Wire-guided versus radio-guided localization for non-palpable occult lesion in breast tissue: A systematic review and meta-analysis.

579 Background: Accurate preoperative localization of non-palpable breast lesions is crucial for successful breast-conserving surgery. Wire-guided localization (WGL) has traditionally been the standard technique; radio-guided localization (ROLL) has emerged as an alternative approach with potential benefits in surgical precision and workflow. Current evidence comparing the efficacy and safety of these two techniques remains inconsistent. This systematic review and meta-analysis evaluates WGL versus ROLL for non-palpable breast lesions with respect to surgical and oncological outcomes. Methods: A systematic literature search was conducted on electronic databases from inception until January 2026. Outcomes included re-excision rates, margin involvement, specimen volume and weight, accurate localisation of lesions and operative time. We employed risk ratios (RRs) with 95% Confidence Intervals (CIs) for dichotomous outcomes. Mean differences (MDs) or standardized mean differences (SMDs) with 95% CIs were computed for continuous outcomes using Review Manager V.5.4. Quality assessment and risk of bias were assessed using the Cochrane Risk of Bias Tool 2 on all included RCTs. Results: This systematic review and meta-analysis included 13 studies with a total of 5,318 patients. There was no statistically significant difference in the re-excision rates between the two interventions (OR = 1.44; 95% CI: 0.73, 2.83, p = 0.143). Localization time (SMD = 1.75; 95% CI: -1.01, 4.51, p = <0.0001) and length of operation time was significantly shorter in the ROLL group (SMD = 0.22; 95% CI: 0.10, 0.34, p = 0.028). There was no statistically significant difference in the margin involvement between the two groups (OR = 0.61; 95% CI: 0.37, 0.99, p = 0.063). ROLL was associated with significantly smaller volume of specimen (SMD = 0.16; 95% CI: -5.41, 5.73, p = <0.0001). Conclusions: ROLL and WGL demonstrate comparable oncological outcomes, with no significant differences in the re-excision rates or margin involvement. However, ROLL is associated with significantly shorter localization and operative times, suggesting procedural efficiency over WGL.