Safety and Margin Positivity Rates of Surgeon-Performed Intraoperative Ultrasound-Guided Wire Localization for Breast Cancer

Background Surgeon-performed intraoperative ultrasound-guided wire localization (IOL) offers an improved patient experience and decreased cost compared to preoperative localization by radiology, yet literature on this technique is sparse. Here we evaluate the safety and margin positivity rate after surgeon-performed IOL for breast cancer. Methods Patients with biopsy-proven breast malignancy and planned breast conservation who underwent IOL by a single breast surgeon between 2017-2023 and had follow-up at our institution were retrospectively identified. Patient and tumor characteristics, method of diagnosis, imaging findings, use of oncoplastic surgery, and follow-up data were analyzed. Results A total of 137 IOLs were performed for biopsy-proven ductal carcinoma in situ (DCIS) or invasive cancer. The median patient age was 69 years. Most patients had a non-palpable tumor (n=104, 76.5%). 84.6% of patients underwent pre-operative biopsy by ultrasound guidance, 12.5% by stereotactic guidance, and 2.9% by MRI. In total, 7.3% of patients (n=10) had positive margins, including 2 with invasive disease at the margin and 8 with DCIS at the margin. Nine patients underwent re-excision for positive or close margins, of which 8 had successful margin-negative breast conservation and 1 patient underwent mastectomy. Thirty-day postoperative complications occurred in 21 patients (15.3%). Of these, most (n=19, 90.4%) had minor complications including seroma (n=14), cellulitis (n=3), and skin allergy (n=2). At median follow-up of 20.4 months, no patients experienced recurrence. Conclusions In our single-surgeon series, IOL is a safe technique for localization of invasive carcinoma and DCIS with margin positivity, re-excision, and postoperative complication rates within previously published ranges. Synopsis This study evaluates the safety of and re-excision rates after intraoperative surgeon-performed ultrasound-guided wire localization (IOL) for breast cancer. Results demonstrate margin positivity and re-excision rates equivalent to or lower than rates reported in literature utilizing preoperative localization techniques.