The Utilization of Wire-Guided Localization in the Management of Nonpalpable Breast Lumps at a Teaching Hospital in Ghana

Introduction: Breast cancer is the highest cause of female cancer deaths worldwide. Africa bears the brunt of this devastating disease mainly due to a lack of awareness and late presentation. Recently, a new cohort of patients in some jurisdictions in Africa have presented with small nonpalpable breast tumors due to early detection or following neoadjuvant chemotherapy. Aim: This study documented the initial experience of wire-guided localization of nonpalpable breast tumors in a Ghanaian tertiary hospital, used to facilitate the achievement of negative surgical margins. Methods: This was a retrospective evaluation and analysis of clinical, radiological, and histopathological data of 45 patients who had image-guided wire localization of nonpalpable lumps immediately prior to surgical excision at the Korle Bu Teaching Hospital over more than a 4-year period. The study evaluated the preprocedural radiological diagnosis, tumor size, histology, and completeness of resection. Results: Median age at presentation was 50 years. Clinical indications of these nonpalpable lesions included 13.3% post neoadjuvant chemotherapy and 40.0% of chemotherapy naive histologically diagnosed breast cancers. The median size of the excised lesions was 13 mm. Excision was associated with clear margins in most cases. Up to 53.3% of the lesions were malignant, out of which invasive ductal carcinoma NST was the commonest histology. Conclusion: Ultrasound-guided wire localization has proven to be a beneficial tool in breast-conserving surgery in an LMIC environment. More than half the pathologies localized were malignant, with 96% showing clear margins.