Dual Modality Surgical Guidance for Non-palpable Breast Lesions
Currently, the majority of lumpectomy and excisional biopsy procedures are performed using the wire localization (WL) technique; however, this technique suffers from several drawbacks including inaccuracy in placement of the wire, possible displacement of the wire prior to surgery, and ambiguity of the lesion’s location along the wire. We propose dual modality surgical guidance (DMSG) as a means to overcome many of the problems associated with WL. The approach uses a dual modality (digital mammography and breast scintigraphy) breast imaging system developed in our lab to place a small radioactive marker (a radiomarker), directly into the lesion. Here we present the results of measurements of the localization and injection accuracy of our system. The localization accuracy, evaluated by determining the difference between the known and measured inter-well separations, were within 0.76 mm (standard deviation of 0.46 mm) of the true distances for x-ray imaging and within 0.66 mm (standard deviation of 0.43) for gamma imaging. Our maximum error in injection accuracy in any of the three Cartesian coordinates was 1.8 mm. On average, the errors were 0.6, 0.4, and 0.9 mm for x, y, and z respectively. The results of these phantom tests provide encouragement that our upright digital mammography unit can accurately a) locate a lesion in three dimensions, b) inject a radiomarker into the lesion, and c) assess the offset between the lesion and radiomarker centers.
KeywordsDigital Mammography Breast Conservation Therapy Lesion Center Wire Localization Radioguided Occult Lesion Localisation
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- 1.van Dongen, J.A., Voogd, A.C., Fentiman, I.S., Legrand, C., Sylvester, R.J., Tong, D., van der, S.E., Helle, P.A., van Zijl, K., Bartelink, H.: Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. Journal of the National Cancer Institute 92, 1143–1150 (2000)CrossRefGoogle Scholar
- 2.Obedian, E., Fischer, D.B., Haffty, B.G.: Second malignancies after treatment of early-stage breast cancer: lumpectomy and radiation therapy versus mastectomy. Journal of Clinical Oncology 18, 2406–2412 (2000)Google Scholar
- 3.Cox, C., Furman, B., Stowell, N., Ebert, M., Clark, J., Dupont, E., Shons, A., Berman, C., Beauchamp, J., Gardner, M., Hersch, M., Venugopal, P., Szabunio, M., Cressman, J., Diaz, N., Vrcel, V., Fairclough, R.: Radioactive Seed Localization Breast Biopsy and Lumpectomy Can Specimen Radiographs Be Eliminated? Annals of Surgical Oncology 10, 1039–1047 (2003)CrossRefGoogle Scholar
- 4.De Cicco, C., Pizzamiglio, M., Trifiro, G., Luini, A., Ferrari, M., Prisco, G., Galimberti, V., Cassano, E., Viale, G., Intra, M., Veronesi, P., Paganelli, G.: Radioguided occult lesion localisation (ROLL) and surgical biopsy in breast cancer. Technical aspects. Quarterly Journal of Nuclear Medicine 46, 145–151 (2002)Google Scholar
- 5.Gennari, R., Galimberti, V., De Cicco, C., Zurrida, S., Zerwes, F., Pigatto, F., Luini, A., Paganelli, G., Veronesi, U.: Use of technetium-99m-labeled colloid albumin for preoperative and intraoperative localization of nonpalpable breast lesions. Journal of the American College of Surgeons 190, 692–698 (2000)CrossRefGoogle Scholar
- 6.Gray, R.J., Salud, C., Nguyen, K., Dauway, E., Friedland, J., Berman, C., Peltz, E., Whitehead, G., Cox, C.E.: Randomized prospective evaluation of a novel technique for biopsy or lumpectomy of nonpalpable breast lesions: radioactive seed versus wire localization. Annals of Surgical Oncology 8, 711–715 (2001)CrossRefGoogle Scholar
- 8.More, M.J., Narayanan, D., Goodale, P.J., Majewski, S., Welch, B., Wojcik, R., Williams, M.B.: X-ray stereotactic lesion localization in conjunction with dedicated scintima-mmography. IEEE Transactions on Nuclear Science 50(5), part 2, 1636–1642 (2003)Google Scholar