Image-Guided Pre-Operative Localisation of Impalpable Breast Lesions: Analysis of the Hook-Wire Localisation Technique

Marita K Prior

doi:10.26717/bjstr.2018.03.000893

Abstract

Hook-wire localisation (HWL) under sonographic, tomosynthesis or MRI guidance is the most common technique...

Highlights

Hook-wire localisation (HWL) under sonographic, tomosynthesis or MRI guidance is the most common technique used to localize impalpable breast lesions
Final histopathology results showed ductal carcinoma in situ (DCIS) in patients, invasive ductal carcinoma (IDC) in patients, DCIS and IDC in 39 patients, lobular cancer in 13 patients, mixed ductal and lobular cancer in 5 patients, Targeting was successful in 98.5%, as 2/141 lesions were missed during HWL. 7/141 (4.9%) patients had complications related to the wire, 4 (57.1%) of which were tomosynthesis guided, and 3 (42.9%) were ultrasound guided
No major surgical complications were reported. 52/141 (36.9%) patients had re-excision due to involved margins, 35/52 (67.3%) were ultrasound guided and 17/52 (32.7%) were tomosynthesis guided. 51/52 (98%) had further malignancy in re-excision, and only 1 patient had fibrocystic changes in the final histopathologic examination, with solid mass on ultrasound which was thought discordant with imaging findings, as such she elected to repeat the excision to exclude a missed tumor; the final re-excision histopathology showed no malignancy

Summary

Introduction

Hook-wire localisation (HWL) under sonographic, tomosynthesis or MRI guidance is the most common technique used to localize impalpable breast lesions. We retrospectively review and discuss HWL success and complication rate, and the number of breast lesions that required re-excision at our institution. We compare our results with other centres, identifying alternative methods for localizing impalpable breast lesions. Breast cancer is one of the leading causes of death in women[1]. In 2007 it was second most common cause of cancer death among Australian women. Impalpable breast lesions nowadays constitute a significant proportion of breast lesions (up to 25%) 2, 3, which subsequently require image guided localisation to facilitate surgical excision. This paper aims to investigate the current procedure of HWL at our institution with a view to identifying common issues that arise with this technique. We want to improve the outcomes of our patients

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Conclusion