Ultrasound Wire Localization Protocol for Breast Lesion Removal

Pre-Localization Requirements

The American Cancer Society recommends that for nonpalpable breast lesions requiring surgical excision, wire localization should be performed with precise placement using needle-hook wire, with the wire positioned to guide the surgeon directly to the lesion, followed by mandatory intraoperative specimen radiography to confirm complete excision 1, 2
Obtain labeled craniocaudal and 90-degree lateral films showing the hook-wire position and send these to the operating room for surgeon orientation, as recommended by the American Cancer Society 1, 3
Current diagnostic films should accompany the localization films to provide additional anatomic context for the surgeon, according to the American Cancer Society 1

The American Cancer Society suggests that the incision must be placed directly over the lesion, not at the point of wire entry into the breast, to ensure optimal cosmesis and accurate removal of the lesion 1, 2, 3
The surgeon should assess the exact location by triangulation based on wire position, depth of penetration, and angle, then place the incision closest to the wire tip for optimal cosmesis, as recommended by the American Cancer Society 2, 4, 5
Avoid tunneling and make the skin incision as close to the lesion as possible, according to the American Cancer Society 1, 2, 3

The American Cancer Society recommends obtaining specimen radiograph in two dimensions immediately after excision to confirm complete removal of the lesion 2, 4, 5
The radiologist must interpret the specimen film without delay and communicate findings to the surgeon in the operating room before closing the excision site, as recommended by the American Cancer Society 2, 4, 5

Place titanium clips outlining the excision cavity to aid radiation therapy planning and demarcate the tumor bed for future imaging, according to the American Cancer Society 1, 2, 3, 4
Meticulous hemostasis is critical, and hematoma formation should be avoided, as recommended by the American Cancer Society 1, 3
Avoid drains in the breast and allow the biopsy cavity to fill with serum for better cosmetic results, according to the American Cancer Society 1, 3

Never tunnel from wire entry point to lesion, as this compromises cosmesis and margin assessment, according to the American Cancer Society 1, 2, 3
Never remove the lesion in fragments, as this makes margin evaluation and size determination impossible, as recommended by the American Cancer Society 1, 6, 3
Never close the excision site before receiving intraoperative specimen radiography confirmation, as additional tissue may need immediate removal, according to the American Cancer Society 2, 4, 5
Never use periareolar incisions for peripheral lesions, as they provide inadequate exposure and compromise negative margin achievement, as recommended by the American Cancer Society 1, 3