Radioguided Localisation Techniques for Non-Palpable Breast Lesions: An Umbrella Review

Background: Accurate localisation of non-palpable breast lesions is essential for the optimization of breast-conserving surgery (BCS) outcomes. While wire-guided localisation (WGL) remains widely used, radioguided techniques-including Radioguided Occult Lesion Localisation (ROLL) and Radioactive Seed Localisation (RSL)-have been proposed to improve margin clearance, reduce reoperations, and enhance patient outcomes. This umbrella review aimed to critically appraise and synthesize evidence from systematic reviews and meta-analyses on radioguided localisation techniques for non-palpable breast lesions, with a primary focus on comparison with wire-guided localisation (WGL). Methods: A comprehensive literature search was conducted using PubMed/Medline and the Cochrane Library databases for eligible systematic reviews/meta-analyses published until 2024, focusing on outcomes such as relative efficacy, safety, margin positivity, re-excision rates, operative efficiency, and patient-related outcomes. Results: In total, 35 records were retrieved, but only 10 evidence-based articles were selected. Radioguided approaches achieved high localisation success (often exceeding 95%) and fewer positive margins compared to WGL, while reoperation findings were mixed. Operative/localisation times were generally shorter for radioguided methods, with comparable specimen volume/weight and favourable safety profiles. Conclusions: Radioguided localisation methods provide superior or at least equivalent outcomes compared with WGL and can improve workflow; Sentinel Node and Occult Lesion Localisation (SNOLL) may support combined lesion localisation and sentinel node evaluation. Further high-quality, standardized comparative studies are needed to define the optimal resection ratio, protocol standardization and cost of the radioguided techniques and other newer probe-guided methods.