Immersion Ultrasonography of Excised Nonpalpable Breast Lesion Specimens after Ultrasound-Guided Needle Localization

Abstract

Objective: Ultrasound-guided needle localization has been used prior to the surgical excision of nonpalpable breast lesions. The aim of the study was to assess the feasibility of the use of a saline immersion specimen ultrasound technique (immersion-US) to confirm the successful removal of breast lesions. Materials and Methods:The devised immersion-US technique was used to examine the excised tissues of 72 ultrasound-guided needle localized breast lesions of 58 patients (34 benign lesions, 30 high-risk lesions and 8 malignant lesions). Freshly excised specimens were placed in a container filled with saline and one radiologist scanned the surgically excised specimens using a high-frequency linear transducer. We evaluated successful lesion removal and the qualities of the immersion-US images. Miss rates were determined by the use of postoperative ultrasound during follow-up.Results: All 72 lesions were identified by the use of immersion-US and satisfactory or excellent quality images were obtained for most lesions (70/72, 97%). Five (7%) lesions were initially identified as incompletely excised, based on the immersion-US findings, and prompt re-excision was undertaken. Follow-up ultrasound examinations showed no residual mass in the surgical field in any patient. Conclusion:The immersion-US technique was found straightforward and efficient to perform. Immersion-US was able to determine whether nonpalpable breast lesions had been successfully excised after ultrasound-guided needle localization.he increased popularity of breast screening programs has resulted in an increased detection rate of nonpalpable breast lesions. Mammography and breast ultrasonography (US) are effective to detect and to diagnose such lesions, and preoperative breast US facilitates performing of a biopsy and needle placement in nonpalpable breast lesions. Moreover, for surgical excision of nonpalpable breast lesions, the lesions should be localized before surgery and specimen imaging should be performed to ensure complete removal.Mammography has been widely used as an imaging modality for needle localization of nonpalpable breast lesions, especially calcifications, and specimen radiography has been traditionally used for standard specimen imaging. However, the number of detected nonpalpable breast lesions continues to increase due to the use of breast US, and some of these lesions seen on breast US are not visualized by mammography. Thus, for such lesions, localization should be attempted only under US guidance. In addition, the use of breast US has advantages for needle localization as its use reduces the time involved and patient discomfort.It may sometimes be difficult to identify a lesion in subsequent specimen US images

A prospective pilot study of analysis of surgical margins of breast cancers using high-resolution sonography

“…Another limitation of this study was not recording the time spent in performing the specimen sonogram in addition to the standard of care digital radiograph of the specimen. The mean time required for technique using immersion of the specimen on saline solution was reported as 5.2 min by a group from Korea (Lee et al 2008 ). Therefore, we believe that the additional time for scanning the specimens is acceptable in a standard of care clinical practice.…”

Role of specimen US for predicting resection margin status in breast conserving therapy

“…This kind of method is particularly effective in many cases where the breast lesion is not visible at mammography but is only detected by means of breast US, as in case of young women with dense breasts (7,(9)(10)(11).…”

“…The main advantages are represented by the minimal time delay during surgical procedures as compared with mammography, the lower costs, the lower time requested for specimen evaluation and the possibility to © C I C E d i z i o n i I n t e r n a z i o n a l i be performed in either the radiology department or the operative room (9)(10)(11).…”

“…In fact, some authors stated that US represents an effective procedure for identifying lesions within specimen; on the other hand, other authors reported a poor performance in the evaluation of surgical specimen margin status (9)(10)(11).…”

Presurgical Localization of Breast Abnormalities: An Overview and Analysis of 202 Cases

“…[11]. A technique of immersion ultrasonography of excised specimens has been reported for lesions localized under ultrasound guidance and those that are not mammographically visible [12]. In our series seven of 47 patients undergoing ultrasound guided localizations had specimen radiography and among these in five specimen radiography confirmed excision of the abnormality.…”