Advances in Breast Localization Techniques: An Opportunity to Improve Quality of Care and Patient Satisfaction

Modalities

Image-guided percutaneous localizations of nonpalpable breast lesions can be performed using mammography, tomosynthesis, ultrasound (US), and magnetic resonance imaging (MRI). Three factors affect modality choice when performing a localization: (1) lesion conspicuity with modality of choice; (2) compatibility of localization system with modality of choice; and (3) patient comfort. Wire guided localization (WGL) systems can be used under mammographic, tomographic, ultrasound, and MRI guidance,

Traditional Wire Localization

Traditional WGL has evolved since Dodd's initial description in 1965. A variety of modified spring hookwires have replaced the original stiff wires⁸ (Fig. 1). These modified spring hookwires are flexible and held in place by a distal hook. In many hookwire models, a stiffened proximal segment can be palpated by the operating surgeon. WGL is most commonly performed with local anesthetic on the same day of the operative procedure. As radiologic imaging equipment is required, WGL procedures are

Radioguided Localization

Luini et al first pioneered radioguided localization techniques for nonpalpable breast lesions in 1998.²³ The radioguided occult lesion localization (ROLL) technique, which mimics injection of ⁹⁹technetium for sentinel node localization, utilizes ⁹⁹technetium (140 keV emission) injection into the breast lesion performed under sonographic or mammographic guidance. Injection can be performed the day prior, or morning of surgery. Surgical intervention must be within 24 hours of injection. At the

Savi Scout

The Savi Scout (Cianna Medical, Aliso Viejo, CA) device was FDA approved for use in the US in 2014, and is now approved for placement up to 30 days prior to surgery. This device consists of a 12 mm infrared-activated electromagnetic wave reflector device, made up of an infrared light receptor, resistor, and 2 antennae. The antennae, located at opposite ends of the device, help anchor the device in the tissue. An infrared light and electromagnetic wave emitting handpiece is used to locate the

Magseed (Endomagnetics, Inc, Austin, TX)

Magseed (Endomagnetics, Inc, Austin, TX) is another nonwire localization device, more recently introduced to the US market in 2016 when it gained FDA approval. While studies are ongoing, there is a paucity of published literature for Magseed localizations.³⁷

Magseed is a 5 mm metal marker containing iron. It is preloaded in a sterile 18-gauge introducer, currently available in only 12 cm and 20 cm lengths. Delivery is very similar to deploying a biopsy marking clip, and placement can be done

Conclusions

Recent advances in localization techniques for nonpalpable breast lesions requiring surgical excision include radioactive seeds, electromagnetic wave reflector devices, and iron containing magnets. These emerging technologies offer an opportunity to schedule localization procedures independently from surgical procedures and to improve quality of care and patient satisfaction. Radiologists and surgeons alike report positive experiences in transitioning to newer localization systems.

Funding Sources

This material is based in part upon work supported by the Office of Academic Affiliations, Department of Veterans Affairs, VA National Quality Scholars Program and with resources and the use of facilities at VA Tennessee Valley Healthcare System, Nashville TN.