Hematoma-directed and ultrasound-guided breast-conserving surgery for nonpalpable breast cancer after Mammotome biopsy.
ABSTRACT Stereotactic vacuum-assisted (Mammotome) breast biopsy is a powerful diagnostic tool for detecting microcalcifications on mammography, but it is difficult to remove the targeted lesion precisely when subsequent breast-conserving surgery is to be carried out. We achieved satisfactory results by performing hematoma-directed breast-conserving surgery after stereotactic Mammotome biopsy in seven patients. To identify the exact location of the Mammotome biopsy during the breast-conserving surgery, we created an iatrogenic hematoma in the biopsy cavity using patient's blood. This hematoma was detected easily on intraoperative ultrasonography in all patients, and was palpable as a soft mass in five of the seven patients. The microcalcifications were completely removed in all patients, and no cancer cells were found in the margin surfaces after breast-conserving surgery. There were no complications during the injection of the patient's blood into the biopsy cavity or during the hematoma-directed surgery. We describe this new procedure of hematoma-directed breast-conserving surgery following Mammotome biopsy for nonpalpable cancer with microcalcifications.
- SourceAvailable from: Anne T Mancino[show abstract] [hide abstract]
ABSTRACT: The standard technique for removal of nonpalpable breast lesions is needle localization breast biopsy. Because traumatic hematomas can often be seen with ultrasound, the authors hypothesized that iatrogenically induced hematomas could be used to guide the excision of nonpalpable lesions using ultrasound. Twenty patients with nonpalpable breast lesions detected by magnetic resonance imaging only were enrolled in this single-institution trial, approved by the institutional review board. A hematoma consisting of 2 to 5 mL of the patient's own blood was injected into the breast to target the nonpalpable lesion. Intraoperative ultrasound of the hematoma was used to direct the excisional biopsy. The average age of women was 53.8 +/- 10 years. Ninety-five percent of lesions detected by magnetic resonance imaging were localized by hematoma injection. All the hematomas used to recognize targeted lesions were identified at surgery by ultrasound and removed without complication. Eight (40%) of the lesions were malignant, with an average tumor size of 12 +/- 6 mm (range 4-25). The remaining 12 lesions (60%) comprised papillomas, sclerosing adenosis, radial scar, fibroadenoma, and areas of atypical ductal hyperplasia. The results of this pilot study show the effectiveness of hematoma-directed ultrasound-guided breast biopsy for nonpalpable lesions seen by magnetic resonance imaging. This new procedure is potentially more comfortable for the patient because no wire or needle is left in the breast. It is technically faster and easier because ultrasound is used to visualize directly the location of the hematoma at surgery and to confirm lesion removal in the operating room by specimen ultrasound. The hematoma can be placed several days before biopsy, easing scheduling, and without fear of the migration that may occur with needle localization. This method may have ready application to mammographically detected lesions.Annals of Surgery 06/2001; 233(5):669-75. · 6.33 Impact Factor
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ABSTRACT: To determine initial placement accuracy, long-term stability, and usefulness as a guide for wire localization for metallic marker clips placed percutaneously after stereotactic breast biopsy. One hundred forty-nine marker clips were placed percutaneously with a straight-needle or through-probe method, and clip positions were measured. The locations of 31 marker clips were followed up from deployment to first follow-up mammography. Thirty-six biopsy sites with marker clips were excised surgically and examined; 18 of these marker clips were targets for wire localization. The locations of 22 benign lesions were measured over time to calibrate the measurement system. Baseline variability was 8 mm. Initial marker clip deployment averaged 5 mm above baseline from the center of the target lesion (P < or = .01). Compared with baseline variability, marker clips remained in place from initial deployment to first imaging follow-up (mean, 8.6 months). Potentially clinically meaningful misplacement rates (deployment > 24 mm from target lesion center) were 7% for the through-probe method and 11% for the straight-needle method (not significantly different; P = .33). The marker clips appear to be useful targets for wire localization when the entire target lesion is removed at directional, vacuum-assisted breast biopsy. Upright, two-view mammography is recommended after deployment of the marker clip to document location.Radiology 12/1997; 205(2):407-15. · 6.34 Impact Factor
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ABSTRACT: A recently developed method of minimally invasive breast biopsy involves use of a directional, vacuum-assisted instrument. Use of this instrument requires some changes in techniques and applications of breast biopsy, but it enables confident biopsy of breast lesions under both ultrasound (US) and stereotactic guidance. The device uses vacuum to pull tissue into the probe and to remove the specimen without withdrawing the probe each time. For stereotactic biopsy, to target the lesion, the probe is placed anterior or posterior to the lesion and stereotactic positioning views are obtained; for a US-guided procedure, the probe is advanced posterior to the lesion. Next, the direction that the probe aperture must be rotated to face the lesion is determined. Tissue samples are obtained at consecutive clock positions of 1 1/2-hour intervals to achieve contiguous sampling. At least 15 samples are obtained with an 11-gauge probe to acquire a minimum of 1,500 mg of tissue. If postbiopsy images reveal that the lesion has been removed, a percutaneous clip is placed to mark the biopsy site for follow-up examination and possible further treatment. Patients are examined the next day and given the biopsy results and treatment considerations, if needed; they are followed up approximately 1 week later to detect any complications (eg, discomfort, ecchymosis). By learning how to perform a directional, vacuum-assisted biopsy with either stereotactic or US guidance, the radiologist has an additional, valuable tool for bringing accurate breast biopsy to his or her community.Radiographics 17(5):1233-52. · 2.79 Impact Factor