Navigating New Frontiers: Initial Auckland Experience of Seed Localisation Techniques for Breast Conserving Surgery

Breast conserving surgery for non-palpable tumours requires imaging-guided localisation, historically achieved with hookwire localisation (HWL). HWL, however, has recognised shortcomings including the need for same-day surgery with associated radiology resource/logistical constraints, psychological impact of wire protrusion, and complications such as wire displacement or fracture. The introduction of novel non-wire surgical marker navigation (SMN) techniques offers promising benefits. This study evaluates the early implementation of SMN (Sirius Pintuition and Merit SAVISCOUT systems) in one radiology department in Auckland, New Zealand.

This is a retrospective cohort study evaluating surgical outcomes in patients with non-palpable tumours who underwent preoperative localisation between May 2023 and June 2024. Three groups were compared: two cohorts who underwent SMN in the form of Pintution (n = 36) and SAVISCOUT (n = 42) and one who underwent HWL (n = 35). Surgical outcomes assessed included histological margin status and rates of re-excision. Technical challenges and complications were recorded.

There was no significant difference in surgical outcomes between HWL and SMN groups. The 'surgery complete' rate was 89% in the HWL group, 82% in the Pintuition group, and 97% in the SAVISCOUT group (p = 0.10). Technique failure occurred in five cases of SMN (6%) due to inadequate seed position and one case of HWL (3%) due to wire displacement.

SMN in the form of Pintuition and SAVISCOUT demonstrate comparable surgical outcomes to HWL, whilst also offering advantages in scheduling flexibility and resource utilisation. A small rate of technical failure highlights the operator learning curve and need for appropriate training.