Hookwire Localisation of Breast Lesion

Hookwire localisation of a breast lesion is a technique used to identify an abnormal area in the breast including a cancer; that can be seen on ultrasound or mammogram but cannot be felt on examination and is required to be removed surgically.

It’s a way to help the surgeon remove a lesion that can not be felt by hand.

A tiny wire is placed in the breast before the operation.  This wire guides the surgeon to the area of concern in the breast, it will be removed during operation.

Insertion of the wire:

The wire will be put in by a radiologist a few hours before the operation, where the area of concern is localized with a mammogram or ultrasound.

An injection of local anaesthetic will be given to numb the area.  The wire (within a needle), will be inserted under the guidance of the mammogram or ultrasound.  Once the wire is in place, the needle will be removed.

A view mammogram might be performed after the wire has been inserted. The mammogram is performed with minimal pressure as to not dislodge the wire or make it move. This checks the position of the wire and helps the surgeon plan the operation.  Most patients don’t have any pain once the wire is in place. The wire will be covered with a dressing and you will be asked not to move the arm on the side of the wire.

In some cases, more than one wire needs to be inserted.  This is sometimes done for large areas of micro-calcification or if there is more than one area that needs to be removed.

If sentinel node localization is required you will be directed to the nuclear medicine department after the wire is inserted.

The operation :

After the wire is inserted (and after the sentinel node localization is completed - as required) you will be directed to the operating theatre waiting room to check in for your operation.

Under anaesthesia, the surgeon will remove the piece of tissue around the tip of the wire. The wire will be included in the specimen removed. All will be sent to be checked under the microscope.

Possible complications of Hookwire localisation?

With all surgical procedures, there are some risks and potential complications.  Fortunately, these risks are rare and Hookwire localisation of the breast usually proceeds without any problems.

In about 2% of cases, the abnormal area is not found in the piece of tissue removed during the operation.  There are several technical reasons why this can happen.  The operation may need to be performed again if the abnormal are isn’t found when the pathologist tests the specimen.

In another 2-3 % of cases the wire might move after its insertion. If that happens and detected before the operation then the wire will be removed and further appointment is arranged for a repeat procedure.

Your doctor will advise you if this is necessary and discuss your results and what further action may be required accordingly.