Radio-labeled seed localized (RSL) biopsy is an emerging modality for localizing tissue of interest that is not amenable to wire localization.
Case Report: A 60 year old female with history of breast cancer presented ten months after her initial resection with a new chest wall mass and an enlarged right axillary lymph node situated posterior and superior to the axillary vein. Given its location, wire localization was not possible and on the other hand operating without localization was too risky. We elected to place a 125I labeled titanium seed in the lymph node which greatly facilitated this otherwise difficult dissection and safely delivered the specimen needed for diagnostic purposes.
Discussion: With the advancement of imaging technology, surgeons are able to safely and accurately recover diagnostic tissue specimen from extremely challenging anatomic spaces. Radio-labeled seed localization is another step in furthering surgical capabilities in this regard. RSL provides several advantages over wire localization: placement in lesions located deep in body cavities, seed placement can be scheduled a day prior to surgery thus making it more easier on patients, and no risk of cutting or dislodging the wire.
Clinical practice points: The use of radio-labeled seed localized (RSL) breast biopsy is growing in popularity and is replacing wire localized breast biopsy.
We present a case of a radioactive seed localized axillary lymph node resection that was not amenable to wire localization. Radioactive seed allowed precise localization of the node in a difficult anatomic location, thus facilitating successful resection of the node.
Seed localization is a versatile approach for localizing lesions of interest and holds promise for not only breast surgery, but also for marking nodes or lesions of interest that are located deep in the abdominal or thoracic cavity.