In case 2 wires were inserted for a tumor smaller than 2 cm, the harpoon width times 2 was used for calculation. When the pathologic tumor diameter was smaller than the width of the wire harpoon (10 mm), the harpoon width was used to calculate the ORV, because the whole wire needs to be excised. In these cases, the total diameter of pure DCIS or the sum of the invasive and DCIS diameters was used for ORV calculation, as surgical excision is based on these dimensions. The maximum tumor diameter, used in the calculation of the ORV, is defined as the maximum diameter of invasive tumor, except in the case of pure ductal carcinoma in situ (DCIS) or preoperatively observed additional DCIS surrounding the invasive tumor. Thus, by following the wires that border the tumor and measuring the length of the wires, the surgeon is able to remove the lesion in a wire-defined cube. Wire length A and B, the lengths from the proximal border of the tumor to the harpoon tip, in proportion to the total wire length (cut at 10 cm), are essential for the surgeon during localization of the tumor and must be measured continuously to monitor the exact 3-dimensional position of the tumor in the breast ( Figures 1 and 2). The post wire placement images are preoperatively discussed between radiologist and surgeon. After insertion, the position of the wire(s) relative to the suspected lesion is verified by mammography in the lateral and craniocaudal directions. Likewise, a single wire is suitable to use in BWL when marking a lesion smaller than 10 mm, as this is the width of the harpoon at the wire tip ( Figure 1C). However, when anatomical borders are present as skin or pectoral fascia, often 1 wire is sufficient ( Figure 1B). ![]() When a tumor is located centrally in the breast, 2 wires are needed for defining tumor borders ( Figure 1A). ![]() Generally, the longest tumor diameter is delineated for wire placement. In BWL, the number of wires to be inserted and the way of inserting depends on specific modalities of each case ( Figure 1). In WGL, a single wire is placed close to the tumor. Wire-guided local excision requires wire insertion at the tumor site before surgery by a radiologist under ultrasound or stereotactic guidance.
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