Localization Of Nonpalpable Breast Lesions Research Articles

3–18 Radioactive Seed Localization of Nonpalpable Breast Lesions is Better Than Wire Localization

3–18 Radioactive Seed Localization of Nonpalpable Breast Lesions is Better Than Wire Localization

Rates of reexcision for breast cancer after magnetic resonance imaging-guided bracket wire localization

We performed this study to determine rates of close or transected cancer margins after magnetic resonance imaging-guided bracket wire localization for nonpalpable breast lesions. Of 243 women undergoing MRI-guided wire localizations, 26 had MRI bracket wire localization to excise either a known cancer (n = 19) or a suspicious MRI-detected lesion (n = 7). We reviewed patient age, preoperative diagnosis, operative intent, mammographic breast density, MRI lesion size, MRI enhancement curve and morphology, MRI Breast Imaging Reporting and Data System (BI-RADS) assessment code, number of bracket wires, and pathology size. We analyzed these findings for their relationship to obtaining clear margins at first operative excision. Twenty-one of 26 (81%) patients had cancer. Of 21 patients with cancer, 12 (57%) had negative margins at first excision and 9 (43%) had close/transected margins. MRI size > or = 4 cm was associated with a higher reexcision rate (7 of 9, 78%) than those < 4 cm (2 of 12, 17%) (p = 0.009). MRI BI-RADS score, enhancement curve, morphology, and preoperative core biopsy demonstrating ductal carcinoma in situ (DCIS) were not predictive of reexcision. The average number of wires used for bracketing increased with lesion size, but was not associated with improved outcomes. On pathology, cancer size was smaller in patients with negative margins (12 patients, 1.2 cm) than in those with close/transected margins (9 patients, 4.6 cm) (p < 0.001). Reexcision was based on close/transected margins involving DCIS alone (6, 67%), infiltrating ductal carcinoma and DCIS (2, 22%), or infiltrating ductal carcinoma alone (1, 11%). Reexcision pathology demonstrated DCIS (3, 33%), no residual cancer (5, 55%), and 1 patient was lost to followup (1, 11%). Interestingly, cancer patients who required reexcision were younger (p = 0.022), but breast density was not associated with reexcision. To our knowledge, this is the first report of MRI-guided bracket wire localization. Patients with MRI-detected lesions less than 4 cm had clear margins at first excision; larger MRI-detected lesions were more likely to have close/transected margins. Reexcision was often because of DCIS and was the only pathology found at reexcision, perhaps because MRI is more sensitive for detecting invasive carcinoma than DCIS.

Radioactive seed localization of nonpalpable breast lesions is better than wire localization

Background The current study sought to validate radioactive seed localization (RSL) as an alternative to wire localization (WL) to facilitate the operative excision of nonpalpable breast lesions. Methods One hundred consecutive patients underwent preoperative WL and the next 100 RSL. Margins were considered negative if ≥2 mm from in situ and invasive disease. Results RSL resulted in 100% retrieval of the seeds and lesions. Sixty-eight percent of patients underwent RSL at least 1 day before surgery. RSL resulted in a 35% relative improvement in the rate of negative margins in the first specimen ( P = 0.01) and a 62% relative improvement in the rate of reoperation for positive margins ( P = 0.01). The sentinel lymph node (SLN) identification rate was 100% in both groups. Conclusions RSL is effective and safe, and this procedure significantly improved the rate of negative margins in the first specimen and the rate of reoperation for positive margins compared to WL. We highly favor RSL over WL.

Novel techniques in sentinel lymph node mapping and localization of nonpalpable breast lesions: the Moffitt experience.

The concept of lymphatic mapping has helped to redefine the clinical significance of lymph nodes with respect to breast cancer. The combination technique using both blue dye and radiocolloid is the most effective method of lymphatic mapping. The data in the literature support the concept that all patients undergoing lumpectomy or especially mastectomy should undergo lymphatic mapping if a diagnosis of invasive cancer is remotely possible. The low morbidity, high sensitivity, and specificity of mapping indicate its use for increasing numbers of patients thought initially not to be candidates for the procedure.

Novel Techniques in Sentinel Lymph Node Mapping and Localization of Nonpalpable Breast Lesions: The Moffitt Experience

Novel Techniques in Sentinel Lymph Node Mapping and Localization of Nonpalpable Breast Lesions: The Moffitt Experience

A new system for localization of nonpalpable breast lesions with adhesive marker plate

The objective of this article is to present a new method of preoperative localization of nonpalpable breast lesions by means of an adhesive marker plate that makes an anteroposterior approach to the thoracic wall possible. Between January 2000 and September 2002, 41 consecutive mammographic localizations were performed with the adhesive marker plate. In most cases ( n=34) the lesions were microcalcifications. The mean age of the patients was 54.7 years. The device used consists of a square plate made of highly flexible plastic with an adhesive film on the back for firm attachment to the area of the breast surface corresponding to the approximate location of the lesion. This plate contains a network of holes and a system of radiopaque coordinates. The technique for its use is described step by step. All 41 lesions were localized: to within 5 mm or by transfixation of the lesion in 95.1% of cases (39/41) and to within 1 cm in the remaining 2 cases. Surgical excision of the breast lesions was carried out successfully in all cases, and in 56% (23/41) it was possible to use a periareolar incision. Histological findings revealed 24 benign and 17 malignant lesions. This new technique permits the localization of nonpalpable breast lesions accurately, simply, and with very little discomfort to the patient. The anteroposterior approach simplifies the surgeon's task in the management of these lesions.

Dual technique for preoperative localisation of non-palpable breast lesions.

Dual technique for preoperative localisation of non-palpable breast lesions.

Localization of nonpalpable breast lesions using hook-wire combined with isosulfan blue dye.

Journal of Surgical OncologyVolume 82, Issue 1 p. 73-74 How I Do It Localization of nonpalpable breast lesions using hook-wire combined with isosulfan blue dye George C. Zografos MD, Corresponding Author George C. Zografos MD gzografo@med.uoa.gr First Department of Propaedeutic Surgery, Athens University, Athens, GreeceAlopekis 22, Kolonaki, 10675 Athens, Greece. Fax: (01) 7229048.Search for more papers by this authorCarmen Doumitriou, Carmen Doumitriou First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorDimitrios Lappas, Dimitrios Lappas First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorGeorge Karatzikos, George Karatzikos First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorEmi Bami, Emi Bami First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorCostas Fotiadis, Costas Fotiadis First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorEvagelos Menenakos, Evagelos Menenakos First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorGeorge Androulakis, George Androulakis First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this author George C. Zografos MD, Corresponding Author George C. Zografos MD gzografo@med.uoa.gr First Department of Propaedeutic Surgery, Athens University, Athens, GreeceAlopekis 22, Kolonaki, 10675 Athens, Greece. Fax: (01) 7229048.Search for more papers by this authorCarmen Doumitriou, Carmen Doumitriou First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorDimitrios Lappas, Dimitrios Lappas First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorGeorge Karatzikos, George Karatzikos First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorEmi Bami, Emi Bami First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorCostas Fotiadis, Costas Fotiadis First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorEvagelos Menenakos, Evagelos Menenakos First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this authorGeorge Androulakis, George Androulakis First Department of Propaedeutic Surgery, Athens University, Athens, GreeceSearch for more papers by this author First published: 24 December 2002 https://doi.org/10.1002/jso.10119Citations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume82, Issue1January 2003Pages 73-74 RelatedInformation

Wire localization of non-palpable breast lesions: out of date ?

Wire localization of non-palpable breast lesions: out of date ?

Wire localization of non-palpable breast lesions: out of date ?

Aims. With the increasing use of screening mammography, more and more non-palpable lesions are found. As less invasive techniques like core needle biopsy are introduced, we evaluated our experience with the well-known standard procedure of surgical excision after wire localization. Methods. We retrospectively evaluated the results of 479 wire localizations for non-palpable breast lesions between 1992 and 1999 in 465 patients. Feasibility and reliability of the procedure and the incidence of complications are reported. Results. The mean age of these patients was 57 years (range 22–81 years). The mammographic finding with the highest rate of malignancy was density combined with architectural distortion (72%). The removal of the lesion was radiologically confirmed in 93%; if the lesion appeared to be not removed, after 3 months mammography was repeated, in 14 patients a second localization procedure was done and in 10 patients still a malignancy was found. In 79%, the excision after initial fine-wire localization was irradical. Twenty-five patients developed a haematoma and five patients had a wound infection. The overall malignancy rate was 50%. With a mean follow-up of 18 months in 11 patients with a diagnosis of benign disease after an adequate procedure, still a malignancy was found at the original excision site. Conclusion. In selected cases, especially as a part of the therapeutic procedure in breast-conserving therapy, there will remain a place for wire localization and excision biopsy. However, we have to reconsider its place as a diagnostic procedure as the results of less invasive procedures are promising.

Radioguided localization of non-palpable breast lesions and simultaneous sentinel lymph node mapping

Radioguided localization of non-palpable breast lesions and simultaneous sentinel lymph node mapping

Use of technetium-99m–labeled colloid albumin for preoperative and intraoperative localization of nonpalpable breast lesions

Background: Management of clinically occult breast lesions is still a major point of debate. Several techniques (eg, skin projection, guidewire localization) have been proposed, but all of them have technical limitations. Study Design: The aim of this study was to assess the efficacy of a new method to locate occult breast lesions using technetium-99m ( 99mTc)-labeled colloid particles of human serum albumin (radioguided occult lesion localization). We studied 647 consecutive patients (mean age 51.3 years; range 25 to 77 years) with nonpalpable breast lesions detected mammographically or by ultrasonography. Within 24 hours before operation, 3.7 MBq (0.1 mCi) of 99mTc-labeled colloid was injected directly into the center of the lesion using stereotactic mammographic guidance (when only microcalcifications were present) or ultrasonographic guidance (for opacities). Excision biopsy was performed with a gamma-detecting probe. After excision, the area was checked for residual radioactivity and the specimen was radiographed to verify complete removal of the lesion. The material was then sent for pathologic examination. The absorbed dose to the inoculated area and the external irradiation to staff were also determined. Results: In all 647 patients, the “hot spot” was located easily and quickly. X-ray and scintigraphy of the specimen verified the presence and centricity of the lesion in all patients but three (99.5%). Pathologic examination revealed 340 cancer lesions (52.6%). Of these patients, 339 (99.7%) were treated by breast-conserving operations and one (0.3%) received a modified radical mastectomy. No major surgical or postoperative complications were encountered. No recurrences were documented during follow-up. The absorbed dose to the breast and other tissue was negligible (0.03 ± 0.02 mGy/MBq), as was the dose to the surgeon’s hands (7.5 ± 5.0 μSv/h). The latter dose represents 0.015% and 0.002% of the recommended limits of the European Community for the general population and for exposed workers, respectively. Conclusions: Radioguided occult lesion localization seems to offer a simple and reliable method to locate occult breast lesions with a gamma-detecting probe, allowing complete removal of the lesion in 99.5% of patients. Because of the small quantity of radioactivity, the procedure is safe for both patients and medical staff.

Intraoperative Ultrasound Localization of Nonpalpable Breast Lesions

Intraoperative Ultrasound Localization of Nonpalpable Breast Lesions

Preoperative Needle Localization of Nonpalpable Breast Lesions: Determination of Appropriate Needle Length.

Determination of needle length for needle localization of nonpalpable breast lesions prior to surgical excision biopsy may occasionally be problematic. A method for more accurate needle length determination is presented for use when uncertainty arises. This method was evaluated in 46 consecutive lesions targeted for excision biopsy following mammographically guided needle localization.

Migration of the guide-wire into the pleural cavity after needle localization of breast lesions

The hook-wire is frequently used for pre-operative localization of non-palpable breast lesions. We describe a case where this hook-wire migrated into the pleural cavity, causing paralysis of the ipsilateral phrenic nerve. A thoracoscopic procedure resulted in successful removal of the wire from the chest. Migration of the hook-wire after localization of mammographic lesions is a serious complication for which potential occurrence should be noted.

Usefulness of Stereotactic Localization of Nonpalpable Breast Lesions

Usefulness of Stereotactic Localization of Nonpalpable Breast Lesions

Computed tomography—guided needle localization of nonpalpable breast lesions: Review of 24 cases

We examined the role of computed tomography (CT) in breast imaging, especially in guiding needle localization procedures. We reviewed our institution's breast imaging database, from 1978 to 1994, for procedures in which CT scanning was used. Twenty-four CT-guided needle localizations were identified. Medical records, mammograms, CT scans, and pathology reports were reviewed for all patients. Twenty-four needle localizations were performed on 22 female patients. The average size of the lesions localized was 12 mm. The most common reason for CT scanning was the inability to image a suspicious density by conventional mammography on two orthogonal views. Nine malignant and 15 benign lesions were localized under CT guidance. One patient developed a postoperative hematoma. No other complications occurred. CT-guided breast localization is a reliable technique that may be used to define selected breast lesions that are difficult to triangulate or localize by conventional two-view mammography.

CT-guided needle localization of non-palpable breast lesions: Review of 23 cases

CT-guided needle localization of non-palpable breast lesions: Review of 23 cases

Indocyanine green dye as a tissue marker for localization of nonpalpable breast lesions.

Indocyanine green dye as a tissue marker for localization of nonpalpable breast lesions.

Ultrasonographically guided wire localization of nonpalpable breast lesions.

The results of 102 preoperative ultrasonographically guided wire localizations of nonpalpable breast lesions were reviewed. Ultrasonography was used because of nonvisualization during mammography (16 cases), a difficult location of the lesion (3 cases), vasovagal syncope during mammographic guidance (two cases), or the radiologist's preference (81 cases). All localizations were successful. Removal was confirmed by specimen mammography or ultrasonography or both in 85 cases and by macroscopic examination in 10 cases. In seven cases specimen radiography was not performed. One syncope and one wire insertion into the pectoralis fascia occurred. Ultrasonographically guided wire localization is accurate and well tolerated in aiding surgical biopsy of breast lesions.