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Review
. 2018 May;91(1085):20170740.
doi: 10.1259/bjr.20170740. Epub 2018 Feb 6.

Innovations in image-guided preoperative breast lesion localization

Ellen Cheang  1 , Richard Ha  2 , Cynthia M Thornton  1 , Victoria L Mango  1
Affiliations
Review

Innovations in image-guided preoperative breast lesion localization

Ellen Cheang et al. Br J Radiol. 2018 May.

Abstract

Screening mammography increases detection of non-palpable breast lesions requiring image-guided localization prior to surgery. Accurate preoperative localization is crucial for successful surgical outcomes. Wire-guided localization is currently the most widely used localization method for non-palpable breast lesions; however, this technique has multiple disadvantages including patient discomfort, possible wire transection and migration, suboptimal surgical incision placement due to wire location and limited scheduling flexibility decreasing operating room efficiency. As a result, promising new techniques including radioactive seed localization, non-radioactive radar localization and magnetic seed localization have been developed as alternatives. In this article, we provide an overview of these techniques and discuss their advantages, drawbacks and currently available outcome data.

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Figures

Figure 1.
Figure 1.
A 34-year-old woman with IDC. (a) Craniocaudal mammogram view confirms appropriate wire placement with the thicker reinforced portion of the wire immediately adjacent to the target mass and clip. (b) Specimen radiograph demonstrates successful removal of the wire, marker clip and mass. IDC, invasive ductal carcinoma.
Figure 2.
Figure 2.
A 72-year-old woman with IDC/DCIS. Components of radioactive seed localization system (a–d). Diagram (courtesy of Best Medical International, Inc.) (a) and radiographic view (b) of the radioactive seed, delivery needle (c) and Geiger counter (d). Mammographic-guided localization of the microcalcifications and marking clip with the delivery needle tip positioned at the targeted clip (e). Radioactive seed deployed adjacent to the clip within the group of microcalcifications(f). Specimen radiograph shows the microcalcifications, mass, radioactive seed and clip (g). DCIS, ductal carcinoma in situ; IDC, invasive ductal carcinoma.
Figure 3.
Figure 3.
SAVI SCOUT surgical guidance system. (a-c, Images courtesy of Cianna Medical, Inc.) (a) Diagram of the reflector (b) Preloaded 5-, 7.5- or 10-cm 16-gauge needle. (c) Handpiece and console system. (d) Reflector deployed within the mass adjacent to the marker clip. (e) Sonographic image shows a linear echogenic reflector within the targeted mass. (f) Radiograph of the specimen demonstrates successful removal of the clip, mass and reflector. SAVI SCOUT, non-radioactive radar localization.
Figure 4.
Figure 4.
Magnetic seed localization system. (Images courtesy of Endomagnetics, Inc.) (a) Diagram of the magnetic seed. (b) Picture of the preloaded 18-gauge delivery needle. (c) Detector probe and console. (d) Mediolateral Oblique mammogram image confirms placement of the magnetic seed adjacent to the marker clip. (e) Specimen radiograph shows a seed, clip and targeted mass.
See this image and copyright information in PMC

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