Breast Needle Localization - Indications, Procedure, Benefits, Risks, and Limitations

What Is a Breast Needle Localization Procedure?

The incidence of breast cancer is rising. It is considered the most common cancer that occurs in women. However, if diagnosed early, the prognosis of a breast cancer patient is good, with a better quality of life. Sonography and mammography are the first-line diagnosis of breast cancer. However, a confirmatory diagnosis is obtained when a sample of the cancer tissue is taken and analyzed for abnormal cells. This procedure is known as a biopsy. Certain tools like ultrasound can guide and assist while taking a biopsy. Such procedures are known as image-guided biopsies.

Breast needle localization is a type of image-guided biopsy. It is most frequently used in the initial stages of impalpable cancer. This procedure uses a small wire to locate the abnormal tissue in the breast with the help of ultrasound. The wire would mark the tissue, thereby facilitating the biopsy process.

Where Is Breast Needle Localization Indicated?

The breast needle localization is indicated in the following situations:

• A breast lesion that cannot be felt but can be seen in ultrasound or mammography.

• To diagnose a suspicious lump.

• To confirm the diagnosis of breast cancer.

• Small lesions which require complete removal.

• Before a core biopsy (where a hollow needle is used to remove a more significant piece of a tissue sample).

• When a core biopsy cannot be done on a patient.

What Are the Advantages and Disadvantages of This Procedure?

Advantages:

• Cost-effective.

• The time taken for the procedure is significantly less compared to a surgical biopsy.

• Relatively easy.

• Patient satisfaction is high due to minimal scarring.

• Reduced patient anxiety level.

• Decreased adverse events while doing the procedure.

Disadvantages:

• Locating very tiny lesions could be challenging.

• Lesions near the chest wall could pose a difficulty.

How Should Patients Prepare for This Procedure?

• Patients should wear comfortable clothes and remove any jewelry or accessories before the procedure.

• They should not apply any deodorant, perfume, talcum powder, or lotion over their body or under their armpit.

• Patients should inform the doctor of any history of allergy.

• Patients on blood thinners or Aspirin should notify the doctor as these medicines may have to be stopped to prevent the risk of bleeding.

• Patients should inform the doctor of their complete medical history, including the details of their prescription medicines, supplements, or over-the-counter medications.

• They may be advised to perform some blood tests before the procedure. Patients should carry all their recent test reports while going for the procedure.

• Diabetic patients who wear a continuous glucose monitor or an insulin pump should remove them before the procedure.

How Is This Procedure Done?

• Patients should change into a hospital gown and will be assisted to the examination room.

• They will be made to lie down on an examination table for an initial ultrasound examination or mammography to identify the lesion site.

1. Ultrasound Examination:

• A gel will be applied to the breast to be examined.

• The transducer (small microphone-like device) will be moved over the area compressing the site a little. Some pressure may be felt by the patient but no pain. The transducer emits sound waves into the body, which bounce off upon striking some structures within the body. A computer processes the returning sound waves into images that are seen on the screen.

• With the help of an ultrasound, the abnormal area is located.

2. Mammography:

• Mammography provides more accurate results than sonography in breasts. However, if lesions are not identifiable on ultrasound, the doctor may suggest using mammography.

• The patient will sit in front of a mammography unit.

• The breast is compressed between two plates, and an X-ray is used to capture the images displayed on the screen.

• There would be slight discomfort when the plates squeeze the breasts, but it is not painful.

3. Wire Localization:

• Once the images are obtained with ultrasound or mammogram, the doctor identifies the abnormal area, which is then marked on the breast.

• A local anesthetic is used to numb the site. The patient may experience a burning sensation when the local anesthetic is injected.

• A hollow needle with a thin wire is then inserted through the lesion. An ultrasound or a mammogram is repeated to check if the needle is in the correct position.

• The needle may have to be repositioned if needed, under the guidance of an imaging process.

• Once the needle tip is in the site, a dye will be injected to demarcate the tissue.

• The needle would then be removed, leaving the wire on the site. This would mark the exact location of the abnormal tissue.

• The wire would be immobilized by fixing it on the skin with tape.

• The doctor would then take a tissue sample from the site marked with the wire. The wire would also be removed along with the tissue.

• The tissue would be immediately placed in a formalin bottle and sent for pathological examination.

• No sutures are required. Pressure will be applied over the wound site to stop the bleeding, and it will be covered with a sterile dressing.

• Breast needle localization is usually done on an outpatient basis, and the procedure takes about an hour to complete.

What Are the Instructions After the Procedure?

• No special instructions are required after the procedure.

• Patients can continue with their routine activities.

• Patients may be advised to avoid any strenuous activities for a day or two.

• Some pain or discomfort may be present after the procedure. An ice pack or painkillers may be taken to relieve the pain.

What Are the Benefits and Risks of This Procedure?

Benefits:

• Widely used in breast cancer detection.

• Highly reliable and accurate in obtaining the tissue sample.

• Quick and cost-effective.

• Well tolerated by the patients.

• Less invasive and hence less scarring.

• The possibility of real-time imaging with an ultrasound helps to place the needle appropriately and also guides them through the lesion.

Risks:

• Possibility of bleeding or formation of a blood clot.

• Chances of infection.

• There is a rare possibility of the needle penetrating the chest wall in lesions near the chest. This could result in air entrapment in the lungs and lung collapse.

• The tissue retrieved may be insufficient, leading to a repeat biopsy.

• Dislodgement of the wire.

• Minor bruising may occur.

What Are the Limitations Associated With This Procedure?

• This procedure is contraindicated in patients with a severe bleeding disorder.

• A very tiny lesion could be challenging to access.

• Site specificity could be challenging as lesions near the chest wall pose a risk of needle perforation.

• Not feasible in uncooperative patients or intellectually disabled patients.

When to Seek Medical Advice?

If patients experience high temperature, increasing pain, bleeding, or discharge from the site biopsied after the procedure, they should contact the doctor as these could be signs of infection.

Conclusion:

Breast needle localization is a beneficial technique in those breast lesions that cannot be felt or palpated but are evident on an ultrasound or a mammogram. Localization methods are advancing day by day. One such novel technique is using radioactive materials to detect abnormal areas. Again, though, further studies may help understand these techniques better and put them into routine practice for the benefit of the patient. Diagnosing breast cancer earlier can prove highly beneficial to the patient as expeditious treatment dramatically improves their quality of life.