Efficacy of intra-operative wire localisation of breast lesions using ultrasound

Ultrasound is commonly used for pre-operative wire localisation of breast lesions and involves an uncomfortable procedure for patients. Intra-operative localisation has the potential to decrease patient discomfort and avoid wire displacement. This study aimed to assess the efficacy of intra-operative wire placement by a breast radiologist.

From January 2007 to July 2008 all patients suitable for ultrasound-guided wire localisation were offered intra-operative placement. After induction of anaesthetic, localisation was performed by one consultant radiologist. Satisfactory excision was confirmed by immediate ultrasound or radiography. Data were collected retrospectively and compared to a patient cohort undergoing pre-operative localisation between 2005 and 2007 using the chi-square test.

All patients offered intra-operative localisation during the study period chose this over pre-operative localisation. Thirty-two patients underwent localisation, 10 for diagnostic procedures and 22 to perform wide local excision of a malignancy. One-hundred percent of lesions were successfully localised. Re-excision was required following 10 of 22 wide local excisions, which is not significantly different to pre-operative localisation in our series. No wires were displaced between localisation and surgery.

Intra-operative localisation avoids patients undergoing two procedures and is preferred by patients. The technique allows the radiologist to place the wire on an anaesthetised patient and gives the surgical team insight into the path and depth of the wire, thus facilitating their dissection. The procedure is efficacious and comparable to pre-operative localisation. Intra-operative localisation is a safe and advantageous procedure to the patient and surgical team but does require a dedicated radiological team.