Guidance Systems for Breast Biopsy

Author: Karen Arnold-Korzeniowski, BSN RN
Content Contributor: Carolyn Vachani, MSN, RN
Last Reviewed:

If a mammogram or ultrasound finds a lesion or mass in your breast, it may need to be removed. If you or your provider cannot feel the mass, it is called non-palpable. When this happens, a “guidance system” is used to help the surgeon find the mass during surgery.  

What guidance systems are used?

There are two different ways to “mark” where the mass is in the breast; a wire or a marker. These devices:

  • Are used to help your surgeon locate a non-palpable mass - one that cannot be felt from the outside of the breast.
  • The wire method is placed on the day of surgery. The marker can be placed before surgery.
  • Both types of markers are removed with the mass during surgery.
  • Knowing exactly where the mass is in the breast can reduce the amount of breast tissue removed. This can mean the look of your breast after surgery is better.

How are they different?

Wires have been used for many years. A wire is exactly what it sounds like – a piece of wire goes through the breast tissue, into the mass and is left in place until surgery. The wire sticks out of the breast and needs to be taped or secured to the breast. This needs to be done the same day as surgery because of the risk of the wire moving if it is done earlier.

A marker is a small “seed”, about the size of a grain of rice. The marker is placed into the mass in your breast where it will stay until surgery. During surgery, a wand is used to find the marker, and in turn, the mass. When the mass is removed, the marker is removed with it. There are 2 markers available, and your team may call them by their brand name:

  • SAVI Scout uses a marker called a “reflector.” During surgery, the surgeon uses a radar wand to find the reflector.
  • MOLLI uses a magnetic marker. During surgery, the surgeon uses a wand to find the magnetic marker.

How is it placed?

Whether you are having a wire or a marker placed, your breast will be numbed using a local anesthetic (numbing medicine). The medication used to numb your breast may sting, but the pain will quickly go away. You will have an imaging test, such as a mammogram or ultrasound to locate the mass. Once the mass is located, a needle that contains either a wire or a marker is inserted into the mass. The wire or marker is pushed through the needle, into the lesion and the needle is removed. You will then have another imaging test to confirm the placement of the wire or marker. 

The wire is long enough that it will stick out of the breast and will be taped to secure it. Wires are often placed the same day as the surgery to remove the mass. You will not be able to see or feel a marker that was placed. A marker can be placed up to 30 days before surgery.  

How is it removed?

If a wire was placed, the surgeon uses it to find the mass. The wire will be removed with the mass during surgery. 

If a marker was used, the surgeon will use a handheld wand to find the marker in your breast. This allows the surgeon to determine exactly where the mass is in the breast. Your surgeon will remove the mass and the marker inside it. Whether a wire or reflector was placed, the goal is for the entire mass to be removed with clean margins, meaning none of the mass has been left in the breast.

References

Bick, U., Trimboli, R. M., Athanasiou, A., Balleyguier, C., Baltzer, P. A., Bernathova, M., ... & Cassano, E. (2020). Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights into Imaging11(1), 1-18.

Mango, V., Ha, R., Gomberawalla, A., Wynn, R., & Feldman, S. (2016). Evaluation of the SAVI SCOUT surgical guidance system for localization and excision of nonpalpable breast lesions: a feasibility study. American Journal of Roentgenology207(4), W69-W72.

SAVI SCOUT®: Cutting-edge Technology for Breast-Conserving Surgery. Found at https://www.pennmedicine.org/cancer/types-of-cancer/breast-cancer/breast-cancer-treatment/breast-cancer-surgery/lumpectomy/savi-scout?_ga=2.94389599.274625109.1620760322-445935904.1620760322

MOLLI website - http://mollisurgical.com

SAVI Scout website - https://www.merit.com/merit-oncology/localization/breast-soft-tissue-localization/scout-radar-localization/

A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
#
A
B
C
E
F
G
H
K
L
M
N
O
P
R
S
T
U
V
 
 
Feedback?

Thank you for your feedback!