Dear Sir, We read with interest the recent article by J.E. Jansen and colleagues [1] regarding the influence of wire localisation for non-palpable breast lesions on visualisation of the sentinel node. We were particularly struck by their conclusion that guide wire localisation prior to the sentinel node procedure negatively influences visualisation of the sentinel node. In the reported series, a total of 136 patients underwent a wireguided tumour excision combined with a sentinel node procedure. Sixty-six patients had guide wire localisation prior to the sentinel node procedure, while 70 had sentinel node visualisation before insertion of the guide wire. The sentinel node was visualised in 41 (62%) of the patients who first underwent guide wire localisation. In the group of patients who underwent visualisation of the sentinel node before placement of the guide wire, the sentinel node was visualised in 62 (89%). This was a significant difference in visualisation (p<0.001). The authors concluded that insertion of a wire in patients with occult breast tumours somehow disturbs the subsequent sentinel node procedure. We would like to point out some considerations. First, regardless of the different timing of the sentinel node biopsy (prior to or after guide wire localisation), the sentinel lymph node identification rate in the series of Jansen et al. appears to be much lower than that reported in the current literature. In the American Society of Clinical Oncology (ASCO) guideline recommendations for sentinel lymph node biopsy in early stage breast cancer [2], 69 studies (10,454 patients) were analysed in which sentinel node biopsy was compared with completion axillary dissection. The overall sensitivity of the sentinel node biopsy ranged from 71% to 100%, but was about 95% in the larger reported studies in which the lymphoscintigraphic technique (alone or in association with the blue dye technique) was used. In the pioneering experience of the European Institute of Oncology, recently published [3], the sentinel node identification rate was 99%. Secondly, in order to explain the findings of their study, Jansen et al. affirm that the localisation of a wire somehow changes the local anatomy and physiology, resulting in a disturbance of tracer drainage. They point out that oedema caused by an inflammatory reaction as a result of the impact of insertion of the wire may offer an explanation for the changes. They also mention that wire insertion causes higher external pressure on lymphatic channels, resulting in distal obstruction of these vessels; this is cited as another possible explanation, especially when several attempts are needed to place the wire at the right location, thus increasing the local impact on the breast tissue. Unfortunately, neither a previous diagnostic biopsy (e.g. fine-needle aspiration cytology, vacuum-assisted biopsy) nor a previous excision biopsy, including tumorectomy and quadrantectomy, is considered a contraindication to sentinel node biopsy. Prior breast surgery does not modify the success rate of sentinel node identification [2], so how can a less invasive procedure such as a simple wire insertion decrease the sentinel node identification rate? Finally, we agree with Jansen et al. that radioguided occult lesion localisation (ROLL) for non-palpable breast lesions can easily substitute for the wire insertion techEur J Nucl Med Mol Imaging (2007) 34:957–958 DOI 10.1007/s00259-007-0397-2