Sonographically-guided Metallic Marker Placement at Time of Wire Localization for Intraductal or Cystic Lesions: A Method to Verify Lesion Retrieval

Abstract

To propose deploying a metallic marker using sonographic guidance immediately before wire localization for excisional biopsy to identify intraductal or complex cystic lesions at specimen radiography. Institutional review board approval was obtained for this study and is Health Insurance Portability and Accountability Act compliant. The clinical, radiographic, and pathologic records of 21 patients, ages 21-78 years, with 22 intraductal or complex cystic masses who underwent excisional biopsy with wire localization immediately after sonographically-guided marker placement were reviewed. The procedure mammogram, ultrasound, and specimen radiographs were reviewed and evaluated for the presence of a metallic marker, lesion, or both. Pathology of all specimens was recorded and reviewed for concordance. Twenty-one (95%) of the markers were visualized on specimen radiographs. No lesions were apparent on specimen radiographs. Mammographic findings in 17 were negative (17/22; 77%); 3 circumscribed or partially obscured masses (3/22; 14%), 1 focal asymmetry (1/22; 5%), and 1 architectural distortion (5%) were also seen. Sonographic findings were 12 intraductal masses (12/22; 55%) and 10 complex cystic masses (10/22; 45%). Median and average size of all lesions were 9 mm (intraductal masses: median, 6 mm, mean, 7; complex cystic masses: median, 10 mm, mean, 11). All lesions were benign and all pathology was concordant with imaging findings. Given the high rate of marker retrieval on specimen radiography and pathologic concordance, marker placement at the time of wire localization is an efficient way to confirm retrieval of intraductal or complex cystic lesions.