Wire-guided localisation vs HOLOGIC® LOCalizer™ radiofrequency identification (RFID) tag localisation of non-palpable breast lesions; a comparative analysis of ease of use and accuracy of localisation.

Background: Breast cancer screening programs have increased the detection of nonpalpable breast lesions. Given its accuracy and low failure rate, wire-guided localisation has long been the gold-standard prior to breast conserving surgery (BCS). Recently, several non-invasive localisation modalities have been developed, with varied efficacy reported. This study aimed to evaluate tag localisation's impact on margin positivity and re-excision rates and utility in management of benign lesions compared to wire-guided localisation.

Methods: A retrospective comparative study was performed of patients, who underwent wide local excision (WLE) from 2020 to 2023, in a single institution. Descriptive statistics were performed on patient, tumour and radiological findings. Binary regression analysis was used to assess the association between localisation techniques and margin positivity and re-excision rates.

Results: Of 680 patients included, 123 (18.1 %) underwent tag localisation, 298 (43.8 %) underwent ultrasound (US) guided wire localisation and 259 (38.1 %) underwent mammogram (MG) guided wire localisation. Tag localisation was associated with a significantly lower rate of positive margins compared to wire guided localisation (p < 0.03). While not statistically significant, a trend towards lower re-excision rates was observed post tag localisation (11.24 %) compared to both US guided wire localisation (18.99 %) and MG guided wire localisation (20.66 %). However, tag localisation was significantly more likely to fail and require a subsequent wire (0 = 0.0003).

Conclusion: While associated with fewer positive margins, tag localisation did not significantly lower re-excision rates and was more likely to fail than wire-guided localisation. Further studies may elucidate its possible benefits in select patients.