• Amna Masud, Huma Majeed Khan, Eisha Tahir, Anam Waseem, Hafsa Ahmed, and Rabia Ikram.
• Department of Breast Surgery, Ittefaq Hospital (Trust), Lahore, Pakistan.
• J Coll Physicians Surg Pak. 2024 Nov 1; 34 (11): 136413681364-1368.

ObjectiveTo measure the effectiveness of localisation and removal of impalpable target lesions without compromising patient safety in a resource-limited setup using preoperative ultrasound and mammography with peroperative use of C-arm image intensifier.Study DesignDescriptive study. Place and Duration of the Study: Department of Breast Surgery, Ittefaq Hospital (Trust), Lahore, Pakistan, from 25th October 2011 to 17th February 2023.MethodologyAll the breast cancer patients who achieved complete clinical response after neoadjuvant systemic treatment and underwent breast conservation surgery during the study period were included. Tumour / clip localisation was done using preoperative ultrasound or image-guided marking, a 2-view mammogram in all cases and the use of an image intensifier to confirm the presence of clips in the excised specimen. The primary outcome was the accurate localisation and removal of the index lesion, while the secondary outcome included the reoperation rate for positive margins and early local recurrence.ResultsData from 144 patients were reviewed. Successful localisation was done in all the patients; only one patient had a positive margin for ductal carcinoma-in situ (DCIS), achieving a 99.3% clear margin rate. Local recurrence within two years after primary operation was seen in one patient only.  Conclusion: By a combined approach of preoperative ultrasound-guided marking, a 2-view mammogram, and the use of image intensifier, successful localisation of an impalpable breast lesion is possible without compromising oncological and aesthetic principles.Key WordsBreast conservation surgery, Localisation, Non-palpable, Margins, Image intensifier.

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