Annals of Surgical Oncology

, Volume 14, Issue 1, pp 148–156 | Cite as

Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy

  • Margaret Thompson
  • Ronda Henry-Tillman
  • Aaron Margulies
  • Jeff Thostenson
  • Gwen Bryant-Smith
  • Robert Fincher
  • Soheila Korourian
  • V Suzanne KlimbergEmail author



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 Words

Breast Hematoma Ultrasound Biopsy Lumpectomy 


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Copyright information

© Society of Surgical Oncology 2006

Authors and Affiliations

  • Margaret Thompson
    • 1
  • Ronda Henry-Tillman
    • 1
  • Aaron Margulies
    • 1
  • Jeff Thostenson
    • 2
  • Gwen Bryant-Smith
    • 3
  • Robert Fincher
    • 3
  • Soheila Korourian
    • 4
  • V Suzanne Klimberg
    • 1
    • 3
    • 4
    Email author
  1. 1.Division of Breast Surgical Oncology, Department of SurgeryUniversity of Arkansas for Medical SciencesLittle RockUnited States
  2. 2.Department of BiostatisticsUniversity of Arkansas for Medical SciencesLittle RockUnited States
  3. 3.Department of RadiologyUniversity of Arkansas for Medical SciencesLittle RockUnited States
  4. 4.Department of PathologyUniversity of Arkansas for Medical SciencesLittle RockUnited States

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