Surgical treatment of nonpalpable primary invasive and in situ breast cancer

A range of alternative techniques to wire-guided localization are available for localization of neoplastic lesions prior to surgical management of nonpalpable breast cancerThe use of radioguided localization is supported by data from meta-analyses; however, overall utilization of this technique has been poor owing to the logistical and legislative issues associated with radioisotope useMore than 95% of localization procedures include ultrasonography, making intraoperative ultrasonography a logical alternative, but this method requires evidence from randomized controlled trials and implementation of training programmes for surgeonsTechniques that use the principles of radioguided localization, but that are radioisotope free, could form the basis of future therapeutic options and warrant investigation in adequately powered clinical trialsNon-invasive surgery using high-intensity focused ultrasound is in its infancy, but could potentially enable real-time visualization and therapy of lesions as an outpatient procedure