Wire Localization versus Intralesional Methylene Blue Marking for Surgical Excision of Impalpable Breast Lesions

Preoperative marking of impalpable breast lesions is crucial for limiting false negative results and reducing the size of the resected breast tissue, thus improving cosmesis. The aim of this study was to evaluate wire localization versus intralesional methylene blue marking for surgical excision of impalpable breast lesions regarding the success of localization, cost, and limitations of both techniques. This prospective cohort study included 50 patients with impalpable breast lesions or an area of suspicious microcalcification who were scheduled for surgical excision in the period between June 2020 and December 2021. Patients were randomly allocated into two groups: group I included 25 patients for surgical excision after preoperative ultrasound-guided methylene blue marking. Group II included 25 patients scheduled for surgical excision after preoperative guide wire localization under radiological guidance. Localization by methylene blue injection has been associated with significantly shorter time of operation with mean duration (P = 0.018) and much reduced cost in comparison with guide wire (P < 0.001). Postoperative pain, reactions, ecchymosis, accuracy of localization, margin status, and patient satisfaction did not vary significantly between both groups. Localization by methylene blue injection is not only equally successful to guide wire in locating and identifying impalpable breast lesions for surgical excision, but also is significantly less costly and associated with a shorter duration of operation.