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Ten-Year Experience with Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy

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

Abstract

Background

Pain, patient inconvenience, vasovagal symptoms, scheduling problems, wire malposition, and a positive margin rate of 40–75% are problems commonly associated with needle localized biopsy (NLBB). Despite these issues, NLBB is still the primary means of identifying nonpalpable lesions in the breast. We hypothesized that the hematoma-directed ultrasound-guided (HUG) procedure for intraoperative localization of nonpalpable lesions would allow for lumpectomy without the downfalls of needle localization and decrease the high positive-margin rate with NLBB.

Methods

This is a retrospective study from January 2000 to October 2009. Electronic chart review identified lumpectomy procedures performed in the clinic and operating room. These patients underwent preoperative core-biopsy diagnosis by ultrasound (US) or stereotactic means. When excision was necessary needle localization or HUG was planned. A multifrequency linear array transducer was used intraoperatively for the HUG procedures, and a block of tissue surrounding the hematoma was removed.

Results

Localization procedures were performed in 455 patients: 126 (28%) via needle localization and 329 (72%) via HUG. The previous core-biopsy site in 100% of patients was successfully excised using HUG: 152 of 329 (46%) were benign and 177 of 329 (54%) were malignant. Margins were positive in 42 of these 177 cases (24%). was successful in 100% of patients: 88 of 126 (70%) were benign and NLBB 38 of 126 (30%) were malignant; margins were positive in 18 of these 38 (47%). Margin positivity was significantly higher for NLBB than HUG (P = 0.045, Fisher exact).

Conclusions

This 10-year experience, representing the largest to date, suggests that HUG is more accurate in localizing nonpalpable lesions than NLBB. Compared with the additional painful procedure of NLBB, HUG is more time and cost-efficient. Preoperative needle core biopsy is not only the minimally invasive diagnostic procedure of choice, but also becomes the localization procedure when excisional biopsy is necessary.

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Acknowledgment

Candy Arentz, Cristiano Boneti supported by the Susan G. Komen Breast Cancer Interdisciplinary Breast Fellowship. Candy Arentz, Cristiano Boneti, V. Suzanne Klimberg supported by the Tenenbaum Breast Cancer Foundation, Little Rock, Arkansas. V. Suzanne Klimberg supported by the Fashion Footwear Association of New York (FFANY/QVC).

Conflict of interest

The authors have no commercial support in this field.

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Authors and Affiliations

  1. Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA

    Candy Arentz MD, Cristiano Boneti MD, Ronda Henry-Tillman MD & V. Suzanne Klimberg MD

  2. Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Kate Baxter MD & Kent Westbrook MD

  3. Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Soheila Korourian MD

Authors
  1. Candy Arentz MD
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  2. Kate Baxter MD
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  3. Cristiano Boneti MD
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  4. Ronda Henry-Tillman MD
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  5. Kent Westbrook MD
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  6. Soheila Korourian MD
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  7. V. Suzanne Klimberg MD
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Correspondence to V. Suzanne Klimberg MD.

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Arentz, C., Baxter, K., Boneti, C. et al. Ten-Year Experience with Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy. Ann Surg Oncol 17 (Suppl 3), 378–383 (2010). https://doi.org/10.1245/s10434-010-1230-x

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  • DOI: https://doi.org/10.1245/s10434-010-1230-x

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