Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy
- 202 Downloads
Needle localization breast biopsy (NLBB) is presently the primary means of localizing non-palpable lesions. Disadvantages of NLBB include vasovagal episodes, patient discomfort, and miss rates. Because hematomas naturally fill the cavity after vacuum-assisted breast biopsies (VABB), we hypothesized that ultrasound (US) could be used to find and accurately excise the actual biopsy site of non-palpable breast lesions without a needle.
This is a retrospective study from January 2000 to July 2005. Electronic chart review identified patients with non-palpable breast lesions detected by means of mammogram who then underwent lumpectomy via NLBB or the hematoma-directed ultrasound-guided technique (HUG). HUG involved localizing the hematoma with a 7.5-MHz US probe and using the “line of sight” technique straight down toward the chest wall. A block of tissue encompassing the hematoma was then excised.
Localization procedures were performed in 186 patients—63 (34%) via needle localization and 123 (66%) via HUG. The previous VABB site in 100% of patients was successfully excised using HUG, 65 of 123 (53%) were benign and 58 of 123 (47%) were malignant; margins were positive in 13 of these 58 (22%). NLBB was successful in 100% of patients, 44 of 63 (70%) were benign and 19 of 63 (30%) were malignant; margins were positive in 14 of these 19 (73%). Margin positivity was significantly higher for NLBB than HUG (P = 0.0001, Fisher Exact).
This study suggests that HUG is more accurate in localizing non-palpable lesions than NLBB. By eliminating the additional procedure needed for NLBB, HUG may also be more time- and cost efficient. HUG makes VABB not only a less invasive diagnostic procedure, but also a localization procedure.
Key WordsBreast Hematoma Ultrasound Biopsy Lumpectomy
- 6.Homer MJ, Smith TJ, Safaii H. Prebiopsy needle localization. methods, problems, and expected results. Radiol Clin North Am 1992; 30(1):139–153Google Scholar
- 12.Children’s Mercy hospitals and clinics, STATS: Steve’s Attempt to Teach Statistics.http://www.cmh.edu/stats/ask/fishers.asp
- 20.Yim JH, Barton P, Weber B, et al. Mammographically detected breast cancer. Benefits of stereotactic core versus wire localization biopsy. Ann Surg 1996; 223(6):688–697; discussion 697–700Google Scholar
- 30.Freedman G, Fowble B, Hanlon A, et al. Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. Int J Radiat Oncol Biol Phys 1999; 44(5):1005–1015PubMedCrossRefGoogle Scholar
- 35.Lechner M, Day D, Elvecrog EL, et al. Ultrasound visibility of a new biopsy marker on serial evaluations. Radiology 2002; 225:115Google Scholar
- 41.Parikh JR. Clip migration within 15 days of 11-gauge vacuum-assisted stereotactic breast biopsy: case report. Am J Roentgenol 2005; 84(3 Suppl):S43–46Google Scholar
- 42.Parikh JR. Delayed migration of Gel Mark Ultra Clip within 15 days of 11-gauge vacuum-assisted stereotactic breast biopsy. Am J Roentgenol 2005; 85(1):203–206Google Scholar