Localisation of occult breast lesion: a comparative analysis of hookwire and radioguided procedures.

Objectives: For occult breast lesions, to retrospectively compare the performance of radioguided and hookwire methods in terms of ease of localisation and surgical procedures, and the ability to obtain a specimen with a clear margin.

Design: Retrospective study.

Setting: Regional hospital, Hong Kong.

Patients: All patients who underwent occult breast lesion localisation by either ultrasonography- or stereotactic-guided radioguided occult lesion localisation or hookwire localisation from August 2003 to December 2007 were included.

Main Outcome Measures: Demographic data, localisation and operation procedure time, size of specimens and margin clearance.

Results: In all, 165 patients (mean age, 52 years) having these procedures were assessed. In 98 instances, the procedure (hookwire=53, radioguided=45) was for diagnostic purposes and in 67 (hookwire=23, radioguided=44) for therapy. Both techniques attained a very high success rate (>95%). For radioguided occult lesion localisation, there was a significantly shorter mean localisation time than for hookwire localisation (18 min versus 31 min; P<0.001), while the mean operating time was similar. Radioguided occult lesion localisation entailed larger specimens and fewer cases with close or involved margins, or recourse to intra-operative re-excision or a second operation, but these differences were not statistically significant. Within the radioguided occult lesion localisation group, there were 42 patients who had a simultaneous sentinel lymph node biopsy (sentinel node and occult lesion localisation), with a 98% success rate although no lymph node metastasis was revealed.

Conclusion: Radioguided occult lesion localisation excels in yielding a much shorter localisation time and is as good as hookwire localisation in terms of specimen margin clearance and need for re-excision. It also offers the advantage of enabling simultaneous sentinel lymph node biopsy for invasive cancers. Therefore it is a recommended procedure that should be used more widely.