Preoperative Wire Localization Research Articles

Does surgeon-performed intraoperative wire localization allow for lower margin positivity rates compared to radiologist-performed preoperative localization in early breast cancer?

BackgroundThis study compares positive margin rates in breast conserving surgery (BCS) for early breast cancer using two localization techniques: surgeon-performed intraoperative ultrasound-guided wire localization (IOWL) versus radiologist-performed preoperative wire localization (POWL). MethodsPatients with unifocal breast cancer undergoing BCS with follow-up at a single institution were retrospectively identified. Factors associated with positive margins were identified. Results177 patients underwent IOWL (N ​= ​85) or POWL (N ​= ​92). There was a significantly lower rate of positive margins for IOWL vs. POWL (7.1 ​% vs. 23.9 ​%, p ​= ​0.002) and a corresponding lower rate of re-excision for IOWL vs. POWL (5.9 ​% vs. 18.5 ​%, p ​= ​0.011). Presence of DCIS was associated with positive margins (p ​= ​0.015). After adjusting for presence of DCIS, tumor size, and volume of tissue removed, the positive margin rate was significantly lower in the IOWL group compared to the POWL group (aOR 0.34, 95 ​% CI 0.13–0.93). ConclusionsIn this study, adjusted analysis favored IOWL in achieving negative tumor margins. Prospective studies are needed to further explore the impact of IOWL on quality, cost-effectiveness, and patient experience.

Preoperative Wire Localization: A Simple Guidance Technique for Excision of Deep, Painful, Small, Soft Tissue Neurofibromas.

A novel use of preoperative wire localization to aid in the removal of small deep-seated soft tissue nerve sheath tumors is described. Wire localization is commonly used in breast surgery, and applying this technique in neurosurgery will enable the surgeon to directly reach the lesion with smaller incisions and prevent unnecessary soft tissue dissection.

Radiofrequency localization of nonpalpable breast cancer in a multicentre prospective cohort study: feasibility, clinical acceptability, and safety

PurposeIn breast conserving surgery, accurate lesion localization is essential for obtaining adequate surgical margins. Preoperative wire localization (WL) and radioactive seed localization (RSL) are widely accepted methods to guide surgical excision of nonpalpable breast lesions but are limited by logistical challenges, migration issues, and legislative complexities. Radiofrequency identification (RFID) technology may offer a viable alternative. The purpose of this study was to evaluate the feasibility, clinical acceptability, and safety of RFID surgical guidance for localization of nonpalpable breast cancer.MethodsIn a prospective multicentre cohort study, the first 100 RFID localization procedures were included. The primary outcome was the percentage of clear resection margins and re-excision rate. Secondary outcomes included procedure details, user experience, learningcurve, and adverse events.ResultsBetween April 2019 and May 2021, 100 women underwent RFID guided breast conserving surgery. Clear resection margins were obtained in 89 out of 96 included patients (92.7%), re-excision was indicated in three patients (3.1%). Radiologists reported difficulties with the placement of the RFID tag, partially related to the relatively large needle-applicator (12-gauge). This led to the premature termination of the study in the hospital using RSL as regular care. The radiologist experience was improved after a manufacturer modification of the needle-applicator. Surgical localization involved a low learning curve. Adverse events (n = 33) included dislocation of the marker during insertion (8%) and hematomas (9%). The majority of adverse events (85%) occurred using the first-generation needle-applicator.ConclusionRFID technology is a potential alternative for non-radioactive and non-wire localization of nonpalpable breast lesions.

A multicenter prospective cohort study to evaluate feasibility of radio-frequency identification surgical guidance for nonpalpable breast lesions: design and rationale of the RFID Localizer 1 Trial

BackgroundBreast cancer screening and improving imaging techniques have led to an increase in the detection rate of early, nonpalpable breast cancers. For early breast cancer, breast conserving surgery is an effective and safe treatment. Accurate intraoperative lesion localization during breast conserving surgery is essential for adequate surgical margins while sparing surrounding healthy tissue to achieve optimal cosmesis. Preoperative wire localization and radioactive seed localization are accepted standard methods to guide surgical excision of nonpalpable breast lesions. However, these techniques present significant limitations. Radiofrequency identification (RFID) technology offers a new, nonradioactive method for localizing nonpalpable breast lesions in patients undergoing breast conserving surgery. This study aims to evaluate the feasibility of RFID surgical guidance for nonpalpable breast lesions.MethodsThis multicenter prospective cohort study was approved by the Institutional Review Board of the University Medical Center Utrecht. Written informed consent is obtained from all participants. Women with nonpalpable, histologically proven in situ or invasive breast cancer, who can undergo breast conserving surgery with RFID localization are considered eligible for participation. An RFID tag is placed under ultrasound guidance, up to 30 days preoperatively. The surgeon localizes the RFID tag with a radiofrequency reader that provides audible and visual real-time surgical guidance.The primary study outcome is the percentage of irradical excisions and reexcision rate, which will be compared to standards of the National Breast Cancer Organisation Netherlands (NABON)(≤ 15% irradical excisions of invasive carcinomas). Secondary outcomes include user acceptability/experiences, learning curve, duration and ease of the placement- and surgical procedure and adverse events.DiscussionThis study evaluates the feasibility of RFID surgical guidance for nonpalpable breast lesions. Results may have implications for the future localization techniques in women with nonpalpable breast cancer undergoing breast conserving surgery.Trial registrationNetherlands National Trial Register, NL8019, registered on September 12th 2019.

The Analysis of Preoperative Wire Localization in Breast Conserving Surgery and Predictors of Surgical Margin Status

Background: At present, the breast conserving therapy (BCT) is considered a treatment of choice for early-stage breast cancer. BCT aims to achieve complete tumor resection with adequate margin and offers better cosmetic outcome. Objective: To describe the experience with preoperative wire localization technique for early breast cancer and analysis of factors affecting positive margin status. Materials and Methods: The authors retrospectively reviewed 190 patients with 206 malignant breast lesions treated by breast conserving surgery (BCS) after mammographic- or ultrasound- guided wire localization. Patient age, lesion type such as mass, mass with calcifications, calcifications alone, and architectural distortion, BI-RADS assessment categories, size, location, modalities of imaging guidance, number of wires used, radiological and surgical margin status, pathological diagnosis, and tumor focality were recorded. Results: A 14.56% of positive surgical margin rate was observed. Mixed-effects logistic regression analysis showed larger lesion size was a significant predictor for positive surgical margin status at larger than 1.5 cm versus 1.0 cm or smaller (p=0.033). Conclusion: The present study data suggested that larger tumor size is the only significant predictor for positive surgical margin status. To deal with non-palpable large tumor, surgeon and radiologist should pay particular attention to achieve adequate surgical margin. Keywords: Wire localization; Breast conserving surgery; Surgical margin status; Specimen radiography

Sentinel lymph node BIOPSY after neoadjuvant therapy in breast cancer patients with lymph node involvement at diagnosis. Could wire localization of clipped node improve our results?

IntroductionSentinel lymph node biopsy (SLNB) after neoadjuvant therapy (NAT) in node-positive (N+) breast cancer patients at diagnosis remains a controversial issue, with no consensus on implementation or safety. ObjectivesWe sought to assess the accuracy of SLNB after NAT in biopsy-proven N+ cases at diagnosis and the efficacy and accuracy of wire localization of the clipped node to improve results. Material and methodsA cross-sectional diagnostic technique validation study in N+ patients following NAT was performed. The biopsy-proven affected lymph node was clipped at diagnosis. SLNB and axillary lymph node dissection (ALND) were performed in cases of clinical-radiological lymph node response after NAT. For the purposes of our study we added wire localization of the clipped node. Results103 patients were included (mean age, 54.4 years [± 12.7]). Wire marking was performed in 28 cases. The overall identification rate (IR) of SLN was 81.6%. The median number of nodes removed was 2 (range 2). The overall false negative rate (FNR) was 6.1%. Sensitivity and overall accuracy were 93.9% and 95.2%, respectively (area under curve 0.97). In the double-marked (clip and wire) group the FNR decreased to 0% and accuracy was 100%. Axillary pathologic complete response was observed in 24.3% of cases. ConclusionsSLNB is useful in node-positive patients at diagnosis who respond to NAT. Combining this with preoperative wire localization of the biopsied lymph node reduces the FNR without increasing the number of complications.

Wired for Surgical Success: Our Experience with Preoperative Ultrasound-Guided Wire Localization of Impalpable Breast Lesions.

Aims The purpose of this study was to review our experience with preoperative ultrasound-guided wire localization and to identify our rate of successful localization and subsequent excision. Materials and Methods At our institution, we performed preoperative wire localization for 28 impalpable breast lesions in 27 women (1 patient underwent wire localization for bilateral breast lesions), between April 2016 and August 2019. We used a Toshiba APLIO2 ultrasound machine and a linear probe (7–12 MHz) to visualize lesions and needle-wire systems comprising a 20-gauge needle with preloaded wire to localize lesions. We analyzed the percentage of specimen mammograms with wire in situ and percentage of excised specimens showing margins free of tumor, along with imaging features, BI-RADS (Breast Imaging-Reporting and Data System) categories, and histopathological and molecular diagnosis of the lesions. Results All specimen mammograms confirmed the presence of wire in situ, except one (96.4%); in the latter case, postponement of surgery due to intractable cough was suspected to have caused wire displacement. All malignant specimens showed margins free of tumor (100%). Conclusions Our results show that wire localization is extremely effective in providing crucial preoperative insight into the precise location of an impalpable lesion. Despite the advent of nonwire localization devices such as radioactive seeds, radar reflectors, magnetic seed markers, and radiofrequency identification tags, wire localization remains the most widely practiced method, especially in resource-limited settings. Its high degree of accuracy serves as a key factor in the successful outcome of breast conservation surgery for impalpable breast lesions.

Retrospective Review of Preoperative Wire Localization for Peripheral Ground Glass Opacities.

Video-assisted thoracoscopy (VATS) is performed for diagnosis and treatment of peripheral lung nodules. Localization of peripherally located ground-glass opacities (GGOs) can be challenging. We report the results and usefulness of preoperative computed tomography (CT)-guided wire localization. Records for patients who underwent CT-guided wire localization prior to VATS resection for peripherally located GGOs were analyzed. Our technique for targeting the GGOs, complications, and histopathology of GGOs is reviewed. Forty patients (mean age 68years) underwent pulmonary resections following CT-guided wire localization. The mean diameter of the GGO was 11.0mm. The mean distance from the pleural surface to the peripheral margin of the GGO was 18.6mm. Complications from the wire localization included pneumothorax in 5 patients (12.5%), none of whom required insertion of a chest tube; parenchymal hemorrhage in 3 patients (7.5%); and pleural effusion requiring chest tube drainage (unrelated to the wire) in 1 patient (2.5%). The mean operative time was 74(range: 21-186) minutes. Pathological examination revealed lung malignancy in 36 patients (90%). The diagnostic yield was 100%. Preoperative CT-guided wire localization for solitary or multiple peripherally located GGOs allows for determination of histopathologic diagnosis and high diagnostic yield.

Preoperative Wire Localization of the Breast on the Day Before Surgery.

To assess the feasibility and accuracy of preoperative wire localization performed one day prior to surgery and the relationship between the time interval following wire placement with migration distance within the time-window examined. Two trials were performed with next-day mammography to assess migration. Trial 1 used a standard hooked wire (50 patients, 61 wires). Trial 2 employed a looped wire (50 patients, 59 wires). A third trial was subsequently performed (16 patients, 18 wires) using the looped wire without repeat mammograms. Complications were recorded. Comparative statistical analyses were performed between patients in Trial 1 and Trial 2. In Trials 1 and 2, no wires required readjustment on the day of surgery. Mean and maximum migration were less with the looped wire (range: 0-7 mm) compared to the hooked wire (range: 0-18 mm), allowing for the elimination of next-day mammograms in Trial 3. A Mann-Whitney U test showed no significant difference between the migration distances for the first two trials (P = 0.11). A Chi-square test showed no significant difference in the direction of the migration between the two trials (P = 0.15). There was no correlation between the time interval of localization and needle migration in the first two trials (r = -0.16, P = 0.22 and -0.12, P = 0.36). Specimen radiographs demonstrated the lesion/biopsy marker clip in all cases in all three trials. No infections or bleeding occurred. Two patients developed an allergic reaction to adhesive. Wire localization performed on the day before surgery is feasible, inexpensive, did not compromise accuracy, and successfully unlinked the radiologic and surgical procedures.

Rapid Implementation of Intraoperative Ultrasonography to Reduce Wire Localization in The Permanente Medical Group.

Preoperative wire localization (WL), the most common localization technique for nonpalpable breast lesions, has drawbacks including scheduling constraints, cost, and patient discomfort. To reduce WL use in our health care system, we investigated using hydrogel clips to facilitate intraoperative ultrasonography-guided lumpectomies. We retrospectively reviewed electronic medical records of patients with nonpalpable, ultrasound-visible breast lesions who underwent lumpectomy by 7 surgeons at 4 pilot sites in Kaiser Permanente Northern California between January 2015 and October 2015. Hydrogel clips, used for several years before the study period, were placed routinely during core-needle biopsy in all patients with nonpalpable, ultrasound-visible breast lesions. Localization method, lesion size, margin positivity, and receipt of neoadjuvant therapy. One hundred forty-three patients underwent hydrogel clip placement and lumpectomy by pilot-site surgeons. Localization consisted of intraoperative ultrasonography alone, preoperative skin marking, or WL. Of the 143 patients, 71.3% did not need WL (60.8% ultrasonography alone and 10.5% skin marking). The non-WL and WL groups had similarly sized lesions, and the positive margin rate was 7.2% overall, with no significant difference between the non-WL and WL groups (5.9% vs 11.5%, p = 0.33). Of the 12 patients who underwent neoadjuvant chemotherapy, 8 (67%) did not require WL. A multifacility protocol using intraoperative ultrasonography to visualize hydrogel clips was implemented, which decreased WL procedures and produced no significant difference in margin positivity between the WL and non-WL groups. This technique can be a cost-effective alternative to WL in patients who are candidates for hydrogel clip placement.

CT-Guided Wire Localization for Involved Axillary Lymph Nodes After Neo-adjuvant Chemotherapy in Patients With Initially Node-Positive Breast Cancer.

Resection of biopsy-proven involved axillary lymph nodes (iALNs) is important to reduce the false-negative rates of sentinel lymph node (SLN) biopsy after neo-adjuvant chemotherapy (NAC) in patients with initially node-positive breast cancer. Preoperative wire localization for iALNs marked with clips placed during biopsy is a technique that may help the removal of iALNs after NAC. However, ultrasound (US)-guided localization is often difficult because the clips cannot always be reliably visible on US. Computed tomography (CT)-guided wire localization can be used; however, to date there have been no reports on CT-guided wire localization for iALNs. The aim of this study was to describe a series of patients who received CT-guided wire localization for iALN removal after NAC and to evaluate the feasibility of this technique. We retrospectively analyzed five women with initially node-positive breast cancer (age, 41-52 years) who were scheduled for SLN biopsy after NAC and received preoperative CT-guided wire localization for iALNs. CT visualized all the clips that were not identified on post-NAC US. The wire tip was deployed beyond or at the target, with the shortest distance between the wire and the index clip ranging from 0 to 2.5 mm. The total procedure time was 21-38 minutes with good patient tolerance and no complications. In four of five cases, CT wire localization aided in identification and resection of iALNs that were not identified with lymphatic mapping. Residual nodal disease was confirmed in two cases: both had residual disease in wire-localized lymph nodes in addition to SLNs. Although further studies with more cases are required, our results suggest that CT-guided wire localization for iALNs is a feasible technique that facilitates identification and removal of the iALNs as part of SLN biopsy after NAC in situations where US localization is unsuccessful.

Abstract P3-01-17: A technique for preoperative axillary lymph node tattooing in patients with breast cancer

Abstract Purpose: To describe the ultrasound technique for tattooing axillary lymph nodes (ALNs) after lymph node (LN) biopsy in patients with breast cancer. Background: Preoperative evaluation of metastatic disease within ALNs in patients with newly diagnosed breast cancer has significant prognostic value and is quickly becoming routine, particularly in the neoadjuvant setting. A recent study showed tattooed LNs are visible intraoperatively and on histological evaluation months following the tattooing procedure. These results suggest that LN tattooing can obviate the need for additional localization procedures during axillary staging, such as wire localization. Given the increasing use of preoperative ALN biopsy, a robust technique to insure proper LN tattoo marking is proposed. Methods and Technique: Tattooing was performed under real-time US guidance using a 5-cm long 21-gauge hypodermic needle attached to a 1 mL tuberculin syringe containing 1 mL carbon suspension tattoo ink (SPOT™, GI-supply Inc). Imaging was performed with the patient in a supine oblique position with the patient's arm over their head. The anatomically anterior and lateral aspects of the node and perinodal fat were marked with ink. The only regions of the LN not targeted for ink tattooing were the hilum and the posterior cortex and perinodal fat. At least 0.5 mL of ink was used. Results: Optimal technique for intraoperative visualization was determined to be tattooing the anatomically anterior and lateral aspects of the LN cortex and the adjacent perinodal fat using at least 0.5mL of ink. Tattooed LNs which had undergone biopsy and tattooing months prior to surgery were visible intraoperatively and on histological evaluation. Factors contributing to less optimal visualization of the tattooed lymph node included: using less than 0.5mL of ink, tattooing only the superficial cortex and not the perinodal fat, and tattooing a portion of the LN that was not visible with the patient in the operative position. Discussion: The most easily accessed portion of the LN during the US procedure may not be the portion of the LN most easily seen intraoperatively. Locating and tattooing the anatomically anterior and lateral aspects of the LN, regardless of the patient position and orientation of the ultrasound probe, is the primary challenge. Doing so will maximize the likelihood that the tattoo ink will be visible by the surgeon when the patient is in a supine position with the arm abducted 90 degrees using an axillary incision. Tattooing using less than 0.5 mL resulted in suboptimal visualization. Using a larger volume of ink may be judged necessary for larger LNs, very fatty axillae, and for deeply seated nodes. Other reports in the medical literature suggest cutaneous tattooing can result in ink within ALNs. In patients with ipsilateral cutaneous tattoos, an alternative method of marking any biopsied LNs should be considered to avoid false positives associated with prior migration of the cutaneous tattoo ink to the LN. Tattooing of ALNs under ultrasound guidance is a straightforward technique which can be performed at the time of initial biopsy and obviates the need for future preoperative wire localization of the LN. Citation Format: Wapnir IL, Downey JR, Lipson JA, Ikeda DM. A technique for preoperative axillary lymph node tattooing in patients with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-17.

Successful Thoracoscopic Resection of Pulmonary Metastasis Less Than 1 cm in Size Utilizing Preoperative CT-Guided Wire Localization

Preoperative computer tomography (CT) guidance localization utilizing a percutaneous guidewire before thoracoscopic resection is safe and beneficial in children with pulmonary nodules less than 1 cm in size or located deep in the pleural surface. This paper describes a successful thoracoscopic resection of a little subpleural pulmonary metastasis of a Wilm's tumor in a 5-year-old child utilizing preoperative CT-guided wire localization of the lesion. The thoracoscopic procedure was performed with the use of two ports, the nodule was easily localized,and the pulmonary wedge resection was made by the use of an endo-GIA linear stapling device after guidewire removal. The operating time was 45 minutes and the chest tube was removed after 48 hours. The postoperative course was uneventful, and the child was discharged on postoperative day 5. This technique allows the surgeon to resect little pulmonary nodules, avoiding the need of more invasive procedures as standard thoracotomy without adjunctive morbidity and with good cosmetic results.

Successful Thoracoscopic Resection of Pulmonary Metastasis Less Than 1 cm in Size Utilizing Preoperative CT-Guided Wire Localization

Successful Thoracoscopic Resection of Pulmonary Metastasis Less Than 1 cm in Size Utilizing Preoperative CT-Guided Wire Localization

Breast Surgery Techniques: Preoperative Bracketing Wire Localization by Surgeons

With the development of expertise in image guidance for breast surgery, many surgeons now perform preoperative wire localization themselves. Use of a single wire versus multiple wires to bracket a radiographic breast abnormality has previously been described, although benefits of this technique based on clinical outcomes such as margin status, tissue volume removed, and re-excision rates have not been established. This study is a retrospective analysis of wire-localized breast biopsies performed by 14 surgeons over 29 months; stereotactic and ultrasound guidance were used. During this time, 489 wire localizations were done, of which 159 used multiple wires. Two hundred eleven of these biopsies were done for malignant disease, 86 using multiple wires. After controlling for tumor node metastases stage, single and multiple wire placements were compared using endpoints of margin status, need for re-excision, and total volume of tissue removed. Neither margin status nor re-excision was related to the number of wires placed. However, the number of wires placed was significantly related to the total volume of tissue removed. Use of more than one localizing wire was associated with greater volume of tissue removal (measured in centimeters cubed) in benign disease (46 vs 25, P < 0.001), equivalent volumes in stage 0 disease (73 vs 67), less volume in stage 1 disease (113 vs 164), and less volume in stages 2 through 4 (158 vs 207, P = 0.03). Outcomes based on surgeon case volume during the study period demonstrated that low- (1-40), medium- (41-80), and high-volume (>80) surgeons did not differ in the type or stage of breast pathology treated. Surgeons with high case volumes were more likely to place multiple localizing wires (P < 0.001) and were more likely to do a breast-conserving procedure if re-excision was performed (P < 0.018). Surgeons with low case volumes were more likely to perform a re-excision (P < 0.025). Surgeon experience has a positive impact on quality outcome measures such as performance of a definitive procedure at the time of initial surgery and use of breast-conserving procedures at the time of re-excision. Multiple wire localization can be used to significantly reduce the volume of breast tissue removed in malignant disease without sacrificing margin status or increasing the need for future re-excision.

DR (a-Se) versus CR (DLR) – ist eine Verbesserung der Treffsicherheit möglich? Eine retrospektiv klinisch/histologische Analyse ( n=100)

Purpose A retrospective clinical-histological study to determine the diagnostic accuracy using high-resolution digital phosphor storage plates (CR) (hardcopy) and full-field digital mammography (DR) (hardcopy) for microcalcifications and focal lesions (BI-RADS ™ category 4 or 5) ( n=100). Materials and Methods From 01/2004 to 06/2004, 100 patients underwent digital storage plate mammography (CR) and, after diagnosis and preoperative wire localization, full-field digital mammography (a-Se) (DR) with the same exposure parameters. Five investigators retrospectively determined the diagnosis after the operation from randomly distributed mediolateral views (hardcopy reading). These results were correlated with the final histology. Results The accuracy of digital storage plate mammography (CR) and full-field digital mammography (DR) was 73% and 76% for all findings ( n=100), 74%, 78% for microcalcifications ( n=50) and 72%, 74% for focal lesions ( n=50). The overall results showed no difference. Conclusion Our findings indicate equivalence of high-resolution digital phosphor storage plate mammography (CR) and full-field digital mammography (a-Se) (DR).

MRI-guided preoperative wire localization of nonpalpable breast lesions

With the increasing use of magnetic resonance imaging (MRI), the physician is more frequently confronted with nonpalpable breast lesions that are only visible on MRI. In these cases, it is often difficult to obtain adequate material for pathological examination. One of the methods that may be performed is excisional biopsy after MRI-guided wire localization. This study intends to examine the feasibility and added benefit of this method. It appears to be a reliable and useful tool that is, therefore, of additional benefit to surgical practice.

Digitale Mammographie mit hochauflösenden Speicherfolien (CR) versus digitaler Vollfeldmammographie (CCD) (DR): Mikrokalzifikationen und Herdbefunde – eine retrospektiv klinisch/histologische Analyse (n=102)

PURPOSE: To determine the diagnostic accuracy of microcalcifications and focal lesions in a retrospective clinical-histological study using high-resolution digital phosphor storage plates (hard copy) and full-field digital mammography (hard copy). MATERIALS AND METHODS: From May 2003 to September 2003, 102 patients underwent digital storage plate mammography (CR), using a mammography unit (Mammomat 3000 N, Siemens) in combination with a high resolution (9 lp/mm) digital storage phosphor plate system (pixel size 50 microm) (Fuji/Siemens). After diagnosis and preoperative wire localization, full-field digital mammography (CCD) (DR) was performed with the same exposure parameters. The full-field digital mammography used a CCD-detector (SenoScan) (Fisher Imaging) with a resolution of 10 Ip/mm and a pixel size of 50 microm. Five investigators determined the diagnosis (BI-RADS I - V) retrospectively after the operation from randomly distributed mediolateral views (hard copy reading). These results were correlated with the final histology. RESULTS: The diagnostic accuracy of digital storage plate mammography (CR) and full-field digital mammography (CCD) (DR) was 73 % and 71 % for all findings (n = 102), 73 % and 71 % for microcalcifications (n = 51), and 72 % and 70 % for focal lesions (n = 51). The overall results showed no difference. CONCLUSION: Our findings indicate the equivalence of high-resolution digital phosphor storage plate mammography (CR) and full-field digital mammography (CCD) (DR).

Magnetic Resonance-Guided Biopsies and Localizations of the Breast

The objective of this study was to evaluate the performance of a new commercially available open breast coil and compatible intervention device (Machnet) for magnetic resonance image (MRI)-guided breast interventions. Breast lesions detected on MRI were evaluated using MRI-guided core biopsy (n = 20) and/or preoperative wire localization (n = 23) on histologic outcome and accuracy of localization. Time needed to perform a procedure and occurring problems were recorded. Mean lesion size was <10 mm. Two of 20 lesions could not be biopsied because they were out of range for the device. Biopsies were conclusive in half of the cases; most lesions missed were <10 mm. The average accuracy for needle placement in the localization procedures was less than 2 mm (range, 0-5 mm). The average procedure time was 40 minutes for a biopsy procedure and 33 minutes for an MRI-guided localization. Preoperative MRI-guided localizations can be performed quickly and accurately. However, in MRI-guided core biopsies, especially in small lesions, the device does not guarantee conclusive histologic evaluation of the lesion targeted.

Digitale Mammographie mit hochauflösenden Speicherfolien (CR) versus digitaler Vollfeldmammographie (CCD) (DR): Mikrokalzifikationen und Herdbefunde - eine retrospektiv klinisch-histologische Analyse (n = 102)

To determine the diagnostic accuracy of microcalcifications and focal lesions in a retrospective clinical-histological study using high-resolution digital phosphor storage plates (hard copy) and full-field digital mammography (hard copy). From May 2003 to September 2003, 102 patients underwent digital storage plate mammography (CR), using a mammography unit (Mammomat 3000 N, Siemens) in combination with a high resolution (9 lp/mm) digital storage phosphor plate system (pixel size 50 microm) (Fuji/Siemens). After diagnosis and preoperative wire localization, full-field digital mammography (CCD) (DR) was performed with the same exposure parameters. The full-field digital mammography used a CCD-detector (SenoScan) (Fisher Imaging) with a resolution of 10 Ip/mm and a pixel size of 50 microm. Five investigators determined the diagnosis (BI-RADS I - V) retrospectively after the operation from randomly distributed mediolateral views (hard copy reading). These results were correlated with the final histology. The diagnostic accuracy of digital storage plate mammography (CR) and full-field digital mammography (CCD) (DR) was 73 % and 71 % for all findings (n = 102), 73 % and 71 % for microcalcifications (n = 51), and 72 % and 70 % for focal lesions (n = 51). The overall results showed no difference. Our findings indicate the equivalence of high-resolution digital phosphor storage plate mammography (CR) and full-field digital mammography (CCD) (DR).