Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy

Thompson, Margaret E.; Henry‐Tillman, Ronda; Margulies, Aaron G.; Thostenson, Jeff D.; Bryant-Smith, Gwen; Fincher, Robert; Korourian, Soheila; Klimberg, V. Suzanne

doi:10.1245/s10434-006-9076-y

Cited by 50 publications

(30 citation statements)

References 40 publications

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“…After every biopsy, a hematoma remains within the biopsy site. Thompson and colleagues hypothesized that the hematoma could be used as a physiological marker that can be detected via ultrasound at the time of resection, 3 and introduced the term hematoma ultrasound-guided to describe the procedure. They have subsequently reported their 10-year successful experience with this method, 14 showing HUG lumpectomy to be safe and accurate in their practice.…”

Section: Discussionmentioning

confidence: 99%

“…Several alternatives to NL, for example, radioactive seed implantation and MRI guidance, have been suggested. 1,2 Thompson and colleagues demonstrated that intraoperative localization of the biopsy hematoma (hematoma ultrasound-guided [HUG] lumpectomy) could eliminate the need for NL 3 without introducing the need for another invasive procedure. Hematoma ultrasound guidance was incorporated into our practice at the University of Iowa Hospitals and Clinics in 2007.…”

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confidence: 99%

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Effect of Introducing Hematoma Ultrasound-Guided Lumpectomy in a Surgical Practice

Larrieux

Cupp

Liao

et al. 2012

Journal of the American College of Surgeons

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BACKGROUND Preoperative needle localization (NL) is the gold standard for lumpectomy of nonpalpable breast cancer. Hematoma ultrasound-guided (HUG) lumpectomy can offer several advantages. The purpose of this study was to compare the use of HUG with NL lumpectomy in a single surgical practice. STUDY DESIGN Patients with nonpalpable lesions who underwent NL or HUG lumpectomy from January 2007 to December 2009 by a single surgeon were identified from a breast surgery database. Ease of scheduling, volume excised, re-excision rates, operating room time, and health care charges were the main outcomes variables. Univariate and multivariate analyses were performed to compare the 2 groups. RESULTS Lumpectomy was performed in 110 patients, 55 underwent HUG and 55 underwent NL. Hematoma ultrasound-guided lumpectomy was associated with a nearly 3-fold increase in the odds ratio of additional tissue being submitted to pathology (p = 0.039), but neither the total amount of breast tissue removed, nor the need for second procedure were statistically different between the 2 groups. Duration of the surgical procedure did not vary between the 2 groups; however, the time from biopsy to surgery was shorter for HUG by an expected 9.7 days (p = 0.019), implying greater ease of scheduling. Mean charges averaged $250 less for HUG than for NL, but this difference was not statistically significant. CONCLUSIONS Hematoma ultrasound-guided is equivalent to NL with regard to volume of tissue excised, need for operative re-excision, and operating room time. Adoption of HUG in our practice allowed for more timely surgical care.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Introducing Hematoma Ultrasound-Guided Lumpectomy in a Surgical Practice

Larrieux

Cupp

Liao

et al. 2012

Journal of the American College of Surgeons

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“…3 The obvious benefit for the patient is that he or she does not need to undergo a secondary localization procedure. 4 We and others have demonstrated the usefulness of intraoperative US after a positive stereotactic core biopsy that results in the need for BCS therapy. The patients traditionally require needle localization breast biopsy (NLBB), a most barbaric procedure during which 10-20 % of patients faint or vomit due to vasovagal reflex.…”

Section: Further Use Of Image-guided Us In Both the Operating Room Anmentioning

confidence: 97%

“…We termed this the hematoma-directed ultrasound-guided (HUG) procedure. 4 Arentz et al7 demonstrated better margin clearance than with traditional NLBB. In addition, a recent study…”

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confidence: 98%

Intraoperative Image-Guided Breast-Conservation Surgery Should be the Gold Standard

Klimberg

2015

Ann Surg Oncol

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The COBALT trial 1 is a small randomized multicenter trial (134 patients) for unicentric palpable breast cancers conducted in the Netherlands primarily to demonstrate the superiority of intraoperative ultrasound (US)-guided breastconservation surgery (BCS) in terms of both cosmesis and patient satisfaction. Indeed, the cosmesis was better for the image-guided surgery than for the palpation-guided surgery, as judged by a three-member panel, a computer program, and self-evaluation (odds ratio, 0.55; p = 0.067). This was primarily due to less volume of excision with US-guided BCS, less reexcision due to positive margins, and improved patient satisfaction. This ultimately led to lower cost, although this datum is not presented in the report. Likewise, Rubio et al. 2 demonstrated utility in the neoadjuvant setting using a USVisible marker placed at the original biopsy. IMPLEMENTATION IN CLINICAL PRACTICEAs described in both reports, the study results would not be difficult to implement in a busy clinical practice. A variety of ultrasound machines are currently available in most operating rooms that could be used for US-guided surgery. This is how I started in my practice more than 20 years ago. I did not charge for such procedures because they were part of my learning curve and because at that time, no certification for surgeons or US courses were available. It made sense that any image-guided procedure was better than what I could feel with my hands.One thing that received no comment in the reports was the use of ex vivo US confirmation of excision completeness immediately on the operating table that could then direct reexcision of a specific margin. How many times has each of us removed a mass only to find that it was not in the center of the lumpectomy specimen. Ultrasound both in vivo and ex vivo help to direct and redirect our efforts, respectively. FURTHER USE OF IMAGE-GUIDED US IN BOTH THE OPERATING ROOM AND THE CLINICThe two studies demonstrate the most rudimentary of uses for surgical US. As proficiency with US is gained by the surgeon, primary lesions and those demonstrated only by US can be removed with the same level of confidence. Many articles attest to the ability to do so. 3 The obvious benefit for the patient is that he or she does not need to undergo a secondary localization procedure. 4 We and others have demonstrated the usefulness of intraoperative US after a positive stereotactic core biopsy that results in the need for BCS therapy. The patients traditionally require needle localization breast biopsy (NLBB), a most barbaric procedure during which 10-20 % of patients faint or vomit due to vasovagal reflex. 5Many procedures have used clips, coils, cryoablation, and radioactive seeds as second procedures to locate nonpalpable lesions, all with results similar to those for NLBB. 6 Our group has demonstrated the usefulness of using the hematoma created in almost all patients after a core biopsy that lasts up to 5 weeks for most patients. We termed this the hematoma-directed ultrasound-guided (HU...

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“…In addition, hematoma formation may disperse cells to even larger volumes. For these reasons VAB procedures have been shown to limit breast conservative surgery in up to 30 % of the cases [3,4,5]. If multiple stereotactic macrobiopsies decrease the likelihood of breast conservation surgery, this important advantage of early detection might be lost.…”

Section: Introductionmentioning

confidence: 99%

Assessment of microcalcifications with limited number of high-precision macrobiopsies

Harries

Lawson

Bruckers

2010

European Journal of Cancer Prevention

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Stereotactic biopsy assessment of microcalcification clusters with direct and frontal macrobiopsies was performed in a population of 46 women screened for breast cancer. In these women the only clinical finding was microcalcification. Sensitivity of the procedure was 98% and calcifications were detected in 107 out of 148 tissue specimen (73%). This is the highest reported ratio so far. Interestingly the total number of cores inversely correlated with the success rate suggesting that the accuracy of the direct and frontal approach is high. 4 out of 46 women underwent surgery for malignancy indicating that 41 women escaped intervention with a mean follow-up of at least one year. Patient satisfaction is high, in particular regarding reported pain, fear and overall appreciation. No complications were seen.The data suggests that a lower number of macrobiopsies for microcalcifications could be acceptable with direct and frontal biopsy methods without reducing sensitivity. Lowering the number of biopsies can optimize surgical margin interpretation and reduce the number of biopsy related mastectomies.

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Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy

Cited by 50 publications

References 40 publications

Effect of Introducing Hematoma Ultrasound-Guided Lumpectomy in a Surgical Practice

Effect of Introducing Hematoma Ultrasound-Guided Lumpectomy in a Surgical Practice

Intraoperative Image-Guided Breast-Conservation Surgery Should be the Gold Standard

Assessment of microcalcifications with limited number of high-precision macrobiopsies

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