Global research trends and thematic evolution of imaging-guided localization in breast cancer surgery: a bibliometric analysis

Introduction

Breast cancer remains the most frequently diagnosed malignancy among women worldwide and continues to represent a major global health burden (1,2). Surgical resection, particularly breast-conserving surgery, is a cornerstone of treatment for early-stage and selected locally advanced disease (3). As screening programs and neoadjuvant systemic therapies have expanded, an increasing proportion of breast cancers present as nonpalpable lesions or exhibit substantial morphological changes before surgery, posing significant challenges for accurate intraoperative tumor localization.

Imaging-guided localization techniques have therefore become essential in modern breast cancer surgery. Traditional approaches such as wire-guided localization, mammography-guided biopsy, and ultrasound-assisted marking have long been used to facilitate lesion identification (4,5). While these methods have proven effective, they are associated with practical limitations, including patient discomfort, scheduling constraints, and variability in surgical precision. In response, technological advances have driven the development of alternative localization strategies, incorporating diverse imaging modalities and marker-based systems to improve accuracy and workflow efficiency (6-8).

Over the past two decades, the role of imaging in breast cancer surgery has expanded beyond basic lesion detection. Ultrasound and magnetic resonance imaging (MRI) are increasingly integrated into preoperative planning and intraoperative decision-making, particularly in patients undergoing neoadjuvant chemotherapy (9-12). Accurate localization of residual disease after systemic treatment has emerged as a critical clinical challenge, as tumor response can be heterogeneous and conventional palpation-based strategies are often insufficient. Consequently, image-guided localization is now closely linked to the broader concept of precision surgery, aiming to optimize oncologic outcomes while minimizing unnecessary tissue resection.

Parallel to these clinical developments, research activity in imaging-guided breast cancer surgery has grown rapidly. Numerous studies have investigated novel localization devices, imaging modalities, and hybrid techniques, often reporting promising technical feasibility and short-term outcomes. However, the rapid diversification of technologies has also led to a fragmented evidence base, making it difficult to discern dominant research themes, collaborative structures, and the extent to which innovation has translated into high-impact clinical practice. In this context, bibliometric analysis offers a systematic approach to quantitatively assess research output, collaboration patterns, thematic evolution, and influential studies within a given field (13-15).

Although bibliometric methods have been increasingly applied in oncology research, a comprehensive bibliometric analysis focusing specifically on imaging-guided localization and surgical management of breast cancer remains limited. Existing reviews have primarily addressed individual techniques or imaging modalities, without providing a global overview of how research priorities, technological focus, and international collaboration have evolved over time (4-8). Moreover, few studies have examined the relationship between emerging localization technologies and their citation impact, which may reflect the maturity of clinical evidence and translational uptake (16-26).

This study focuses specifically on imaging-guided localization techniques directly serving breast cancer surgery, including preoperative lesion marking, intraoperative image-guided resection, and localization of residual tumor after neoadjuvant therapy. Studies purely focusing on diagnostic imaging, artificial intelligence (AI)-based image classification or digital pathology without surgical localization application are explicitly excluded. Therefore, the aim of this study was to perform a comprehensive bibliometric analysis of imaging-guided localization and surgical research in breast cancer from 2000 to 2025, using data from the Web of Science Core Collection (WoSCC). By analyzing publication trends, country and author collaboration networks, journal citation patterns, and keyword co-occurrence, this study seeks to map the intellectual structure of the field and identify evolving research hotspots. In addition, by integrating bibliometric findings with representative high-impact clinical studies, we aim to provide insights into the translational trajectory of imaging-guided localization technologies and highlight directions for future research and clinical application. We present this article in accordance with the BIBLIO reporting checklist (available at https://gs.amegroups.com/article/view/10.21037/gs-2026-0319/rc).

Methods

Data source and search strategy

A comprehensive literature search was conducted using the WoSCC on November 15, 2025, to identify publications related to imaging-guided localization and surgical management of breast cancer. To ensure data consistency and reproducibility, all records were retrieved on the same day, and no updates were applied thereafter.

The search strategy was constructed using topic terms (TS) combined with Boolean operators and covered four conceptual domains: breast cancer, imaging-guided techniques, localization methods, and surgical or perioperative treatment context. The full search query was as follows: TS = (“breast cancer” OR “breast neoplasm” OR “breast tumor”) AND (“image-guided” OR “imaging-guided” OR “ultrasound-guided” OR “mammograph*” OR “stereotactic” OR “X-ray guided” OR “MRI-guided” OR “magnetic resonance-guided” OR “digital breast tomosynthesis” OR “DBT”) AND (“localization” OR “marker clip*” OR “tissue marker*” OR “biopsy clip*” OR “fiducial marker*” OR “clip placement” OR “clip localization” OR “seed localization” OR “wire localization” OR “radio-guided” OR “magnetic seed” OR “iodine seed”) AND (“preoperative” OR “surgery” OR “operative” OR “neoadjuvant chemotherap*” OR “NAC” OR “tumor response”).

The initial combined search (#1–#4) yielded 476 records (Table 1).

Study selection and eligibility criteria

Retrieved records were screened in a stepwise manner. First, results were limited to English-language publications and eligible document types. After restricting the dataset to articles and applying the language filter, 387 records remained.

Subsequently, titles, abstracts, and author keywords were independently reviewed by two researchers (H.G. and J.T.) to assess relevance. The initial screening consistency rate was 92.3%, and all disagreements were resolved through discussion with the senior author (D.L.). Publications were excluded if they did not focus on imaging-guided localization techniques or image-guided surgical approaches in breast cancer, or if they addressed imaging exclusively in non-surgical or purely diagnostic contexts. Studies focusing solely on tumor biology or systemic therapy without surgical relevance were also excluded. A total of 21 irrelevant records were excluded at this stage.

Following this screening process, 366 articles published between 2000 and 2025 met the inclusion criteria and were included in the final bibliometric analysis. The 387 records after database filtering (document type + language) correspond to the eligibility assessment stage in Figure 1, and the final 366 articles are the manually screened final set. The study selection process is illustrated in Figure 1.

Figure 1 Literature screening and inclusion process.

Inclusion criteria were: (I) studies published between 2000 and 2025; (II) articles focusing on breast cancer localization techniques with imaging guidance (e.g., ultrasound, MRI, stereotactic methods); (III) English-language research articles and reviews.

Exclusion criteria included: (I) non-English publications; (II) non-peer-reviewed document types (e.g., conference abstracts, editorials, letters); (III) studies purely focusing on diagnostic imaging, AI image classification or digital pathology without direct association with surgical localization; (IV) studies not related to imaging-guided localization or surgical management of breast cancer.

Data extraction

All eligible records were exported from WoSCC with full records and cited references. Extracted bibliographic information included publication year, authors, institutional affiliations, countries, source journals, author keywords, cited references, and citation counts as provided by the database.

Bibliometric analysis and visualization

Bibliometric analyses were conducted using VOSviewer (version 1.6.20) and the Bibliometrix package (version 5.1.1) implemented in R software (version 4.3.3).

VOSviewer was used to construct and visualize collaboration networks (co-authorship analysis at the country and author levels), journal citation networks, and author keyword co-occurrence maps. Bibliometrix was applied to perform descriptive bibliometric analyses, including annual publication trends, citation analysis, and author productivity metrics.

Network analyses were performed using the full counting method. The minimum number of occurrences for author keywords was set to three, and all other parameters were maintained at the default settings recommended by the software. Network strength was quantified using total link strength (TLS), which reflects the intensity of collaborative or associative relationships between nodes in the network.

Overlay visualizations were generated to examine temporal trends and identify shifts in research focus over time. As this is a bibliometric analysis focusing on publication trends, collaboration networks, and keyword co-occurrence, traditional statistical analysis of clinical variables was not applicable. Quantitative data were analyzed using descriptive statistics and bibliometric software (VOSviewer 1.6.20 and Bibliometrix 5.1.1).

Methodological considerations

This study applied established bibliometric methods to quantitatively and thematically analyze the evolution of imaging-guided localization and surgical research in breast cancer. As the analysis was based exclusively on published literature and did not involve patient-level or human-subject data, ethical approval was not required.

Table 1 presents the construction of search strategy and results of each retrieval domain. The search was conducted using the Web of Science database with specific keywords (steps #1 to #4). After filtering for document type (articles and reviews) and language (English), 387 records remained for further eligibility assessment.

Results

Publication growth

The analysis of publication trends in the field of breast cancer research reveals a steady growth in the number of articles published from 2000 to 2025. In the early years, from 2000 to 2010, the annual publication count remained relatively low, with a peak of 18 articles in 2002. However, starting in 2011, a significant increase in the number of publications was observed, reaching 22 articles in 2015, which continued to rise through 2018. Notably, the number of publications peaked in 2021 with 23 articles published, reflecting the growing global interest in this research area.

The growth in publications since 2011 coincides with the widespread popularization of breast-conserving surgery and the increasing detection of non-palpable lesions via screening, which continuously drives the clinical demand for precise localization techniques. The average citations per article showed a declining trend in recent years, mainly due to the short publication window of recent studies, rather than a decline in research value.

As illustrated in Figure 2, the chart depicting publication and citation trends from 2000 to 2025 highlights this shift, where the publication count remained high despite the decreasing citation trend, emphasizing the evolving dynamics of breast cancer research and its reception within the scientific community.

Figure 2 Publication and citation trends (2000–2025).

Country network analysis

The country network analysis reveals a strong collaboration among the leading contributors in breast cancer research. The United States (USA) is at the center of this network, with the highest number of TLS and citations. As shown in Table 2, the USA leads with 27 TLS, 130 documents, and 4,698 total citations, forming a significant hub in the network, as illustrated in Figure 3. The USA is closely connected with other major research contributors such as Germany, China, and the Netherlands, forming distinct collaborative clusters.

Figure 3 Co-authorship network visualization of countries in publication for 2000–2025.

Germany ranks second with 13 TLS and 32 documents, followed by China with 10 TLS and 32 documents. These countries have a considerable impact on the research network, as shown in Figure 3, where Germany and China are closely linked to USA in the collaborative structure. The Netherlands, South Korea, and Spain also play important roles, contributing to the research network with significant TLS and document counts.

Notably, smaller research hubs, such as France and Sweden, exhibit minimal connectivity and fewer documents, with France contributing just 5 documents and Sweden 3 documents, reflecting their smaller roles in the broader collaborative network. Conversely, countries like the USA, China, and Germany, through higher TLS and citation counts, are central to advancing the research landscape in breast cancer studies. The highly centralized collaboration structure may lead to uneven diffusion of advanced localization technologies in regions with weak research capacity, suggesting the necessity of international cooperation to promote technical standardization.

The clusters presented in Table 2 further categorize these countries, showing that countries like the USA and Germany belong to larger clusters, with robust research output and citations, while countries like Sweden and France are isolated in smaller clusters. Figure 4 visualizes these clusters, highlighting the collaborative intensity and the distribution of research efforts globally.

Figure 4 Co-authorship overlay visualization of USA.

Author network analysis

The author network analysis highlights the key contributors in breast cancer research, with Zhu Q. emerging as the central figure in the network. As shown in Table 3, Zhu Q. has the highest TLS of 26, indicating strong collaborative ties with other prominent researchers. With 8 documents and 326 citations, Zhu Q.’s work is heavily cited, and this is evident in Figure 5 where Zhu’s network cluster is clearly visible as the most central node, linking to authors such as Tannenbaum S. and Kane M., who also show strong collaborative connections.

Figure 5 Author co-authorship network. Node size represents total link strength; node color indicates average publication year. (A) Co-authorship network visualization of authors in publication for 2000–2025. (B) Density visualization of authors in publication for 2000–2025.

Following closely are Tannenbaum S. and Kane M., with TLS values of 20 and 19, respectively, reflecting their substantial roles in the network. Both authors have contributed to multiple documents and have garnered significant citations. Hegde P., Merkulov A., and Xu C. are also important contributors, although they show slightly fewer documents and citations compared to the top authors. Their collaborations, however, are crucial for understanding the evolution of research in breast cancer.

The collaborative structure depicted in Figures 6,7 shows the geographic and collaborative relationships between these key authors, with clusters representing specific research areas, such as image classification, deep learning, and convolutional neural networks. These visualizations highlight the global nature of the collaboration, with key hubs in the USA, Europe, and Asia.

Figure 6 Citation network visualization of journals in publication for 2000–2025.

Figure 7 Co-occurrence overlay visualization of keywords in publication for 2000–2025 (time axis spans the full period with 5-year intervals, labels displayed at 2005 and 2020).

In terms of research focus, Table 4 provides a detailed overview of the affiliations and research foci of the leading authors. Institutions such as Case Western Reserve University, Indian Institute of Technology Kharagpur, and Shenzhen University focus on AI-assisted imaging lesion recognition and localization technology, providing technical support for precise surgical localization, which is reflected in their high document counts and TLS.

Journal network analysis

The journal network analysis, shown in Figure 6 and detailed in Table 5, highlights the prominent journals in breast cancer research, with a focus on key areas such as medical imaging, surgical oncology, and breast cancer treatment. The analysis reveals how these journals are interconnected through collaboration and research contributions.

American Journal of Roentgenology, with the highest TLS of 35, leads the journal network. It has published 929 documents and accumulated an average of 27.76 citations per document, reflecting its substantial influence in the field of radiology and medical imaging techniques in breast cancer research. This journal is central to the network, with strong links to other high-impact journals in the imaging field.

Annals of Surgical Oncology, also with a TLS of 35, follows closely. With 1200 documents and an impressive 47.04 citations per document, it plays a critical role in the surgical oncology community, particularly in advancing surgical treatments for breast cancer. The journal’s high citation count underscores its significance in the field.

Breast, another major journal with a TLS of 35, is central to the research network. Although it has published fewer documents [255], it has a significant citation count of 9.98 citations per document, indicating its importance in breast cancer research and clinical applications. The journal is widely recognized for its contributions to clinical research and treatment strategies.

Breast Cancer Research and Treatment, with a TLS of 35, contributes extensively with 320 documents and an average of 16.27 citations per document. This journal serves as a key resource for researchers focusing on the latest advancements in breast cancer research, including diagnostic methods, treatment options, and patient care strategies.

Radiology, with a TLS of 32, stands as another major journal in the network. With 1,093 documents and an average of 23.95 citations per document, it plays a crucial role in advancing medical imaging techniques used in breast cancer diagnosis and treatment. The journal’s high publication and citation numbers demonstrate its significant influence in shaping the field of breast cancer imaging.

Academic Radiology and Breast Journal are also part of this extensive network, although they have a lower TLS (32 and 31, respectively). These journals focus on specific aspects of radiology and breast cancer research, publishing important articles that contribute to niche areas in the field.

The visual network in Figure 6 illustrates these relationships, showing that American Journal of Roentgenology, Annals of Surgical Oncology, and Breast Cancer Research and Treatment are central to the network. Their collaborative relationships with other journals reflect the highly interdisciplinary nature of this field: imaging-guided localization requires close integration of radiology and breast surgery, which is consistent with the clinical demand for multidisciplinary collaboration in precise breast cancer surgery.

Journals like Surgical Oncology Clinics of North America, with a TLS of 30, are more specialized in surgical aspects of cancer treatment, forming smaller but significant clusters in the network. These journals contribute to the focused research in surgical oncology, further enriching the broader network.

Co-occurrence analysis of author keywords

The co-occurrence analysis of author keywords, depicted in Figure 7, provides a comprehensive visualization of the interconnectedness between key research topics in breast cancer studies. The analysis highlights how different areas of research are related and the evolution of focus within the field.

Breast cancer stands at the center of this network, with a dense cluster of associated keywords like biopsy, surgery, ultrasound, mammography, and MRI. These terms are tightly interconnected, reflecting their critical roles in breast cancer diagnosis and treatment. The close relationship between mammography and breast biopsy suggests that imaging techniques and biopsies are essential for the accurate diagnosis of breast cancer. Moreover, the connection between breast cancer and biopsy further underscores the importance of biopsy in determining cancer type and stage.

As the research progresses, breast conserving surgery, lumpectomy, and sentinel node biopsy emerge as key surgical terms that are also strongly linked in the network. These terms highlight the significance of surgical techniques and procedures in treating breast cancer, particularly for early-stage or localized cases. The inclusion of neoadjuvant chemotherapy in the network, along with breast surgery and preoperative localization, emphasizes its growing importance in modern treatment regimens, where chemotherapy is used to shrink tumors prior to surgery.

Additionally, newer advancements such as Magseed, mammography, and radioguided surgery form a smaller but notable cluster, indicating a shift towards more precise and image-guided interventions in breast cancer surgery. These trends suggest an increasing focus on minimally invasive procedures that improve patient outcomes.

The color gradient in Figure 7 illustrates the changing focus of research over time, with earlier studies predominantly centered around traditional diagnostic and treatment methods such as biopsy and surgery. More recent research, however, is increasingly oriented towards advanced imaging-guided localization technologies, such as MRI-guided and ultrasound-guided intraoperative localization, and precision surgery strategies, signaling the growth of personalized and precise breast cancer surgical management.

Advancements in imaging-guided surgery for localization and treatment of breast cancer

Recent advancements in imaging-guided surgery have significantly improved the precision and effectiveness of breast cancer treatments, particularly in the localization and treatment of tumors. Several representative highly cited studies published in high-impact factor journals have explored the role of imaging technologies in surgical outcomes. These studies are summarized in Table 6. The selection is based on both total citation count and landmark contribution to the field; the journal impact factor column is presented for objective information only and is not used as the sole criterion for study evaluation.

Krekel et al. (2013) conducted the COBALT trial, a pivotal study comparing intraoperative ultrasound-guided lumpectomy with traditional palpation-guided surgery for palpable breast cancer. Published in The Lancet Oncology, the trial demonstrated that ultrasound guidance not only improved surgical precision but also reduced the margin of error in tumor removal, making it a critical advancement in breast cancer surgery (28). The study, which has been cited 160 times and holds an Impact Factor of 35.9, has had a significant impact on the field, promoting the widespread adoption of ultrasound in clinical settings.

Similarly, Rahusen et al. (2002) explored the effectiveness of ultrasound-guided lumpectomy compared to wire-guided excision for nonpalpable breast cancer in Annals of Surgical Oncology. Their study, cited 184 times, underscored the benefits of ultrasound in precisely locating tumors that are not easily detectable by touch, further advancing the surgical techniques used for nonpalpable breast cancer (29). With an Impact Factor of 3.5, this research reinforced the utility of ultrasound guidance in improving tumor localization during surgery.

In the domain of MRI-guided surgery, Furusawa et al. (2006) made significant contributions with their study on MRI-guided focused ultrasound surgery (MRgFUS) for the ablation of breast carcinoma, published in Journal of the American College of Surgeons. This non-invasive approach, which has been cited 214 times and holds an impact factor of 3.4, demonstrated the potential of MRI to guide focused ultrasound in targeting and ablating tumors, offering a promising alternative to traditional surgical methods (30).

Yeh et al. (2005) provided a comprehensive comparison of imaging techniques, specifically mammography, sonography, and MRI, for evaluating residual tumors after neoadjuvant chemotherapy in AJR American Journal of Roentgenology. Their study, which has been cited 299 times and boasts an impact factor of 6.1, emphasized the superiority of MRI in assessing tumor response to chemotherapy, providing valuable insights into the effectiveness of treatment and post-treatment monitoring (9).

Finally, Hynynen et al. (2001) pioneered research in MRgFUS for breast fibroadenomas in Radiology. This groundbreaking study, cited 505 times and with an impact factor of 15.2, demonstrated the non-invasive potential of MR-guided ultrasound in treating benign breast tumors, marking a significant milestone in the application of ultrasound technology for breast surgery (31).

These studies collectively illustrate the growing role of imaging-guided surgery in the localization and treatment of breast cancer. By enhancing tumor detection and precision in tumor removal, these technologies have revolutionized the way surgeons approach breast cancer treatment, leading to improved patient outcomes and reduced complications. The continued evolution of imaging modalities promises to further refine surgical techniques and provide new avenues for non-invasive and minimally invasive treatments (32).

Discussion

Interpretation of the overall research landscape

Rather than merely reflecting an increase in publication volume, the evolving bibliometric patterns observed in this study reveal a deeper transformation in how imaging-guided localization is conceptualized and applied within breast cancer surgery. The steady growth in publications since 2011 coincides with a period of rapid technological diversification, during which imaging modalities and localization tools expanded beyond conventional wire-guided techniques toward more precise and patient-adapted approaches (4-8). However, the concurrent decline in average citations per article suggests that research output has become increasingly fragmented, with many studies addressing highly specific technical refinements rather than broadly generalizable clinical questions.

This divergence between publication quantity and citation density should not be interpreted as a decline in scientific relevance. Instead, it likely reflects a transitional phase in which emerging localization technologies are actively explored but have not yet accumulated sufficient longitudinal evidence to exert substantial citation impact (16-26). From a bibliometric perspective, this pattern highlights a maturation process of the field, where innovation precedes large-scale validation and clinical consolidation.

From localization feasibility to surgical precision: conceptual evolution of the field

The thematic evolution identified through keyword co-occurrence and highly cited references illustrates a clear conceptual shift in breast cancer surgery research. Early investigations primarily addressed the feasibility of tumor localization, particularly for nonpalpable lesions, focusing on wire-guided techniques and basic imaging modalities such as mammography and ultrasound. These approaches successfully established the technical foundation for breast-conserving surgery but were often limited by workflow inefficiencies and suboptimal margin control (4,5,7,8).

Subsequent research increasingly emphasized imaging-guided precision rather than simple detectability. The growing prominence of intraoperative ultrasound, MRI-based assessment, and image-guided evaluation following neoadjuvant chemotherapy reflects a broader recognition that imaging plays a decisive role in surgical planning and intraoperative decision-making (9-12,28,29). Highly cited clinical trials and comparative imaging studies underscore that imaging guidance can directly influence oncologic outcomes by reducing positive margins and re-excision rates (28,29). Recent large-sample cohort studies further confirm this advantage: a multicenter study including patients with non-palpable breast cancer showed that intraoperative ultrasound-guided localization reduced positive margin rate and re-excision rate compared with wire-guided localization (33); a 2024 study focusing on residual disease after neoadjuvant chemotherapy reported that intraoperative ultrasound achieved an accurate localization rate of 89.2%, effectively avoiding excessive normal tissue resection (34). These contemporary data strongly support the clinical value of ultrasound-guided localization and are consistent with the growing research focus identified by our keyword analysis.

More recent bibliometric signals, including the emergence of keywords such as “Magseed”, “radioguided surgery”, and “neoadjuvant chemotherapy”, suggest that the field has entered a phase characterized by technological refinement and personalization. Importantly, this evolution is driven not solely by innovation in imaging devices, but by increasingly complex clinical scenarios—such as tumor downstaging after systemic therapy—that demand accurate spatial information at the time of surgery. In this context, imaging-guided localization is no longer an auxiliary technique but a central component of precision breast surgery (23-26,32).

Global collaboration and uneven knowledge translation

The country-level collaboration network demonstrates a highly centralized global research structure, with the United States functioning as the principal hub of scientific output and international connectivity. This dominance likely reflects the concentration of advanced imaging infrastructure, multidisciplinary research environments, and access to large patient cohorts. European countries such as Germany and the Netherlands, despite lower publication volumes, exhibit strong citation performance, suggesting a focus on high-impact clinical studies and methodological rigor.

In contrast, the rapid growth of publications from China is accompanied by comparatively lower citation impact, indicating that increased research productivity does not necessarily translate into proportional academic influence. This discrepancy may be attributable to differences in study design, clinical integration, or the time required for emerging research programs to gain international recognition. Smaller contributors with limited network connectivity further illustrate the persistence of structural inequalities in research visibility and collaboration.

From a translational standpoint, these findings suggest that the diffusion of imaging-guided localization technologies is uneven across regions. While innovation is globally distributed, the generation of high-level clinical evidence remains concentrated in a limited number of research-intensive settings. Strengthening international collaboration and promoting multicenter validation studies may therefore be essential for accelerating the equitable adoption of advanced localization strategies.

Clinical and research implications: bridging innovation and evidence

The bibliometric trends identified in this study carry important implications for both clinical practice and future research. Clinically, the expanding focus on imaging-guided localization reflects a paradigm shift in breast-conserving surgery, where accurate spatial guidance is increasingly viewed as integral to achieving optimal oncologic and cosmetic outcomes. The growing body of research on localization after neoadjuvant chemotherapy further underscores the need for reliable imaging-based strategies to address tumor heterogeneity and treatment response (9-12).

At the same time, the diversification of localization technologies raises critical questions regarding comparative effectiveness and evidence maturity. Bibliometric signals suggest that while novel approaches such as magnetic seed localization and radioguided surgery are gaining visibility, robust head-to-head comparisons and long-term outcome data remain limited (7,8,18,22). This imbalance highlights a potential gap between technological enthusiasm and evidence-based clinical adoption.

Future research should therefore prioritize prospective, multicenter studies that directly compare localization techniques across different clinical contexts, including post-neoadjuvant settings. In addition, the integration of multimodal imaging and emerging computational approaches, such as artificial intelligence-assisted image interpretation, represents a promising avenue for enhancing surgical precision. Importantly, such innovations should be evaluated not only in terms of technical feasibility but also with respect to patient-centered outcomes and health system efficiency.

Limitations and future directions

Several limitations should be considered when interpreting the findings of this bibliometric analysis. The reliance on a single database may have resulted in incomplete coverage of relevant literature, and the exclusion of non-English publications may have introduced language bias. Furthermore, recently introduced localization technologies may be underrepresented in citation analyses due to their limited time in clinical practice (16,17,23-26).

Nevertheless, by combining quantitative bibliometric metrics with thematic interpretation, this study provides a nuanced overview of the evolving research landscape in imaging-guided breast cancer surgery. As the field continues to advance, future bibliometric investigations incorporating multiple data sources and longitudinal clinical outcomes may further clarify the relationship between technological innovation and meaningful clinical impact.

Conclusions

This bibliometric analysis provides a comprehensive and integrative overview of research trends in imaging-guided localization and surgical management of breast cancer over the past two decades. By examining publication growth, collaboration networks, thematic evolution, and highly cited clinical studies, this work highlights a clear transition from basic localization feasibility toward precision-oriented, imaging-guided surgical strategies.

The findings demonstrate that advances in imaging technologies have progressively reshaped the conceptual role of localization in breast cancer surgery—from a technical prerequisite to a central component of surgical decision-making, particularly in complex clinical scenarios such as post-neoadjuvant chemotherapy management. While research output has expanded rapidly, the uneven distribution of citation impact and collaborative influence across countries suggests that high-level clinical evidence remains concentrated within a limited number of research-intensive regions.

Importantly, the bibliometric patterns identified in this study reveal a potential gap between technological innovation and evidence consolidation. Emerging localization techniques have gained increasing visibility, yet robust comparative studies and long-term outcome data are still relatively scarce. Addressing this imbalance will be essential for ensuring that innovation in imaging-guided localization translates into meaningful and equitable improvements in clinical practice.

In summary, this study maps the evolving research landscape of imaging-guided localization in breast cancer surgery via bibliometric methods, and reveals the gap between technological innovation and evidence consolidation. These findings may provide a reference for future research direction in this field. Clinical application of emerging localization technologies still requires verification by high-quality prospective clinical trials.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the BIBLIO reporting checklist. Available at https://gs.amegroups.com/article/view/10.21037/gs-2026-0319/rc

Peer Review File: Available at https://gs.amegroups.com/article/view/10.21037/gs-2026-0319/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-2026-0319/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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