Wire localization works on day before breast surgery

By Theresa Pablos, AuntMinnie staff writer

May 8, 2020 -- Wire localization performed on the day before a scheduled breast surgery proved to work effectively in a study published on April 22 in the Journal of Breast Imaging. The decoupling of wire localization and surgery could have benefits for patients, surgeons, and clinics, the authors noted.

Wire localization in the U.S. typically has been performed on the day of surgery due to risks of bleeding, wire migration, and patient discomfort. However, new technologies are making it easier and safer to add more time between wire localization procedures and surgeries.

"The results of this study indicate that needle localization performed on the day prior to surgery is feasible given the small wire migration distances that did not require adjustment prior to surgery," wrote the authors, led by Dr. Linda Sanders from the Ambulatory Care Breast Center in Livingston, NJ.

Dr. Sanders and colleagues initially sought approval from their institution to conduct an initial trial for performing wire localization for some patients one day prior to surgery, often around the same time they had another scheduled procedure. The authors specifically selected patients who had surgeries scheduled on a Tuesday through Friday and who lived within 30 minutes of the breast center.

Radiologists with at least 11 years of interventional experience performed 42 mammographic and 19 sonographic hooked wire localizations in the initial trial. The wires were placed between 16 and 25 hours before surgery, with a median time of about 20 hours.

Mammography performed on the day of surgery revealed that the wires migrated 2 mm on average. However, none of the wires needed adjustment before surgery.

Based on the success of the first trial, the institution approved the use of wire localization on the day prior to surgery for all patients. During a five-month period in 2019, the same radiologists performed 52 mammographic and 7 sonographic looped wire localizations.

Similar to the first trial, an average of about 19 hours passed between wire placement and breast surgery. The wires moved about 1 mm on average, and once again, no wires needed adjustment.

"The successful unlinking of localization to surgery suggests localization on the day prior to surgery represents an alternative to placement of other devices, including radar reflectors, iodine-125 radioactive seeds, and radiofrequency localizer tags," the authors wrote.

Notably, two patients in the first trial complained of mild rash, and there were a few anecdotal complaints from patients that seeing the wire caused anxiety. However, no patients showed signs of infection or bleeding.

The breast center still uses same-day wire localizations for some patients, including for those who live far from the center. But they also noted that wire localization before surgery has its own advantages, including more flexible surgery scheduling and shorter operating days for patients.

"Our results demonstrate the feasibility of performing wire localization on the day prior to surgery, accomplishing the desired goal of unlinking the radiological and the surgical procedures," the authors concluded.

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