Table 1.
Comparison of different localization techniques. Abbreviations: ROLL = radio-guided occult lesion localization; RSL = radioactive seed localization; Magseed = magnetic seed localization; IOUS = intraoperative ultrasound; Skin tattoo = preoperative localization with skin tattoo; OR = operating room; US = ultrasound; MRI = magnetic resonance imaging. * Success is defined as removal of target lesion. ** Authors’ experience.
| Technique | Materials/Procedures | Advantages | Disadvantages | Success * Rate | Clear Margins Rate |
|---|---|---|---|---|---|
| Wire localization | Wire Preloaded needle introducer |
Simple Cost-effective Different kinds of image-guidance |
Wire migration Scheduling difficulties Limits surgical decisions |
97.5% [14] | 70.8–87.4% [15] |
| Carbon marking | Diluted charcoal powder | Simple Different kinds of image-guidance Cost-effective Cannot dislodge Scheduling flexibility |
Carbon can distort or obscure lesion Unfit for large breasts Unfit for multifocal or extensive lesions |
99% [16] | 61–85% [17,18] |
| ROLL | Nuclear radiotracer Technetium 99 Gamma ray probe |
Different kinds of image-guidance Does not limit surgeon |
Scheduling difficulties Radiation Cost |
95–99% [19] | 92% [20,21] |
| RSL | Iodine 125 seed Preloaded needle introducer Gamma probe set for I-125 |
Scheduling flexibility Does not limit surgeon Different kinds of image-guidance |
Radiation Not repositionable after deployment |
100% [22,23] | 73.5–96.7% [22,23] |
| Magseed | Paramagnetic seed Preloaded needle introducer |
Scheduling flexibility No radiation Does not limit surgeon |
Cost Not repositionable after deployment Non magnetizable surgical equipment MRI artifacts |
99.86% [24,25,26,27] | 88.75% [24] |
| Radiofrequency identification tags | Radiofrequency reflector Needle introducer Detector |
Scheduling flexibility No radiation Does not limit surgeon |
Cost Depth limit Not repositionable after deployment Interference with halogen lights in the OR |
97–100% [28,29] | 85–100% [28,29,30] |
| IOUS | Portable or OR-stationed US machine and sterile transducer cover | Scheduling flexibility No radiation Does not limit surgeon Non-invasive |
Unemployable in US-invisible lesions Surgeon learning curve Interference with air during dissection |
100% [31,32,33,34,35] | 81–97% [32,34] |
| Skin tattoo | Dermographic marker Lead markers |
Simple and safe Cost-effective Non-invasive Different kinds of image-guidance Does not limit surgeon |
Scheduling difficulties Inability to depict marker |
99.5% ** | 95.9% ** |