Daly Gordon R, Hamza Eman, Singh Sneha, Patterson Rory, Hassett Caoimhe, Hembrecht Sandra, Crilly Emily, O'Brien Aoife, Downey Eithne, Hegarty Aisling, Mhuircheartaigh Neasa Ní, Power Colm, Healy Nuala A, Duke Deirdre, Hill Arnold D K
The Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland; The Department of Surgery, Beaumont Hospital, Dublin, Ireland.
The Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland; The Department of Surgery, Beaumont Hospital, Dublin, Ireland; The Department of Radiology, Beaumont Hospital, Dublin, Ireland.
Surgeon. 2025 Aug;23(4):248-253. doi: 10.1016/j.surge.2025.04.052. Epub 2025 May 8.
Breast cancer screening programs have increased the detection of nonpalpable breast lesions. Given its accuracy and low failure rate, wire-guided localisation has long been the gold-standard prior to breast conserving surgery (BCS). Recently, several non-invasive localisation modalities have been developed, with varied efficacy reported. This study aimed to evaluate tag localisation's impact on margin positivity and re-excision rates and utility in management of benign lesions compared to wire-guided localisation.
A retrospective comparative study was performed of patients, who underwent wide local excision (WLE) from 2020 to 2023, in a single institution. Descriptive statistics were performed on patient, tumour and radiological findings. Binary regression analysis was used to assess the association between localisation techniques and margin positivity and re-excision rates.
Of 680 patients included, 123 (18.1 %) underwent tag localisation, 298 (43.8 %) underwent ultrasound (US) guided wire localisation and 259 (38.1 %) underwent mammogram (MG) guided wire localisation. Tag localisation was associated with a significantly lower rate of positive margins compared to wire guided localisation (p < 0.03). While not statistically significant, a trend towards lower re-excision rates was observed post tag localisation (11.24 %) compared to both US guided wire localisation (18.99 %) and MG guided wire localisation (20.66 %). However, tag localisation was significantly more likely to fail and require a subsequent wire (0 = 0.0003).
While associated with fewer positive margins, tag localisation did not significantly lower re-excision rates and was more likely to fail than wire-guided localisation. Further studies may elucidate its possible benefits in select patients.
