IntroductionMetallic foreign bodies (MFB) within the breast develop out of surgical clips, broken pieces of guide-wires and gunshot injuries (GSI) (1). As such, metallic foreign bodies can cause local breast pain, abscess, cardiac tamponade, granuloma or pneumothorax, which are clinically significant (1-2). In this report, we aim to present a 35-year-old female patient diagnosed with a metallic foreign body in the left breast as the second case in the literature in which radio-guided occult lesion localization (ROLL) was used for the excision of the foreign body.
Case PresentionA 35-year-old female patient presented to the general surgery department with pain in the left breast. She had a history of a gunshot wound in the breast four months ago, shortly after which the symptoms had started. The patient told that the bullet was still in her breast. Physical examination revealed tenderness in the upper outer quadrant of the left breast. The breast ultrasound indicated a 10 mm hyperechoic formation in the upper outer quadrant of the left breast. The mammography and chest x-ray confirmed the presence of a 10 mm hyperdense MFB within the breast. The object was not fragmented (Figure 1-2). It was decided to surgically remove the foreign body and written informed consent from the patient was obtained. On the morning of surgery, the MFB was marked using the ROLL technique in the radiology unit. The foreign body was excised along with the surrounding fibrosis and inflammatory breast tissue by applying a gamma probe through a 3 cm incision in a 20-minute operation. Specimen mammography was performed on the excision material to confirm that the MFB was located within the tissue (Figure 3).
Discussion and ConclusionSince metallic foreign bodies can cause symptoms such as local breast pain, abscess, cardiac tamponade, granuloma or pneumothorax, they have clinical importance (1-2). Korbin et al. (3) reported broken guide-wire pieces in 5 of 3500 patients who underwent guide-wire biopsy. Montrey et al. (4) reported that the most common types of MFB in the breast are surgical clips and broken pieces of guide-wires. In that same study, the prevalence of MFB related to broken guide-wire pieces was found to be 0.2%. As reported in several studies addressing MFB in the breast, surgical clips, pieces of guide-wires and GSIs are the most common factors in etiology. Mammography is usually helpful for the diagnosis (1, 2, 5). In our case, the patient had a history of GSI as well as pain in the left breast as consistent with the literature. The MFB was clearly visualised in ultrasound, mammography and chest x-ray. Eur J Breast Health 2017; 13: 159-160 DOI: 10.5152/ejbh.2017.3428 159
Extraction of a Foreign
ABSTRACTThe most common clinical causes of metallic foreign body in the breast are surgical clips, pieces of guide-wire and gunshot wounds. Metallic foreign bodies can lead to local breast pain, abscesses, pneumothorax after granulomas or migration, and cardiac tamponade. Mammotome biopsy, fluoroscopy, guide-wire biopsy and radi...
