ABSTRACT
Impalpable lesions in the breast are defined as incidental lesions detected on imaging that cannot be felt clinically. These can often be tricky to manage. This chapter describes how to assess and, if required, surgically excise them. The history, development, and pros and cons of the different localization techniques like wire-guided localization (WGL), intraoperative ultrasound (IOUS), radioisotope occult lesion localization (ROLL), radioiodine seed, and magnetic and electromagnetic seeds are described. We touch upon minimally invasive excision and also address the role of localization in patients undergoing neoadjuvant chemotherapy. The authors give some very valuable tips to surgeons to help centralize the lesion in the excision specimen and take out a minimal amount of uninvolved breast tissue. The management of the missed lesion is also discussed. The chapter ends with a section on localization of impalpable lesions in low-resource centers and stresses the importance of multidisciplinary teamwork.
