Preoperative Localization Planning in Breast-Conserving Surgery

Preoperative localization planning is a foundational step in breast-conserving surgery. When tumors are non-palpable or have responded to neoadjuvant therapy, surgical success depends on how well the lesion or tumor bed has been identified, documented, and translated into a clear intraoperative target. This article provides an in-depth overview of preoperative localization planning, its clinical importance, and how modern localization systems support accurate and reproducible surgery.

Why Preoperative Localization Planning Is Clinically Critical

Breast-conserving surgery aims to remove malignant tissue with clear margins while preserving healthy breast tissue. In many patients, however, the tumor cannot be reliably identified by palpation alone. This is particularly true for screen-detected lesions, multifocal disease, and tumors that have responded to neoadjuvant systemic therapy.

In these scenarios, localization planning determines whether the surgeon removes the correct tissue, achieves clear margins, and avoids unnecessary re-excision. Multiple studies and clinical guidelines emphasize that insufficient localization is a leading contributor to positive margins and repeat surgery.

The NCCN breast cancer guidelines describe accurate localization as a prerequisite for optimal surgical management in breast-conserving treatment.

Key Components of Preoperative Localization Planning

Effective localization planning begins well before the day of surgery and requires structured collaboration between radiology and surgery. Core components include:

• Clear identification of the index lesion or tumor bed
• Documentation of lesion size, depth, and spatial orientation
• Assessment of imaging modality suitability
• Selection of an appropriate localization technique

Each of these steps directly influences intraoperative decision-making and surgical confidence.

Role of Imaging in Localization Decisions

Imaging determines both whether a lesion can be localized and how this should be done. The modality used for localization typically reflects the modality that best visualizes the lesion:

• Mammography or tomosynthesis for calcifications and architectural distortion
• Ultrasound for masses or lymph nodes with sonographic visibility
• MRI for lesions visible only on contrast-enhanced imaging or in dense breast tissue

When lesions become less visible after neoadjuvant therapy, previously placed biopsy clips often serve as the only reliable landmark. More background on biopsy-related markers is available in Breast Biopsy Devices.

Choosing the Right Localization Technique

Once the target and imaging pathway are defined, the localization technique must be selected. Options include wire-guided localization, radioactive seed localization, and non-radioactive magnetic seed localization.

Key considerations in this decision include:

• Timing flexibility between radiology and surgery
• Regulatory and radiation safety requirements
• Need for directional intraoperative guidance
• Workflow efficiency in high-volume centers

A detailed comparison of localization techniques is provided in Seed Localization vs Wire-Guided.

Impact of Structured Planning on Surgical Outcomes

Structured preoperative localization planning has been shown to reduce re-excision rates and improve margin status. A systematic review published on PubMed demonstrates that standardized localization workflows are associated with more consistent oncologic outcomes in breast-conserving surgery.

From a clinical perspective, this translates into fewer repeat operations, reduced patient anxiety, and more efficient use of operating room resources.

How Sirius Medical Enables Reliable Localization Planning

Sirius Medical focuses on translating preoperative planning into precise intraoperative execution. The Pintuition Marker® is a non-radioactive magnetic seed that can be placed days before surgery, allowing radiology and surgical schedules to be decoupled.

During the operation, the Pintuition System® provides real-time directional guidance, enabling the surgeon to follow the planned trajectory toward the target with confidence. This supports:

• Accurate resection of non-palpable tumors
• Clear margin achievement aligned with the preoperative plan
• Consistent workflows across institutions

By integrating seamlessly into existing imaging and surgical pathways, Sirius Medical supports both clinical accuracy and operational efficiency.

Interested in improving preoperative localization planning?

Request a demo or explore our resources to learn how Pintuition® supports breast-conserving surgery.

Disclaimer
This article is intended for informational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional.