Health Technology Assessment on Non-Wire Localization for Non-Palpable Breast Lesions

Condition Description - Breast cancer is a prevalent disease affecting the breast tissue, typically as ductal or lobular carcinoma. In Canada, it is the most common cancer among women, with an estimate of approximately 30,000 new cases diagnosed in 2023. Non-palpable breast cancer refers to cancerous growths in the breast that cannot be felt during a physical examination but are visible through ultrasound or mammogram. These growths are often discovered through screening programs and are usually at an early stage.

Current treatment options - The main goal of treating non-palpable breast cancer is to prevent recurrence and prolong survival. Surgical excision is the primary treatment option for many non-palpable breast cancers, with breast-conserving surgery (lumpectomy) being the preferred surgical approach.

Description of the Assessed Technology(ies) - While traditional wire-guided localization has been the standard method, newer non-wire localization techniques such as radioactive seed localization, magnetic seed localization, and radar reflectors are gaining popularity due to their potential benefits in accuracy and patient comfort. Non-wire devices can be inserted using a special needle by a trained radiologist under ultrasound or mammogram guidance days or weeks before the surgery, which allows flexibility in scheduling.

Health Technology Assessment Committee’s Findings:

After review of the HTA, the Health Technology Assessment Committee found that non-wire technologies are at least as clinically effective as compared to the status quo (wire localization), but offer some other benefits including:

• reduced patient anxiety (i.e. that a wire will fall out) and improved comfort (especially regarding travel requirements for patients in rural and remote regions) and,
• an opportunity for reduced administrative burden and operating room scheduling issues given that localization and surgery do not have to occur on the same day.

The cost of non-wire technology per use is currently higher than wire localization. The Health Technology Assessment Office has developed a costing tool to aid health authorities with implementation planning activities. The costing tool includes an overview of cost differentials for consumables, capital equipment, and technology purchasing price for wire vs. non-wire technologies.

It will be at the discretion of each health authority to assess the value of potential benefits in comparison to the additional implementation cost of the non-wire technology options.