CHARLOTTE, N.C., Dec. 18, 2025 — A new study led by researchers at Wake Forest University School of Medicine and Atrium Health Levine Cancer has found that a modern technique for locating breast tumors before surgery, called radioactive seed localization (RSL), is just as effective as the traditional wire localization (WL) method, while offering patients and surgeons a better overall experience.
The study, which is the largest randomized trial in the U.S. comparing these two localization methods for breast cancer surgery, was recently published in the December issue of Annals of Surgery .
Each year, thousands of women diagnosed with breast cancer undergo surgery to remove tumors that cannot be felt by hand. Locating these tumors accurately is critical for successful treatment. Traditionally, surgeons have relied on wire localization, which can be uncomfortable and stressful for patients. A newer technique, RSL, uses a tiny I-125 radioactive seed to mark the tumor, potentially making the process easier and less anxiety-provoking.
“Improving the patient experience during breast cancer treatment is a top priority,” said Lejla Hadzikadic-Gusic, M.D. , principal investigator on the study and surgical oncologist at Atrium Health Levine Cancer and associate professor of surgery at Wake Forest University School of Medicine. “Our study shows that radioactive seed localization is a safe and effective alternative that patients and providers prefer.”
The research team conducted a randomized, prospective clinical trial at Atrium Health Levine Cancer between July 2015 and January 2021, the largest such trial at this institution. Four hundred women with nonpalpable malignant breast tumors were randomly assigned to receive either RSL or WL before breast-conserving surgery. The main goal was to compare how often surgeons were able to remove the tumor with clear margins (no cancer cells at the edge of the tissue). Researchers also measured patient anxiety, pain, satisfaction and the cost of each procedure, in addition to the experience of surgeons, pathologists and radiologists with the technology.
Key Findings
Both RSL and WL were equally effective at helping surgeons remove tumors with clear margins.
Patients who received RSL reported less pain and anxiety as well as higher satisfaction with their procedure.
Surgeons and radiologists also rated RSL as more convenient and satisfying to perform.
The cost of RSL was slightly higher, about $600 more per patient. This cost refers to the procedure itself and does not necessarily reflect out-of-pocket expenses for patients.
“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 findings support the use of 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.
The research team plans to continue studying ways to make breast cancer surgery even safer and more comfortable for patients. Hadzikadic-Gusic said future studies may examine long-term outcomes, cost-effectiveness and how RSL can be integrated into more hospitals and surgical centers.
This trial was led by Atrium Health Levine Cancer, the largest cancer program in the Carolinas, which includes the NCI-designated Comprehensive Cancer Center at Atrium Health Wake Forest Baptist. Wake Forest University School of Medicine, the academic core of Advocate Health, advances cancer care through more than 1,000 clinical trials nationwide.
Annals of Surgery
Randomized controlled/clinical trial
People
A Randomized, Single-Center, Superiority Trial of Radioactive Seed Localization Versus Wire Localization for Malignant Breast Disease