Localization Of Occult Breast Lesions Research Articles

Techniques Used to Localize Occult Breast Lesions: An Update

With breast cancer screening programs becoming more available worldwide and covering larger age ranges, the prevalence of impalpable breast pathology is increasing. Whilst there is a ‘tried and tested’ technique for localizing occult lesions, the market for alternative methods is increasing and is estimated to pass $1 billion by 2024. In this article, we review the techniques currently available for localization of occult breast lesions and discuss the pros and cons of each.

Polydimethylsiloxane: a new contrast material for localization of occult breast lesions

BackgroundThe radioguided localization of occult breast lesions (ROLL) technique often utilizes iodinated radiographic contrast to assure that the local injection of 99mTc-MAA corresponds to the location of the lesion under investigation. However, for this application, this contrast has several shortcomings. The objective of this study was to evaluate the safety, effectiveness and technical feasibility of the use of polydimethylsiloxane (PDMS) as radiological contrast and tissue marker in ROLL.Materials and methods.The safety assessment was performed by the acute toxicity study in Wistar rats (n = 50). The radiological analysis of breast tissue (n = 32) from patients undergoing reductive mammoplasty was used to verify the effectiveness of PDMS as contrast media. The technical feasibility was evaluated through the scintigraphic and histologic analysis.ResultsWe found no toxic effects of PDMS for this use during the observational period. It has been demonstrated in human breast tissue that the average diameter of the tissue marked by PDMS was lower than when marked by the contrast medium (p <0.001). PDMS did not interfere with the scintigraphic uptake (p = 0.528) and there was no injury in histological processing of samples.ConclusionsThis study demonstrated not only the superiority of PDMS as radiological contrast in relation to the iodinated contrast, but also the technical feasibility for the same applicability in the ROLL.

A new radioguided procedure for localization and surgical treatment of neck node metastasis of papillary thyroid cancer

We intended to use a radioguided technique for pre-operative localization of neck node recurrences in patients with papillary thyroid cancer (PTC) already submitted to thyroidectomy and radioiodine treatment. We selected 20 patients affected by PTC with evidence of neck nodes recurrences at ultrasound examination. Our method has been derived from the Radioguided Occult Lesion Localization technique used for pre-operative localization of occult breast lesions. The technique involves the inoculation of human albumin macroaggregates labeled with radioactive technetium (0.4 mCi in a volume of 0.05 ml) directly in the suspicious lesion, under ultrasound guidance. The persistence of the radioactive tracer in the nodes is confirmed by a scintigraphy performed 2 h after injection. During surgery, a gamma detecting probe is used to locate the suspicious lesions as "hot spots". Fifty lymph-nodes were injected with the tracer. All radiolabeled lymph-nodes were located and removed during surgery. At histology, metastasis of PTC was confirmed in 38/50 (76%) lymph-nodes. At least one metastatic lymph-node per patient was removed. In 8/20 (40%) patients, reactive lymphoid hyperplasia was found in 12/50 (24%) lymph-nodes. This radioguided technique has been highly effective for localization and surgical treatment of suspicious lymph-node detected at neck ultrasound and may play a valuable role in case of node metastases of thyroid cancer that show no radioiodine uptake.

Emprego concomitante da localização radioguiada da lesão e do estudo do linfonodo sentinela para o carcinoma invasor de mama não palpável

OBJETIVO: analisar o emprego concomitante da localização radioguiada de lesão não palpável e do estudo do linfonodo sentinela (LS) em mulheres com câncer de mama. MÉTODO: estudo prospectivo de 45 pacientes com carcinoma não palpável de mama. O radiofármaco utilizado foi o dextram marcado pelo 99mTc. Realizou-se injeção no sítio peritumoral, sob orientação ultra-sonográfica ou estereotáxica, com auxílio de agulha de raquianestesia de gauge 18. A linfocintilografia, para visualização pré-operatória do local da lesão e do LS, foi feita em gama câmera convencional, com abdução de 90º do membro superior ipsilateral. A exérese da lesão primária e a do LS foram realizadas com auxílio de sonda de detecção de radiação gama. RESULTADOS: quanto à remoção do tumor primário, obteve-se taxa de sucesso em todos os casos. Houve necessidade de ampliação de margem cirúrgica em cinco pacientes. Em relação ao LS houve falha em quatro casos, com índice de localização de 93%. Não foram observadas complicações. CONCLUSÃO: os resultados obtidos parecem demonstrar que a utilização simultânea dos dois procedimentos constitui estratégia eficaz para o tratamento do câncer inicial de mama em uma única sessão

CT-guided preoperative needle localization of MRI-detected breast lesions

To assess the value of accurate preoperative CT-guided needle localization of occult breast lesions, we reviewed a total of 39 needle-directed biopsies of breast tumors in 24 women. The average age was 52.9 years (range 31–67). All lesions were nonpalpable and mammographically, as well as sonographically occult. They were solely seen on MR-images. After demonstrating the suspicious region on CT scans, a hookwire was inserted. The correct position was confirmed by a control scan. The subsequent histopathological examination showed that 28 of the lesions (71.8%) were benign, among them mastopathy, fibrosis, fibroadenoma, papilloma, intramammary lymph node, liponecrosis and epitheliosis. Eleven lesions (28%) were malignant and showed either lobular, ductal or tubular cancer. Our results endorse that CT guided needle localization is a helpful method that allows a precise surgical excision of the suspect area with the removal of a minimal amount of breast tissue.

Radioguided localization of occult breast lesions

Abstract Clinically occult breast lesions are found with increasing frequency by breast screening, and several methods have been used to locate suspicious occult lesions prior to excision. We have developed a new localization technique called ROLL (radioguided occult lesion localization) in which a small quantity of 99m Tc-labelled colloidal serum albumin is injected into the lesion during mammographic or ultrasonic examination. Correct positioning is checked by scintigraphy. A gamma detecting probe is then used to locate the lesion and guide its surgical removal. We report on the first 225 patients in whom we have employed this technique; all had non-palpable breast lesions identified by mammography or ultrasound as clusters of microcalcifications or small opacities. Pathology revealed 134 cancers, 133 of which were treated by breast-conserving surgery. In all but 2 cases (99%), radiolabelling coincided with the lesion site. X-radiography verified that the specimen removed contained all of the lesion. Removal of clinically occult breast lesions is greatly facilitated by the gamma probe, which locates the skin projection accurately, allowing choice of the most appropriate incision, and which can be employed continuously during surgery.

Minimal-volume excision of nonpalpable breast lesions.

To explore the value of accurate preoperative localization of occult breast lesions, we reviewed 100 consecutive needle-directed breast biopsies performed by the same surgeon over a 1-year period. A spring hookwire device for localization was inserted parallel to the chest wall. Two thirds of biopsies were performed under local anesthesia, and all were performed in an outpatient setting. Sixteen lesions were invasive carcinomas, and eight were ductal carcinomas in situ. In 96 lesions, the localizing wire was placed within 2 mm of the lesion, and in the remaining four it was within 5 mm of the abnormality. The mammographic lesion was excised in the first specimen in 96 cases. One patient required a second biopsy because of failure to excise the lesion in question after three specimens were taken. The only surgical complication was one hematoma, which resolved within 3 months. Median specimen volume for the entire series was 6.0 cm3. Median largest specimen diameter was 2.5 cm. Precise preoperative localization with a spring hookwire to within 2 mm of the mammographic lesion allows the surgeon to excise a median volume of 6 cm3 breast tissue with consistent retrieval of the lesion.

Localization of occult breast lesions: practical solutions to problems of triangulation.

The preoperative triangulation and localization of some occult breast lesions can be complicated if the lesion is located deep in the breast. Based on the authors' experience of 1,400 localization procedures, standard breast positions were modified to help locate lesions that were difficult to see in two projections. Standard compression plates were also modified, allowing placement of fenestrations over deep lesions--especially those in the axillary tail of the breast--to facilitate safe, accurate localization.

Stereotaxic needle localization and cytological diagnosis of occult breast lesions.

A stereotaxic technique for localization of occult breast lesions and fine needle aspiration for cytological diagnosis was used on examination of 543 patients. Successful localization with the needle tip within 1 mm of the suspected lesion was possible in 490 patients (90.2%). Based on a high mammographic index of suspicion for malignancy, 187 of 490 patients were selected to undergo open biopsy, following aspiration cytology and localization with methylene blue injection. The statistical results (cytologic vs. histologic examination) revealed a sensitivity of 97.5% and a specificity of 95.2% for cytologic diagnosis of occult breast lesions. The technique is easy to learn and takes 20-30 minutes to perform. Compliance was 100% and complications were nil. This new technique expedites localization and maximizes the specificity of mammography for occult breast lesions.

Needle localization of occult breast lesions with a curved-end retractable wire: technique and pitfalls.

A series of 100 consecutive occult mammographic abnormalities were localized with a curved-end retractable wire system. A true-positive rate of 24% and a failure rate of 4% for initial excision were found. The pitfalls and advantages of this new needle-wire breast localizer are presented.

Needle localization of occult breast lesions

Excision of mammographically demonstrated breast lesions that are clinically occult remains a surgical challenge. Eighteen lesions were preoperatively localized (all but 1 with the Frank hooked wire technique). Eleven lesions were evaluated with specimen radiography. Three lesions proved to be malignant at biopsy and 15 were benign. We found hooked wire needle placement to be extremely accurate, enabling rapid excision of the suspicious mass with excision of rather small areas of the breast with no significant cosmetic defect. Mean anesthetic time for breast biopsy alone was slightly less than time for biopsy with needle localization, which was less than that when specimen radiography was employed. In the absence of a discrete lesion, specimen radiography is a useful adjunct. Needle localization is simple, accurate, rapid, and requires no special apparatus. Its widespread use should lead to the identification of more breast carcinomas in a potentially curable state.

Ultrasound localization of occult breast lesions.

High-resolution real-time ultrasound with either a 7.5- or 10-MHz transducer was used to localize 7/9 nonpalpable breast masses previously detected by mammography and to determine where the biopsy needle should be inserted.

Localization of occult breast lesions.

Localizing nonpalpable suspicious lesions seen by mammography is a challenge to the surgeon. Using a previously reported technique we report our experience in 66 needle localization procedures for nonpalpable lesions of which fourteen were carcinoma. We emphasize the ease and accuracy of this technique with minimal loss of breast substance.

Preoperative roentgenographically guided percutaneous localization of occult breast lesions: three-year experience with 180 patients and description of a method.

The identification of a suspicious occult breast lesion with mammography should, in most instances, result in roentgenographically guided localization followed by surgical excision. Over a three-year period, we performed 180 roentgenographically guided preoperative localizations for occult breast lesions, 32% (57/180) of which were malignant. Of the total, there were 85 masses and 95 clustered microcalcifications. We prefer to use a modified hookwire for lesion localization.

A modified needle-hookwire technique to simplify preoperative localization of occult breast lesions.

Accurate preoperative localization of breast lesions is important to ensure removal of the suspected area without also removing large quantities of tissue. By using a hook retracted into the needle lumen, repositioning prior to the final anchoring of the wire in the tissue is simplified.

Preoperative localization of occult breast lesions: a new technic.

Percutaneous needle placement before biopsy is a simple method of localizing occult breast lesions found by mammography. A biopsy of the exact area within the breast is done. Specimen radiography assures that the correct area is included for histologic study.