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Ultrasound-Guided Segmental Mastectomy and Excisional Biopsy Using Hydrogel-Encapsulated Clip Localization as an Alternative to Wire Localization

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Wire localization is currently the most widely used localization strategy for excision of nonpalpable breast lesions. Its disadvantages include patient discomfort, wire-related complications such as wire displacement/fracture, and operating room delays related to difficulties during wire placement. We have implemented the technique of intraoperative ultrasound-guided excision using hydrogel-encapsulated (HydroMARK) biopsy clips for lesion localization. We hypothesize that this method is as effective as wire localization for breast conserving therapy.

Methods

This is a retrospective review of 220 consecutive patients who underwent segmental mastectomy or excisional biopsy using wire localization or hydrogel-encapsulated clip localization from January 2014 to July 2015. Data were collected and analyzed. Statistical analyses for differences between groups were performed using t tests and Mann-Whitney rank-sum analyses.

Results

A total of 107 excisions were performed using hydrogel-encapsulated clip localization, and 113 excisions were performed using the traditional wire localization technique; 68 % of our patients underwent excision for malignant pathology. Wire placement took a mean of 46 minutes (range 20–180 min), compared with 5 minutes for ultrasound localization (p <  .001). Successful intraoperative ultrasound localization and excision was performed on 100 % of patients. There was no difference in re-excision rates for positive margins or overall specimen size between the two groups.

Conclusions

Intraoperative ultrasound-guided excision of nonpalpable breast lesions using a hydrogel-encapsulated biopsy clip for breast conserving therapy is a safe and feasible alternative to the traditional preoperative wire localized excision. This technique will lead to improvement in patient experience, operative efficiency, and alleviate wire-related complications.

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Authors contribution

LFG contributed to the collecting and analysis of data and interpretation, conception, design, composition, drafting, and editing of the manuscript. AH contributed to data collection and editing of the manuscript. CMS contributed to conception, design, participated in procedures, and to the editing of the manuscript. AB contributed to IRB submission and approval process. EV contributed to the conception, design, and editing of the manuscript. JM contributed to the conception, design, and manuscript editing. LRPS contributed to the conception and design of the manuscript, data analysis and interpretation, and the composition/editing/writing of the manuscript.

Disclosures

None of the authors have disclosed any conflict of interest

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Authors and Affiliations

  1. Department of Surgery, University of Florida, Gainesville, Florida, USA

    Lori F. Gentile MD, Amber Himmler MD, Christiana M. Shaw MD, MS, FACS, Amber Bouton BA, CCRC, CCRP & Lisa R. P. Spiguel MD

  2. Department of Radiology, University of Florida, Gainesville, Florida, USA

    Elizabeth Vorhis MD & Julia Marshall MD

Authors
  1. Lori F. Gentile MD
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  2. Amber Himmler MD
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  3. Christiana M. Shaw MD, MS, FACS
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  4. Amber Bouton BA, CCRC, CCRP
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  5. Elizabeth Vorhis MD
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  6. Julia Marshall MD
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  7. Lisa R. P. Spiguel MD
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Corresponding author

Correspondence to Lisa R. P. Spiguel MD.

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Gentile, L.F., Himmler, A., Shaw, C.M. et al. Ultrasound-Guided Segmental Mastectomy and Excisional Biopsy Using Hydrogel-Encapsulated Clip Localization as an Alternative to Wire Localization. Ann Surg Oncol 23, 3284–3289 (2016). https://doi.org/10.1245/s10434-016-5325-x

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  • DOI: https://doi.org/10.1245/s10434-016-5325-x

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