Localization of Lesions

Localization of Lesions

The diagnosis of a breast abnormality typically involves a biopsy, which involves the removal of a piece of tissue from your breast so it can be tested in a laboratory. Most often a core biopsy, also known as a needle biopsy, is performed. A biopsy clip, which is a small titanium marker or pellet, is left in the breast to mark the site where the biopsy was performed. If the biopsy result comes back normal, the clip will remain in your breast indefinitely in order to follow the area on subsequent mammograms. The clip is safe and painless.

However, if the abnormality needs to be removed with surgery, you will likely need a localization procedure if the abnormality is not apparent on physical exam. It is typically used for breast-conserving surgery, also known as a lumpectomy or excisional biopsy. The procedure will ‘localize’ the abnormal tissue in the breast before surgery to guide the surgeon in locating the abnormality in order to remove it. The biopsy clip within the breast is too small to find without a ‘localization’.

Localization devices are used to allow the surgeon to check the location of the breast abnormality continually throughout surgery, enhancing precision and reliability in order to be adequately removed. The localization procedure will seem very similar to your biopsy procedure except no tissue will be removed. The objective is simply to place the localization device into the breast abnormality that is marked by a clip. A radiologist or surgeon will implant a localization device using mammography or ultrasound prior to your surgery.

There are a number of different options for localization, but they mostly fall into two categories: wire-guided and wire-free.

Wire-guided localization entails the following:
Plan a full day and an early morning start, around 7 or 8a.m., to arrive in the radiology department for the wire localization procedure. After localization is completed, you will proceed to surgery with the wire in your breast. If radiology is within with your surgery facility, you will need transportation to your surgery site. Most often, the surgery time in the operating room is planned around the time needed to place the wire. While you wait, you will be required to maintain your fasting from the night before.

Alternatively, newer wire-free localization technologies are available. One of the benefits of wire-free localization is that surgery to remove the abnormal tissue may be scheduled the same day or up to 30 days following seed localization. You have freedom to schedule the seed localization and surgical procedures around your schedule. However, it requires an additional visit if the seed localization is not performed the same day as your surgery. Most patients can resume normal activity while they wait, but talk to your doctor for specific recommendations.

Please visit the Resource section on Breast360.org for more information on localization under the Breast Conserving Surgery heading.