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

TL;DR

This umbrella review compares radioguided techniques with traditional wire-guided methods for localizing non-palpable breast lesions, finding radioguided methods to be more effective and efficient.

Contribution

The study provides a comprehensive synthesis of evidence comparing radioguided and wire-guided localization techniques for non-palpable breast lesions.

Findings

Radioguided methods showed high localisation success rates (often over 95%) and fewer positive margins compared to wire-guided localisation.

Operative and localisation times were generally shorter with radioguided techniques, with comparable specimen volume and safety.

Reoperation rates were mixed, but radioguided approaches showed potential for improved workflow and combined lesion-sentinel node evaluation.

Abstract

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.

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