Carbon localisation of impalpable breast lesions

Background: Hookwire localisation (HL) is the most widely used technique for excision of impalpable breast lesions. This method has several drawbacks, particularly with logistics. Carbon localisation (CL) is an alternative procedure which is logistically superior to HL, but comparisons of accuracy and costs have not been reported. Methods: A consecutive case series of all patients from Northwestern BreastScreen undergoing either CL or HL between January 1999 and March 2001. Findings: Of 511 procedures, 219 CLs and 292 HLs were performed. The accuracy of excision did not vary significantly. Where a preoperative diagnosis of malignancy had been made by percutaneous needle biopsy (PNB), the margins were <1 mm in 27 of the CL group (18.9%) and 21 of the HL group (29.2%) (P=0.087). Cost analysis was very favourable for CL performed concurrently with PNB since the costs were incremental. Interpretation: At service delivery level, CL is an accurate alternative to HL with better logistics and favourable costs. Nationally, it has the potential to improve the cost effectiveness of breast screening programmes.