What Is Needle Localization?

Needle-localized biopsy is the insertion of a computer-guided wire (needle) into an area of breast tissue that appeared abnormal during a screening procedure, such as a mammogram or ultrasound.

When Is Needle Localization Done?

1. For women who have no symptoms (no “lump” is felt) but their screening mammograms show an abnormality that suggests cancer.
2. The procedure may also be performed during a wide local excision (lumpectomy) if the breasts are large but the tumor is small so it is difficult to feel the tumor. 

Before the Procedure

Before you come for your procedure, you will have:

• Physical exam
• Blood tests
• Chest x-ray

Tell your doctors and nurses about:

• Your medical history including previous illnesses and surgeries and any current medical problems 
• Any allergies you have including to those to foods, drugs, and any other substances
• Any medications you are taking including prescription and over-the-counter drugs, and any herbal/vitamin/supplement products

Do not eat or drink anything after midnight the night before your procedure.

Do not take any aspirin or other anti-inflammatory medications (such as ibuprofen) for 10 days prior to the procedure as they may increase the risk of bleeding.

For all other medications: Check with your doctor to see if you should take your medication the day of the procedure.

Do not wear (or bring) any jewelry or other valuables to the hospital.

Please make arrangements for someone to drive you home after the procedure. 

At the Hospital

• Report to the front desk, you will be sent to the Breast Center
• You will be asked to put on a gown
• You may get an sedative to help you relax during the procedure
• An intravenous line (IV) will be started
• If you will be having general anesthesia, a member of the anesthesiology team will visit you to ask a few questions and tell you about the surgery

Remember to tell your doctors and nurses:

• Any allergies you have to food, medications, or other substances
• All medications you are taking including prescription drugs, over-the-counter drugs, and any herbal or supplements

About the Procedure

This procedure is usually considered to be a simple operation.

• Local anesthetic is used in the majority of cases (in unusual cases, a woman may be given general anesthesia).  A local anesthetic numbs the area so you will not feel any pain but allows you to remain awake and reduces the risks associated with general anesthesia. Local anesthesia allows you feel back to normal more quickly as it takes longer for your body to clear the effects of general anesthesia. 
• Using your last mammogram (or ultrasound) as a guide, your doctor will insert the thin wire into the area that appears abnormal on that test.
• An x-ray will be taken to ensure the wire is in the desired location.   If the wire needs to be repositioned, another confirmation x-ray will be taken after it is moved.
• You will then be transferred to the operating table, antiseptic will be applied to the breast, and sterile drapes will be placed around the operative site. 
• The breast will be injected with a local anesthetic (like when you get Novacaine before dental work) to numb the area. (You may feel pressure or tugging sensations during the procedure, but no pain; if you do begin to feel any discomfort, tell your surgical team right away.)
• After the breast is completely numb, the surgeon will make a small incision (cut) into the breast. He or she will then continue to cut along the path of the wire until the abnormal area is reached and then that tissue is removed.
• Another x-ray will be taken to ensure that the targeted tissue has been removed.
• The guide wire is removed and the incision closed and is covered by a sterile dressing.
• The excised tissue is sent to the lab for analysis.
• Note: Axillary lymph node dissection is not normally done at this time – it is done after a diagnosis of cancer has been confirmed. This is a general rule, however, and there may certain circumstances when axillary lymph node surgery may be performed at the same time as needle localization.

After The Procedure

• You will be moved to a recovery room until the effects of the anesthetic and any sedative you were given have worn off.
• Nurses will monitor your condition and when you are stable, you will be allowed to go home. 
• You may be given a prescription for a mild medication to relieve any discomfort you may experience.