Needle localization
Needle localization, also referred to as wire localization or stereotactic localization, is a medical procedure primarily employed to identify nonpalpable masses, particularly in the breast, prior to biopsy. This technique is essential in cases where tumors cannot be physically felt, allowing surgeons to accurately locate and biopsy the affected tissue. The procedure involves the use of imaging technologies such as ultrasound, mammography, or MRI to guide the placement of a thin wire that marks the tumor's location.
Typically performed in a radiology office or specialized biopsy room, needle localization requires some patient preparation, including fasting and preoperative assessments. During the procedure, a local anesthetic is administered, and a hollow needle is inserted to confirm tumor positioning through imaging before placing the wire. Following localization, either a surgical or core needle biopsy is conducted to remove the marked tissue for pathological analysis.
While there are minor risks associated with the procedure, such as bleeding or infection, needle localization has demonstrated a high success rate in detecting early-stage breast cancer, especially in cases involving challenging microcalcifications. This makes it a vital tool in breast cancer diagnosis and treatment planning.
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Subject Terms
Needle localization
ALSO KNOWN AS: Wire localization, stereotactic (exact) localization
DEFINITION: Needle localization is a procedure used to mark a nonpalpable mass (one that cannot be felt) prior to biopsy (removal of a piece of tissue). It is most commonly associated with breast biopsies. A radiologist or surgeon performs needle localization using ultrasound, mammography, or magnetic resonance imaging (MRI) to view the tumor.
Cancers diagnosed:Breast cancer
Why performed: Since the breast mass is not palpable, the surgeon needs a way to find the tumor in order to biopsy it. The wire is placed to mark the tumor for biopsy or surgery.
Patient preparation: Needle localization is associated with surgical and core needle breast biopsy. Usually, this procedure is performed in a radiology office or a breast biopsy room. For a surgical biopsy, within a month before the procedure, the patient has a preoperative physical examination, routine blood work, and possibly an electrocardiogram (EKG). She must fast after midnight on the day of the procedure. For core needle biopsy, the patient only needs to fast for two to three hours before the procedure.
Steps of the procedure: First, the mass is localized. When ultrasound is used, the transducer (used to transmit and receive sound waves) is held to the side of the mass while the needle is inserted. With mammography, special plates with a screen or a small door are necessary so the needle can be inserted while the breast is compressed. MRI imaging requires a special attachment through which the needle can be inserted.
A local anesthetic is injected over the tumor, and a thin, hollow needle is inserted. The position of the needle is verified using radiologic imaging. The needle is removed, leaving a thin wire to mark the area of concern. The procedure typically takes less than one hour.
After the procedure: The biopsy is performed either in an operating room (for a surgical biopsy) or in the biopsy room (for a core needle biopsy). The wire or needle is removed with the abnormal breast tissue.
Risks: There is a slight risk of bleeding or infection after this procedure.
Results: The surgeon can localize the nonpalpable breast tumor by the presence of the wire and then remove it. Pathology will be performed on the tissue sample to determine whether it is cancerous. Needle localization has a high detection rate for early-stage breast cancer in difficult-to-detect microcalcifications.
Bibliography
Cadavid-Fernández, Natalia, et al. "The Role of Core Needle Biopsy in Diagnostic Breast Pathology." Revista de Senología y Patología Mamaria, vol. 35, 2022. doi.org/10.1016/j.senol.2022.04.006.
Fillion, Michelle M., et al. "The Effect of Multiple Wire Localization in Breast Conservation." American Surgeon, vol. 78, no. 5, 2012, pp. 519–22. doi:10.1177/000313481207800530.
Kalambo, Megan, et al. “Step by Step: Planning a Needle Localization Procedure.” Clinical Imaging, vol. 60, no. 1, 2020, pp. 100-108. doi:10.1016/j.clinimag.2019.12.007.
"Surgical Breast Biopsy." American Cancer Society, 14 Jan. 2022, www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/breast-biopsy/surgical-breast-biopsy.html. Accessed 20 June 2024.
Rosen, Paul Peter, and Syed A. Hoda. Breast Pathology: Diagnosis by Needle Core Biopsy. 3rd ed., Lippincott, 2015.
Shin, Sandra J., Yunn-Yi Chen, and Paula S. Ginter. A Comprehensive Guide to Core Needle Biopsies of the Breast. 2nd ed., Springer International Publishing, 2022.
Tse, Gary M., Puay Hoon Tan, and Fernando Schmitt. Fine Needle Aspiration Cytology of the Breast: Atlas of Cyto-Histologic Correlates. 2nd ed., Springer, 2023.
Yusupov, Benny, and Sharon Zlochiver. "Biopsy Needle Localization Using Magnetic Induction Imaging Principles: A Feasibility Study." IEEE Transactions on Biomedical Engineering, vol. 59, no. 8, 2012, pp. 2330–37.