Skip to main content

Advertisement

SpringerLink
Log in

Current Trends in Localization Techniques for Non-palpable Breast Lesions: Making the Invisible Visible

  • Local-Regional Evaluation and Therapy (EP Mamounas, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of review

With ever more sophisticated imaging modalities and screening programs, the incidence of small, non-palpable breast cancers is increasing. This poses a unique challenge to surgeons who seek to obtain negative margins while maintaining a cosmetically acceptable breast. Herein, we review the current localization techniques available and discuss the latest advancements.

Recent findings

While wire localization remains the historical gold standard for non-palpable breast lesion localization, many new invasive and non-invasive techniques have been utilized in recent years. These techniques can be performed by the surgeon alone or in conjunction with a radiologist partner. Multiple new techniques employ the insertion or deposit of a radioactive device or substance to identify the lesion. Positive margin status, clinician and patient comfort, and procedural time and ease have been serially evaluated as means to judge differences between localization techniques. However, the literature measuring these variables is heterogeneous with respect to definition across techniques making direct comparisons difficult. Further, the recent widespread adoption of “no tumor” at ink as a negative margin has revolutionized and standardized what constitutes a negative margin in invasive breast cancer. As a result, some of the previously reported benefits to certain localization techniques may not be as relevant today.

Summary

Localization techniques for non-palpable breast lesions are evolving. Trends away from wire-guided localization to radioactive-implanted sources to surgeon-directed, ultrasound-guided or non-radioactive implantable devices are occurring. Unfortunately, current literature is heterogenous with respect to type of localization technique and outcomes reported, making direct comparison between the multiple localization techniques difficult. As such, the main differences among techniques remain with volume of resection, source radioactivity, institutional resources, and surgeon and radiologist preference. The future will likely see implementation of technology that has the benefits of current techniques but without the associated limitations of tracking radioactive sources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Veronesi U. Conservative treatment of breast cancer: a trial in progress at the cancer Institute of Milan. World J Surg. 1977;1(3):324–6.

    Article  CAS  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, 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(16):1227–32.

    Article  PubMed  Google Scholar 

  3. Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Outlaw ED, Strom EA, et al. Breast conservation after neoadjuvant chemotherapy. Cancer. 2005;103(4):689–95.

    Article  PubMed  Google Scholar 

  4. Huang EH, Strom EA, Perkins GH, Oh JL, Chen AM, Meric-Bernstam F, et al. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score. Int J Radiat Oncol Biol Phys. 2006;66(2):352–7.

    Article  PubMed  Google Scholar 

  5. Kaufmann M, von Minckwitz G, Bear HD, Buzdar A, McGale P, Bonnefoi H, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006. Ann Oncol. 2007;18(12):1927–34.

    Article  CAS  PubMed  Google Scholar 

  6. Jakub JW. The search continues for the ideal method to localize nonpalpable breast lesions. Ann Surg Oncol. 2016;23(6):1799–800.

    Article  PubMed  Google Scholar 

  7. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol. 2014;21(3):704–16.

    Article  PubMed  Google Scholar 

  8. Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Pract Radiat Oncol. 2016;6(5):287–95.

    Article  PubMed  Google Scholar 

  9. Dodd G, Fry K, Delany W. Pre-operative localization of occult carcinoma of the breast. Nealon TF Management of the patient with cancer Philadelphia: Saunders. 1965:88–113.

  10. Hall FM, Frank HA. Preoperative localization of nonpalpable breast lesions. Am J Roentgenol. 1979;132(1):101–5.

    Article  CAS  Google Scholar 

  11. Rodhouse C, Soliman I, Cruse M, Kastrenakes J, Augustine CJ, Ludy A, et al. Localization methods for excisional biopsy in women with nonpalpable mammographic abnormalities. Clin Breast Cancer. 2017;17(1):18–22.

    Article  PubMed  Google Scholar 

  12. Davis PS, Wechsler RJ, Feig SA, March DE. Migration of breast biopsy localization wire. AJR Am J Roentgenol. 1988;150(4):787–8.

    Article  CAS  PubMed  Google Scholar 

  13. Grassi R, Romano S, Massimo M, Maglione M, Cusati B, Violini M. Unusual migration in abdomen of a wire for surgical localization of breast lesions. Acta Radiol. 2004;45(3):254–8.

    Article  CAS  PubMed  Google Scholar 

  14. Seifi A, Axelrod H, Nascimento T, Salam Z, Karimi S, Avestimehr S, et al. Migration of guidewire after surgical breast biopsy: an unusual case report. Cardiovasc Intervent Radiol. 2009;32(5):1087–90.

    Article  PubMed  Google Scholar 

  15. Svane G. A stereotaxic technique for preoperative marking of non-palpable breast lesions. Acta Radiol Diagn (Stockh). 1983;24(2):145–51.

    CAS  Google Scholar 

  16. Mazy S, Galant C, Berliere M, Mazy G. Localization of non-palpable breast lesions with black carbon powder (experience of the Catholic University of Louvain). J Radiol. 2001;82(2):161–4.

    CAS  PubMed  Google Scholar 

  17. Rose A, Collins JP, Neerhut P, Bishop CV, Mann GB. Carbon localisation of impalpable breast lesions. Breast. 2003;12(4):264–9.

    Article  CAS  PubMed  Google Scholar 

  18. Ko K, Han BK, Jang KM, Choe YH, Shin JH, Yang JH, et al. The value of ultrasound-guided tattooing localization of nonpalpable breast lesions. Korean J Radiol. 2007;8(4):295–301.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Egan JF, Sayler CB, Goodman MJ. A technique for localizing occult breast lesions. CA Cancer J Clin. 1976;26(1):32–7.

    Article  CAS  PubMed  Google Scholar 

  20. Nasrinossadat A, Ladan F, Fereshte E, Asieh O, Reza C, Akramossadat S, et al. Marking non-palpable breast masses with injected methylene blue dye, an easy, safe and low cost method for developing countries and resource-limited areas. Asian Pac J Cancer Prev. 2011;12(5):1189–92.

    PubMed  Google Scholar 

  21. Czarnecki DJ, Feider HK, Splittgerber GF. Toluidine blue dye as a breast localization marker. AJR Am J Roentgenol. 1989;153(2):261–3.

    Article  CAS  PubMed  Google Scholar 

  22. Tafra L, Fine R, Whitworth P, Berry M, Woods J, Ekbom G, et al. Prospective randomized study comparing cryo-assisted and needle-wire localization of ultrasound-visible breast tumors. Am J Surg. 2006;192(4):462–70.

    Article  PubMed  Google Scholar 

  23. Sahoo S, Talwalkar SS, Martin AW, Chagpar AB. Pathologic evaluation of cryoprobe-assisted lumpectomy for breast cancer. Am J Clin Pathol. 2007;128(2):239–44.

    Article  PubMed  Google Scholar 

  24. Larrieux G, Cupp JA, Liao J, Scott-Conner CE, Weigel RJ. Effect of introducing hematoma ultrasound-guided lumpectomy in a surgical practice. J Am Coll Surg. 2012;215(2):237–43.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Layeequr Rahman R, Crawford S, Larkin A, Quinlan R. Superiority of sonographic hematoma guided resection of mammogram only visible breast cancer: wire localization should be an exception--not the rule. Ann Surg Oncol. 2007;14(8):2228–32.

    Article  PubMed  Google Scholar 

  26. Layeequr Rahman R, Iuanow E, Crawford S, Quinlan R. Sonographic hematoma-guided vs wire-localized lumpectomy for breast cancer: a comparison of margins and volume of resection. Arch Surg. 2007;142(4):343–6.

    Article  PubMed  Google Scholar 

  27. Thompson M, Henry-Tillman R, Margulies A, Thostenson J, Bryant-Smith G, Fincher R, et al. Hematoma-directed ultrasound-guided (HUG) breast lumpectomy. Ann Surg Oncol. 2007;14(1):148–56.

    Article  PubMed  Google Scholar 

  28. Luini A, Zurrida S, Galimberti V, Paganelli G. Radioguided surgery of occult breast lesions. Eur J Cancer. 1998;34(1):204–5.

    Article  CAS  PubMed  Google Scholar 

  29. Medina-Franco H, Abarca-Perez L, Garcia-Alvarez MN, Ulloa-Gomez JL, Romero-Trejo C, Sepulveda-Mendez J. Radioguided occult lesion localization (ROLL) versus wire-guided lumpectomy for non-palpable breast lesions: a randomized prospective evaluation. J Surg Oncol. 2008;97(2):108–11.

    Article  PubMed  Google Scholar 

  30. Moreno M, Wiltgen JE, Bodanese B, Schmitt RL, Gutfilen B, da Fonseca LM. Radioguided breast surgery for occult lesion localization—correlation between two methods. J Exp Clin Cancer Res. 2008;27:29.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Rampaul RS, Bagnall M, Burrell H, Pinder SE, Evans AJ, Macmillan RD. Randomized clinical trial comparing radioisotope occult lesion localization and wire-guided excision for biopsy of occult breast lesions. Br J Surg. 2004;91(12):1575–7.

    Article  CAS  PubMed  Google Scholar 

  32. Dua SM, Gray RJ, Keshtgar M. Strategies for localisation of impalpable breast lesions. Breast. 2011;20(3):246–53.

    Article  PubMed  Google Scholar 

  33. Nadeem R, Chagla LS, Harris O, Desmond S, Thind R, Titterrell C, et al. Occult breast lesions: a comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL). Breast. 2005;14(4):283–9.

    Article  CAS  PubMed  Google Scholar 

  34. Chan BK, Wiseberg-Firtell JA, Jois RH, Jensen K, Audisio RA. Localization techniques for guided surgical excision of non-palpable breast lesions. Cochrane Database Syst Rev. 2015;12:CD009206.

    Google Scholar 

  35. Follacchio GA, Monteleone F, Anibaldi P, De Vincentis G, Iacobelli S, Merola R, et al. A modified sentinel node and occult lesion localization (SNOLL) technique in non-palpable breast cancer: a pilot study. J Exp Clin Cancer Res. 2015;34:113.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Monti S, Galimberti V, Trifiro G, De Cicco C, Peradze N, Brenelli F, et al. Occult breast lesion localization plus sentinel node biopsy (SNOLL): experience with 959 patients at the European Institute of Oncology. Ann Surg Oncol. 2007;14(10):2928–31.

    Article  PubMed  Google Scholar 

  37. Thind CR, Tan S, Desmond S, Harris O, Ramesh HS, Chagla L, et al. SNOLL. Sentinel node and occult (impalpable) lesion localization in breast cancer. Clin Radiol. 2011;66(9):833–9.

    Article  CAS  PubMed  Google Scholar 

  38. Pavlicek W, Walton HA, Karstaedt PJ, Gray RJ. Radiation safety with use of I-125 seeds for localization of nonpalpable breast lesions. Acad Radiol. 2006;13(7):909–15.

    Article  PubMed  Google Scholar 

  39. Dauer LT, Thornton C, Miodownik D, Boylan D, Holahan B, King V, et al. Radioactive seed localization with 125I for nonpalpable lesions prior to breast lumpectomy and/or excisional biopsy: methodology, safety, and experience of initial year. Health Phys. 2013;105(4):356–65.

    Article  CAS  PubMed  Google Scholar 

  40. Goudreau SH, Joseph JP, Seiler SJ. Preoperative radioactive seed localization for nonpalpable breast lesions: technique, pitfalls, and solutions. Radiographics. 2015;35(5):1319–34.

    Article  PubMed  Google Scholar 

  41. Graham RP, Jakub JW, Brunette JJ, Reynolds C. Handling of radioactive seed localization breast specimens in the pathology laboratory. Am J Surg Pathol. 2012;36(11):1718–23.

    Article  PubMed  Google Scholar 

  42. Sung JS, King V, Thornton CM, Brooks JD, Fry CW, El-Tamer M, et al. Safety and efficacy of radioactive seed localization with I-125 prior to lumpectomy and/or excisional biopsy. Eur J Radiol. 2013;82(9):1453–7.

    Article  PubMed  Google Scholar 

  43. Jakub J, Gray R. Starting a radioactive seed localization program. Ann Surg Oncol. 2015;22(10):3197–202.

    Article  PubMed  Google Scholar 

  44. Lovrics PJ, Cornacchi SD, Vora R, Goldsmith CH, Kahnamoui K. Systematic review of radioguided surgery for non-palpable breast cancer. Eur J Surg Oncol. 2011;37(5):388–97.

    Article  CAS  PubMed  Google Scholar 

  45. Murphy JO, Moo TA, King TA, Van Zee KJ, Villegas KA, Stempel M, et al. Radioactive seed localization compared to wire localization in breast-conserving surgery: initial 6-month experience. Ann Surg Oncol. 2013;20(13):4121–7.

    Article  PubMed  PubMed Central  Google Scholar 

  46. van der Noordaa ME, Pengel KE, Groen E, van Werkhoven E, Rutgers EJ, Loo CE, et al. The use of radioactive iodine-125 seed localization in patients with non-palpable breast cancer: a comparison with the radioguided occult lesion localization with 99m technetium. Eur J Surg Oncol. 2015;41(4):553–8.

    Article  PubMed  Google Scholar 

  47. Janssen NN, Nijkamp J, Alderliesten T, Loo CE, Rutgers EJ, Sonke JJ, et al. Radioactive seed localization in breast cancer treatment. Br J Surg. 2016;103(1):70–80.

    Article  CAS  PubMed  Google Scholar 

  48. Diego EJ, Soran A, McGuire KP, Costellic C, Johnson RR, Bonaventura M, et al. Localizing high-risk lesions for excisional breast biopsy: a comparison between radioactive seed localization and wire localization. Ann Surg Oncol. 2014;21(10):3268–72.

    Article  PubMed  Google Scholar 

  49. Dryden MJ, Dogan BE, Fox P, Wang C, Black DM, Hunt K, et al. Imaging factors that influence surgical margins after preoperative 125I radioactive seed localization of breast lesions: comparison with wire localization. AJR Am J Roentgenol. 2016;206(5):1112–8.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Carmon M, Olsha O, Gekhtman D, Nikitin I, Cohen Y, Messing M, et al. Detectability of hygroscopic clips used in breast cancer surgery. J Ultrasound Med. 2017;36(2):401–8.

    Article  PubMed  Google Scholar 

  51. James TA, Harlow S, Sheehey-Jones J, Hart M, Gaspari C, Stanley M, et al. Intraoperative ultrasound versus mammographic needle localization for ductal carcinoma in situ. Ann Surg Oncol. 2009;16(5):1164–9.

    Article  CAS  PubMed  Google Scholar 

  52. Ahmed M, Douek M. Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancers: systematic review and meta-analysis. Breast Cancer Res Treat. 2013;140(3):435–46.

    Article  CAS  PubMed  Google Scholar 

  53. Haloua MH, Volders JH, Krekel NM, Lopes Cardozo AM, de Roos WK, de Widt-Levert LM, et al. Intraoperative ultrasound guidance in breast-conserving surgery improves cosmetic outcomes and patient satisfaction: results of a multicenter randomized controlled trial (COBALT). Ann Surg Oncol. 2016;23(1):30–7.

    Article  PubMed  Google Scholar 

  54. Harlow SP, Krag DN, Ames SE, Weaver DL. Intraoperative ultrasound localization to guide surgical excision of nonpalpable breast carcinoma. J Am Coll Surg. 1999;189(3):241–6.

    Article  CAS  PubMed  Google Scholar 

  55. Rahusen FD, Bremers AJ, Fabry HF, van Amerongen AH, Boom RP, Meijer S. Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: a randomized clinical trial. Ann Surg Oncol. 2002;9(10):994–8.

    Article  PubMed  Google Scholar 

  56. Rubio IT, Esgueva-Colmenarejo A, Espinosa-Bravo M, Salazar JP, Miranda I, Peg V. Intraoperative ultrasound-guided lumpectomy versus mammographic wire localization for breast cancer patients after neoadjuvant treatment. Ann Surg Oncol. 2016;23(1):38–43.

    Article  PubMed  Google Scholar 

  57. Ahmed M, Anninga B, Goyal S, Young P, Pankhurst QA, Douek M, et al. Magnetic sentinel node and occult lesion localization in breast cancer (MagSNOLL trial). Br J Surg. 2015;102(6):646–52.

    Article  CAS  PubMed  Google Scholar 

  58. Landercasper J, Attai D, Atisha D, Beitsch P, Bosserman L, Boughey J, et al. Toolbox to reduce lumpectomy reoperations and improve cosmetic outcome in breast cancer patients: the American Society of Breast Surgeons Consensus Conference. Annals of surgical oncology. 2015;22(10):3174–83.

  59. Bennett C. Use of radioactive seed localization for nonpalpable breast cancer. LWW; 2017.

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Jinny Gunn & Sarah McLaughlin

Authors
  1. Jinny Gunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah McLaughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah McLaughlin.

Ethics declarations

Conflict of Interest

Jinny Gunn and Sarah McLaughlin declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Local-Regional Evaluation and Therapy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gunn, J., McLaughlin, S. Current Trends in Localization Techniques for Non-palpable Breast Lesions: Making the Invisible Visible. Curr Breast Cancer Rep 9, 165–171 (2017). https://doi.org/10.1007/s12609-017-0244-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-017-0244-9

Keywords

Search

Navigation