Wire localization
Wire localization, also known as needle localization, is a medical procedure used primarily in breast cancer diagnosis. This technique involves the insertion of a fine wire under radiologic guidance to mark specific areas of concern detected on mammograms, such as breast densities or microcalcifications, which may indicate precancerous changes. These lesions are often not palpable, making wire localization essential for accurate biopsy targeting. The procedure typically starts with the administration of a local anesthetic to numb the breast area, followed by the use of x-ray or ultrasound imaging to accurately position the wire. Once the wire is in place, it serves as a guide during the biopsy, ensuring that the surgeon samples the correct tissue. After the biopsy, confirmation via follow-up imaging is performed to verify the removal of the suspect area. While wire localization is effective, emerging techniques, such as wire-free methods using magnetic seeds, offer less invasive alternatives. The risks associated with wire localization are minimal, generally involving minor discomfort and bruising. Overall, wire localization plays a crucial role in the early detection and treatment of breast cancer.
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Subject Terms
Wire localization
ALSO KNOWN AS: Needle localization
DEFINITION: Wire localization is the insertion of a fine wire under radiologic guidance to mark for biopsy areas of breast density or calcifications that can be seen on mammograms but are not detectable by touch.
Cancers diagnosed:Breast cancers
Why performed: Certain types of images seen on mammograms may indicate precancer or developing cancer. Some of these lesions cannot be seen with the naked eye or felt by touch. Wire localization enables the surgeon to accurately target areas for biopsy. A follow-up radiologic image after the biopsy assures that the suspect tissue was removed.
Conditions of concern that require wire localization include microcalcifications and certain types of breast densities. Microcalcifications are tiny calcium deposits in the breast tissue, which show up on mammograms as white specks. Microcalcifications are generally only of concern when they appear in irregular patterns or are concentrated in one area of the breast. These patterns or concentrations may indicate the rapid cell growth associated with precancer.
Patient preparation: Patients usually get a local anesthetic to numb feeling in the area of the breast where the wire will be inserted.
Steps of the procedure: To locate the area for biopsy, the surgeon uses radiologic images in which the wire site is marked. X-ray is the preferred method used for wire localization. Ultrasound can also be used, but conditions requiring wire localization are often not visible by ultrasound. Guided by radiologic images of the breast, a radiologist locates the area in question, first inserts a thin, hollow needle into the area, and then, through the needle, a fine wire with a hook. The hook keeps the wire in place in the breast and marks the specific area for biopsy. The wire in the breast provides a guide for where the is made. The wire is removed along with the breast tissue.
After the procedure: After the biopsy, the patient remains in the operating room until a repeat radiologic image confirms that the suspect area was removed. If the target area was missed, then another biopsy can be done immediately.
As the twenty-first century progressed, surgeons continued to use wire localization to remove nonpalpable breast lesions, the incidence of which had seen a rapid increase. However, wire-free techniques using magnetic seeds, radar reflectors, and radiofrequency identification tags became less invasive options.
Risks: The risks of wire localization are minimal and include minor pain, possible bruising, and limited radiation exposure.
Results: Wire localization and follow-up radiologic images assure accurate targeting of the area for biopsy.
Bibliography
Blumencranz, Peter W., Debra Ellis, and Kylee Barlowe. "Use of Hydrogel Breast Biopsy Tissue Markers Reduces the Need for Wire Localization." Annals of Surgical Oncology, vol. 21.10, 2014, pp. 3273–77.
Choi, Young J. "Migration of the Localization Wire to the Back in Patient with Nonpalpable Breast Carcinoma: A Case Report." World Journal of Clinical Cases, vol. 9, no. 26, 2021, pp. 7863-7869, doi.org/10.12998/wjcc.v9.i26.7863. Accessed 15 June 2024.
De Roos, M. A. J., W. N. Welvaart, and K. H. Ong. "Should We Abandon Wire-Guided Localization for Nonpalpable Breast Cancer? A Plea for Wire-Guided Localization." Scandinavian Journal of Surgery, vol. 102.2, 2013, pp. 106–9.
Fillion, Michelle M., et al. "The Effect of Multiple Wire Localization in Breast Conservation." American Surgeon, vol. 78.5, 2012, pp. 519–22.
Masroor, Imrana, et al. "Usefulness of Hook Wire Localization Biopsy under Imaging Guidance for Nonpalpable Breast Lesions Detected Radiologically." International Journal of Women's Health, vol. 4, 2012, pp. 445–9.
Sajid, M. S., et al. "Comparison of Radioguided Occult Lesion Localization and Wire Localization for Non-Palpable Breast Cancers: A Meta-Analysis." Journal of Surgical Oncology, vol. 105.8, 2012, pp. 852–8.
Shirazi, Shahram, et al. "Comparison of Wire and Non-Wire Localisation Techniques in Breast Cancer Surgery: A Review of the Literature with Pooled Analysis." Medicina, vol. 59, no. 7, 2023, doi.org/10.3390/medicina59071297. Accessed 15 June 2024.