Abstract
Breast conserving surgery has become the standard of care and is more commonly performed than mastectomy for early stage breast cancer, with recent studies showing equivalent survival and lower morbidity. Accurate preoperative lesion localization is mandatory to obtain adequate oncological and cosmetic results. Image guidance assures the precision requested for this purpose. This review provides a summary of all techniques currently available, ranging from the classic wire positioning to the newer magnetic seed localization. We describe the procedures and equipment necessary for each method, outlining the advantages and disadvantages, with a focus on the cost-effective preoperative skin tattoo technique performed at our centre. Breast surgeons and radiologists have to consider ongoing technological developments in order to assess the best localization method for each individual patient and clinical setting.
Highlights
Introduction iationsBreast cancer (BC) is the most commonly diagnosed cancer and the leading cause of cancer-related death among women [1]
Carbon marking (CM) is an alternative method for non-palpable breast lesion localization first reported by Svane in 1983, consisting of an injection of sterile charcoal powder diluted with saline solution in close proximity to the lesion [46]
(arrow) in the left upper outer quadrant in a 77-year-old woman. (b) Intratumoral injection of a small amount (0.2–0.3 mL) of human serum albumin marked with nuclear radiotracer technetium 99 in order to perform radio-guided occult lesion localization
Summary
Wires emit no ionizing radiation and can be stored safely within the imaging department This approach allows localizations of breast lesions under different kinds of image guidance (US, mammography/tomosynthesis or MRI). The hookwire can be transected during the surgery, with pieces being retained in the breast post-operatively [44,45] This localization approach requires adequate coordination between trained breast radiologists and surgeons because the wire placement has to occur on the day of surgery to avoid displacement. This limitation can lead to inconvenience and delay in the operating room or suboptimal localization. Wire localization could limit the surgical approach and cause a potential worse cosmetic outcome; the placement route of the wire, chosen by the radiologist, often dictates incision choice for the surgeon who has to follow the wire’s course during dissection
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