Rationale and Objectives
To propose deploying a metallic marker using sonographic guidance immediately before wire localization for excisional biopsy to identify intraductal or complex cystic lesions at specimen radiography.
Materials and Methods
Institutional review board approval was obtained for this study and is Health Insurance Portability and Accountability Act compliant. The clinical, radiographic, and pathologic records of 21 patients, ages 21–78 years, with 22 intraductal or complex cystic masses who underwent excisional biopsy with wire localization immediately after sonographically-guided marker placement were reviewed. The procedure mammogram, ultrasound, and specimen radiographs were reviewed and evaluated for the presence of a metallic marker, lesion, or both. Pathology of all specimens was recorded and reviewed for concordance.
Results
Twenty-one (95%) of the markers were visualized on specimen radiographs. No lesions were apparent on specimen radiographs. Mammographic findings in 17 were negative (17/22; 77%); 3 circumscribed or partially obscured masses (3/22; 14%), 1 focal asymmetry (1/22; 5%), and 1 architectural distortion (5%) were also seen. Sonographic findings were 12 intraductal masses (12/22; 55%) and 10 complex cystic masses (10/22; 45%). Median and average size of all lesions were 9 mm (intraductal masses: median, 6 mm, mean, 7; complex cystic masses: median, 10 mm, mean, 11). All lesions were benign and all pathology was concordant with imaging findings.
Conclusions
Given the high rate of marker retrieval on specimen radiography and pathologic concordance, marker placement at the time of wire localization is an efficient way to confirm retrieval of intraductal or complex cystic lesions.
The miss rates for excisional biopsy of nonpalpable breast lesions, defined as the lack of partial or complete removal of the lesion, range from 0% to 17.9% ( ). With the use of image-guided core needle biopsies of nonpalpable breast lesions increasing, those lesions undergoing presurgical wire localization for excision may be more subtle ( ). If the lesion is apparent only by sonography, confirmation of excision by specimen radiography may be problematic ( ). Although specimen sonography has been described as a reliable method to confirm excision of breast masses ( ), Mesurolle et al ( ) recently described limitations of specimen sonography. Specifically, small lesions (smaller than 1 cm), particularly in a fatty background, may lead to false-negative specimen sonography. Also, lesions with a fluid component (papillomas) may disappear in the specimen on ex vivo examination and make sonographic confirmation difficult ( ). According to the recent National Comprehensive Cancer Network practice guidelines for breast cancer screening and diagnosis, primary surgical excision is preferred if sonographic findings are of an irregular cyst wall or intracystic mass ( ). Although the accuracy of sonographically guided core biopsy, including large-gauge vacuum-assisted biopsy, has been described ( ), little has been published describing the accuracy or validity of sonographic core biopsy of nonpalpable, cystic, or intraductal lesions <1 cm ( ). Lesions may become obscured by hemorrhage during sonographic core biopsy ( ), potentially limiting sampling of the lesion. The usefulness of metallic marker placement at the time of percutaneous core biopsy, and in patients undergoing neoadjuvant chemotherapy has already been well documented ( ). The purpose of our study is to propose deploying a metallic marker using sonographic guidance immediately before wire localization for excisional biopsy to aid in the identification of intraductal or complex cystic lesions at specimen radiography.
Materials and methods
Institutional review board approval was obtained. Individual patient informed consent for this retrospective study was not required. The study is Health Insurance Portability and Accountability Act compliant.
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Results
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Discussion
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