Preoperative localization of breast lesions: Current techniques


      • Localization of breast lesions is a common procedure that has evolved as surgical, imaging, and biomedical technology have progressed.
      • Wire localization, introduced almost 50 years ago, was the first technique introduced to help localize nonpalpable, image-detected breast lesions.
      • Preoperative radioactive seed localization was one of the first alternatives proposed to avoid some of the limitations encountered with wire localization.
      • Non-ionizing devices have recently emerged in the wake of progress made with radioseed localization.
      • Currently radiofrequency reflectors and magnetic seeds are gaining in popularity and will be seen more widely in the future.
      • Comparing and contrasting these techniques enables informed decisions about which technique is the best operational fit for a given practice.


      Image-guided preoperative localization of breast lesions is a common procedure. This article describes several commercially available localization options—wire localization, radioactive seed localization, localization with a radiofrequency reflector, and magnetic seed localization—and outlines the advantages and disadvantages of each. This information may help radiologists initiate conversations at their facilities with surgeons, pathologists, and hospital administration as they seek to add value and provide patient-centered care.


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        U.S. breast cancer statistics.
        ([120 East Lancaster Avenue, Suite 201 Ardmore, PA 19003])
        • NCC Network
        NCCN guidelines for patients.
        in: NCCN guuidelines for patients, breast cancer-early stage (stages I and II), version 12016. National Comprehensive Cancer Network, 2017
        • AC Society
        Cancer facts & figures 2017.
        American Cancer Society, 2017 ([250 Williams Street, NW, Atlanta, Georgia, U.S.A. 30303-1002])
        • Halsted W.S.
        I. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894.
        Ann Surg. 1894; 20: 497-555
        • Bland C.S.
        The Halsted mastectomy: present illness and past history.
        West J Med. 1981; 134: 549-555
        • Ghossain A.
        • Ghossain M.A.
        History of mastectomy before and after Halsted.
        J Med Liban. 2009; 57: 65-71
        • Hall F.M.
        • Kopans D.B.
        • Sadowsky N.L.
        • Homer M.J.
        Development of wire localization for occult breast lesions: Boston remembrances.
        Radiology. 2013; 268: 622-627
        • Frank H.A.
        • Hall F.M.
        • Steer M.L.
        Preoperative localization of nonpalpable breast lesions demonstrated by mammography.
        N Engl J Med. 1976; 295: 259-260
        • Kwasnik E.M.
        • Sadowsky N.L.
        • Vollman R.W.
        An improved system for surgical excision of needle-localized nonpalpable breast lesions.
        Am J Surg. 1987; 154: 476-477
        • Fisher B.
        • Anderson S.
        • Bryant J.
        • et al.
        Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.
        N Engl J Med. 2002; 347: 1233-1241
        • Veronesi U.
        • Cascinelli N.
        • Mariani L.
        • et al.
        Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.
        N Engl J Med. 2002; 347: 1227-1232
        • Agarwal S.
        • Pappas L.
        • Neumayer L.
        • Kokeny K.
        • Agarwal J.
        Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer.
        JAMA Surg. 2014; 149: 267-274
        • Lautner M.
        • Lin H.
        • Shen Y.
        • et al.
        Disparities in the use of breast-conserving therapy among patients with early-stage breast cancer.
        JAMA Surg. 2015; 150: 778-786
        • Homer M.J.
        • Pile-Spellman E.R.
        Needle localization of occult breast lesions with a curved-end retractable wire: technique and pitfalls.
        Radiology. 1986; 161: 547-548
        • Kopans D.B.
        • Meyer J.E.
        Versatile spring hookwire breast lesion localizer.
        Am J Roentgenol. 1982; 138: 586-587
        • Loving V.A.
        • Edwards D.B.
        • Roche K.T.
        • et al.
        Monte Carlo simulation to analyze the cost-benefit of radioactive seed localization versus wire localization for breast-conserving surgery in fee-for-service health care systems compared with accountable care organizations.
        Am J Roentgenol. 2014; 202: 1383-1388
        • Romanoff A.
        • Nulsen B.
        • Mester J.
        • Jaffer S.
        • Weltz C.
        Ultrasound-guided wire localization of focal ductal dilatation in the evaluation and treatment of pathologic nipple discharge.
        Breast J. 2017; 24: 356-359
        • Morris E.A.
        • Liberman L.
        • Dershaw D.D.
        • et al.
        Preoperative MR imaging-guided needle localization of breast lesions.
        Am J Roentgenol. 2002; 178: 1211-1220
        • Liberman L.
        • Kaplan J.
        • Van Zee K.J.
        • et al.
        Bracketing wires for preoperative breast needle localization.
        Am J Roentgenol. 2001; 177: 565-572
        • Helvie M.A.
        • Ikeda D.M.
        • Adler D.D.
        Localization and needle aspiration of breast lesions: complications in 370 cases.
        Am J Roentgenol. 1991; 157: 711-714
        • Homer M.J.
        Transection of the localization hooked wire during breast biopsy.
        Am J Roentgenol. 1983; 141: 929-930
        • Homer M.J.
        Localization of transected wire.
        Am J Roentgenol. 1991; 157: 645
        • Bronstein A.D.
        • Kilcoyne R.F.
        • Moe R.E.
        Complications of needle localization of foreign bodies and nonpalpable breast lesions.
        Arch Surg. 1988; 123: 775-779
        • van Susante J.L.
        • Barendregt W.B.
        • Bruggink E.D.
        Migration of the guide-wire into the pleural cavity after needle localization of breast lesions.
        Eur J Surg Oncol. 1998; 24: 446-448
        • Banitalebi H.
        • Skaane P.
        Migration of the breast biopsy localization wire to the pulmonary hilus.
        Acta Radiol. 2005; 46: 28-31
        • Azoury F.
        • Sayad P.
        • Rizk A.
        Thoracoscopic management of a pericardial migration of a breast biopsy localization wire.
        Ann Thorac Surg. 2009; 87: 1937-1939
        • Jakub J.
        • Gray R.
        Starting a radioactive seed localization program.
        Ann Surg Oncol. 2015; 22: 3197-3202
        • Lovrics P.J.
        • Cornacchi S.D.
        • Vora R.
        • Goldsmith C.H.
        • Kahnamoui K.
        Systematic review of radioguided surgery for non-palpable breast cancer.
        Eur J Surg Oncol. 2011; 37: 388-397
        • Jackman R.J.
        • Marzoni Jr., F.A.
        Needle-localized breast biopsy: why do we fail?.
        Radiology. 1997; 204: 677-684
        • Berlin L.
        Faster reporting speed and interpretation errors: conjecture, evidence, and malpractice implications.
        J Am Coll Radiol. 2015; 12: 894-896
        • Sokolovskaya E.
        • Shinde T.
        • Ruchman R.B.
        • et al.
        The effect of faster reporting speed for imaging studies on the number of misses and interpretation errors: a pilot study.
        J Am Coll Radiol. 2015; 12: 683-688
        • Gray R.J.
        • Salud C.
        • Nguyen K.
        • et al.
        Randomized prospective evaluation of a novel technique for biopsy or lumpectomy of nonpalpable breast lesions: radioactive seed versus wire localization.
        Ann Surg Oncol. 2001; 8: 711-715
        • Hughes J.H.
        • Mason M.C.
        • Gray R.J.
        • et al.
        A multi-site validation trial of radioactive seed localization as an alternative to wire localization.
        Breast J. 2008; 14: 153-157
        • Sharek D.
        • Zuley M.L.
        • Zhang J.Y.
        • Soran A.
        • Ahrendt G.M.
        • Ganott M.A.
        Radioactive seed localization versus wire localization for lumpectomies: a comparison of outcomes.
        Am J Roentgenol. 2015; 204: 872-877
        • Dryden M.J.
        • Dogan B.E.
        • Fox P.
        • et al.
        Imaging factors that influence surgical margins after preoperative 125I radioactive seed localization of breast lesions: comparison with wire localization.
        Am J Roentgenol. 2016; 206: 1112-1118
        • Jakub J.W.
        • Gray R.J.
        • Degnim A.C.
        • Boughey J.C.
        • Gardner M.
        • Cox C.E.
        Current status of radioactive seed for localization of non palpable breast lesions.
        Am J Surg. 2010; 199: 522-528
      1. United States Nuclear Regulatory Commission. Iodine-125 and palladium-103 low dose rate brachytherapy seeds used for localization of non-palpable lesions. In: Nuclear materials. Accessed 2/14/2019

        • Bloomquist E.V.
        • Ajkay N.
        • Patil S.
        • Collett A.E.
        • Frazier T.G.
        • Barrio A.V.
        A randomized prospective comparison of patient-assessed satisfaction and clinical outcomes with radioactive seed localization versus wire localization.
        Breast J. 2016; 22: 151-157
        • Caudle A.S.
        • Yang W.T.
        • Mittendorf E.A.
        • et al.
        Selective surgical localization of axillary lymph nodes containing metastases in patients with breast cancer: a prospective feasibility trial.
        JAMA Surg. 2015; 150: 137-143
        • Pavlicek W.
        • Walton H.A.
        • Karstaedt P.J.
        • Gray R.J.
        Radiation safety with use of I-125 seeds for localization of nonpalpable breast lesions.
        Acad Radiol. 2006; 13: 909-915
        • Mango V.
        • Ha R.
        • Gomberawalla A.
        • Wynn R.
        • Feldman S.
        Evaluation of the SAVI SCOUT surgical guidance system for localization and excision of nonpalpable breast lesions: a feasibility study.
        Am J Roentgenol. 2016; : w1-w4
        • Hayes M.K.
        Update on preoperative breast localization.
        Radiol Clin North Am. 2017; 55: 591-603
        • Kalambo M.
        • Parikh J.R.
        Implementing the SAVI SCOUT system in community radiology practice.
        J Am Coll Radiol. 2017; 14: 1234-1238
        • Cox C.E.
        • Garcia-Henriquez N.
        • Glancy M.J.
        • et al.
        Pilot study of a new nonradioactive surgical guidance technology for locating nonpalpable breast lesions.
        Ann Surg Oncol. 2016; 23: 1824-1830
        • Schermers B.
        • van der Hage J.A.
        • Loo C.E.
        • et al.
        Feasibility of magnetic marker localisation for non-palpable breast cancer.
        Breast (Edinburgh, Scotland). 2017; 33: 50-56
        • Price E.R.
        • Khoury A.L.
        • Esserman L.J.
        • Joe B.N.
        • Alvarado M.D.
        Initial clinical experience with an inducible magnetic seed system for preoperative breast lesion localization.
        Am J Roentgenol. 2018; 210: 913-917
        • Harvey J.R.
        • Lim Y.
        • Murphy J.
        • et al.
        Safety and feasibility of breast lesion localization using magnetic seeds (Magseed): a multi-centre, open-label cohort study.
        Breast Cancer Res Treat. 2018; 169: 531-536
        • Mayo 3rd, R.C.
        • Parikh J.R.
        Breast imaging: the face of imaging 3.0.
        J Am Coll Radiol. 2016; 13: 1003-1007
        • Mango V.L.
        • et al.
        Beyond wires and seeds: reflector-guided breast lesion localization and excision.
        Radiology. 2017; 284: 365-371
        • Lamb L.R.
        • et al.
        Evaluation of a nonradioactive magnetic marker wireless localization program.
        Am J Roentgenol. 2018; 211: 940-945