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Pilot trials indicate the Breast Cancer Locator\n                      <jats:sup>TM<\/jats:sup>\n                      (BCL), a novel supine magnetic resonance imaging\u2013based guidance system, helps surgeons resect cancers with a low positive margin rate (PMR). Our objective was to evaluate BCL noninferiority and superiority compared with wire localization (WL) in reducing the PMR with BCS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with nonpalpable, magnetic resonance imaging\u2013visualized invasive breast cancer or ductal carcinoma in situ undergoing BCS were prospectively randomized to either BCL or WL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 418 randomized patients underwent surgery. The PMR was 14.4% (30\/209) in the BCL group and 21.1% (44\/209) in the WL group, a relative decrease of 32%. In primary analysis, the treatment difference was \u22127.1% (95.4% confidence interval [CI] \u221214.3 to 0.1). Noninferiority was demonstrated (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011). The one-sided\n                      <jats:italic>p<\/jats:italic>\n                      -value for superiority (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.025) slightly exceeded the prespecified significance level of 0.023. In prespecified analysis stratified by final tumor type, the PMR was significantly lower in the BCL group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019). Fewer BCL patients underwent re-excision: 12.9% versus 19.6%, a relative decrease of 34%. The PMR for all tumor types was lower in the BCL group, with a &gt;\u200960% relative reduction in PMR in patients with ductal carcinoma in situ (20.6% vs. 53.3% [95% CI \u221252.1 to \u22129.1]) and invasive lobular carcinoma (9.1% vs. 25.6% [95% CI \u221232.9 to \u22120.2]). Adverse event rates were similar.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BCL was noninferior to WL and superior in analysis stratified by final tumor type. Clinically meaningful relative reductions in PMR and re-excision rates were observed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-20657-6","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:29:25Z","timestamp":1792690165000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An International Randomized Prospective Trial Comparing a Supine MRI-based Guidance System, The Breast Cancer LocatorTM, to Wire Localization for Breast-Conserving Surgery for Non-palpable Breast Cancer"],"prefix":"10.1245","author":[{"given":"Jennifer S.","family":"Gass","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Pesek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Czerniecki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Edmonson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wey-Liang","family":"Leong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Patterson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winne","family":"Polen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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