Comparing hookwire and wire-free localisation techniques in breast cancer surgery: oncological and patient-reported outcomes in a New Zealand cohort.

Abstract

Aims: Hookwire localisation (HWL) is traditionally used to guide resection of non-palpable breast lesions but is associated with patient discomfort and logistical constraints due to same-day placement. Wire-free localisation (WFL) may overcome these limitations while maintaining oncological safety. This study aimed to pilot WFL adoption in a tertiary New Zealand centre and evaluate whether international findings comparing HWL and WFL are reproducible, focussing on reoperation rates and patient experience.

Methods: A cohort study was conducted at Middlemore Hospital. HWL patients were identified retrospectively and compared with a prospectively recruited WFL cohort (Magseed n=17, Pintuition n=30, SAVI Scout n=26). The primary outcome was reoperation for margin inadequacy. Secondary outcomes included patient satisfaction assessed using a structured questionnaire. Clinical, operative, pathological and operator variables were also analysed.

Results: A total of 216 patients were included (HWL n=143; WFL n=73). Reoperation rates were similar between groups (HWL 13% vs WFL 11%, p=0.8). There was a trend towards lower specimen weights with WFL. Patient-reported outcomes significantly favoured WFL across overall experience, pain, distress and peri-operative comfort.

Conclusion: WFL demonstrated comparable reoperation rates to HWL, supporting oncological non-inferiority in this pilot New Zealand cohort, with significantly improved patient experience supporting wider adoption.