Step by step: Planning a needle localization procedure

In patients with nonpalpable early-stage breast cancer eligible for breast conservation surgery (BCS), wire-guided localization (WGL) is widely accepted as a standard technique for preoperative image-guided lesion localization. In preparation for this procedure, lesion location, size, type and configuration play important roles in preoperative localization planning. Successful preoperative planning requires review of all pertinent imaging studies, imaging reports and pathology reports, with special attention to pre- and post-biopsy imaging and evaluation of the targeted lesions and the type and the position of the marker clips. Preoperative communication with the surgeon is key in the planning process to ensure that clarity in localization objectives are reached in complex cases. This pictorial essay will provide a methodical, step by step approach to planning successful image-guided preoperative needle localizations. These steps include selection of the imaging modality, the equipment, the procedure and intraoperative specimen radiography. The case-based review will also include key steps and considerations during the planning stage, the procedure stage, and the post-procedure stage. These same techniques can also be applied to newer, non-wire image-guided breast localization techniques now available for widespread commercial use.