Charcoal granuloma mimicking breast cancer: an emerging diagnosis

Abstract

BackgroundImage-guided charcoal injection in suspicious breast lesions for preoperative localization is a procedure that has been increasing over the years because it is safer, faster, and more affordable when compared to needle-wire preoperative localization. To date, no complications have been associated with the method. However, in recent years there have been some reports about charcoal granulomas mimicking malignant lesions in some postoperative patients or in a conservative follow-up.PurposeTo report a series of 11 cases which had suspicious imaging findings for malignancy and resulted in charcoal granulomas on histopathological analysis.Material and MethodsA database of 1650 patients that attended our center from January 2007 to June 2018 was reviewed and detected 495 patients who had been previously submitted to ultrasound-guided charcoal marking in a breast lesion. Then, patients whose imaging studies were compatible with new suspicious lesions on mammography, breast ultrasound, and/or magnetic resonance imaging and biopsy of this new lesion indicating charcoal granuloma were selected.ResultsFrom 495 patients who had undergone charcoal localization injections in previous biopsies, we selected 11 who had new lesions with malignant characteristics on imaging studies but histopathological analysis resulted in charcoal granuloma.ConclusionCharcoal granuloma should be considered in patients with previous preoperative injection localization, since the residual charcoal in the breast tissue may form granulomas and mimic malignant lesions on follow-up imaging studies.

Efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours: systematic review

“…Also, in recent years, cases of charcoal granulomas have been reported. These lesions might mimic breast cancer during mammographic or ultrasonographic follow-up, resulting in misdiagnoses 27 , 28 . Therefore, charcoal localization can be of value for communities with low resources, but is inferior to ICG fluorescence in more prosperous communities 29 .…”

Effectiveness of Carbon Localization for Invasive Breast Cancer: An Institutional Experience

“…No allergic reactions or carbon-related complications were reported in our study population, apart from simple complications related to the insertion of the needle itself. A few cases of carbon granuloma formation have been reported in the literature, many of which were injected and kept in place in the breast for certain reasons (e.g., benign etiology at biopsy and patient refusal) [ 11 , 24 , 25 ]. These have been reported to be benign formations, and no malignant transformations have been reported.…”

“…CL involves the use of a sterile suspension of charcoal that is injected around the outer edges of the tumor, leaving a fine track in the parenchyma and under the skin. It is a simple, fast, and safe technique, with rare associated complications, has lower cost than that of other methods, and offers the possibility of marking at longer intervals [ 11 ].…”

Image-Guided Localization Techniques for Surgical Excision of Non-Palpable Breast Lesions: An Overview of Current Literature and Our Experience with Preoperative Skin Tattoo

“…To avoid this, the carbon should be injected only as far as the edge of the lesion. Another possible, although uncommon, complication of CM is the incomplete surgical removal of the injected charcoal, which can cause a late-onset granuloma that may mimic malignant lesions in postoperative controls [ 47 , 48 ]. In terms of missed lesions and clear margin rates, CL shows similar results as WG: the proportion of cases with close or involved margins ranges between 15% (for invasive cancer) and 39% (in situonly lesions) [ 17 , 18 ].…”