Abstract Background Wire-free localization systems are essential for removing nonpalpable breast cancer lesions, a crucial aspect of surgical outcomes. These systems vary in mechanisms (radioactive, magnetic, radar), making direct comparisons across patients during surgery challenging. This study evaluated the performance of four localization systems through ex vivo experiments. Methods The systems evaluated were magnetically guided Pintuition and Magseed, radar-guided SCOUT, and radioactive seed localization (RSL). The assessment included signal propagation in water, the accuracy of displayed distances, and the accuracy of detection by surgeons in a tissue model. Results The experiment in water demonstrated disparate maximal detection ranges (50 mm for Pintuition, 30 mm for SCOUT, 25–30 mm for Magseed, and ≥ 50 mm for RSL) and different signal directionality. The signal presence behind the marker position axis was properly absent for Pintuition and SCOUT. For SCOUT, inconsistent behavior depending on the marker orientation and a bias in displayed distances were observed. The accuracy of the detection by the surgeons was the highest using Pintuition (indistinct from SCOUT, p = 0.1585 and significantly distinct from RSL, p = 0.0263), whereas Magseed was significantly inferior to that of all other systems ( p < 0.0001). Conclusion All evaluated systems were capable of detecting the marker. Nevertheless, notable inter-system differences in performance observed under controlled ex vivo conditions should be considered, particularly given their significant practical implications for breast cancer surgeons. Relative performance trends favored the Pintuition and SCOUT, followed by RSL and Magseed. Awareness of system-specific physical behavior may support informed system selection in clinical practice.
Zapletal et al. (Wed,) studied this question.