Localization of impalpable breast masses: value of sonography in the operating room and scanning of excised specimens.

Fornage, Bruno D.; Ross, Merrick I.; Singletary, S. Eva; Paulus, David D.

doi:10.2214/ajr.163.3.8079846

Cited by 50 publications

(31 citation statements)

References 9 publications

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“…This procedure therefore avoids the need of a preoperative localization. An ultrasound scanning of the surgical specimen can also be done to assess the presence of the lesion and the adequacy of SM [54, 55]. However, it must be remembered that ductal carcinoma in situ rarely has a clear visibility on US [56], and since it represents an increasing number of breast malignancies, some methods for improving its visibility on ultrasound have been developed.…”

Section: Margin Assessment Techniquesmentioning

confidence: 99%

Preoperative Localization and Surgical Margins in Conservative Breast Surgery

Corsi

Sorrentino

Bossi

et al. 2013

International Journal of Surgical Oncology

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Breast-conserving surgery (BCS) is the treatment of choice for early breast cancer. The adequacy of surgical margins (SM) is a crucial issue for adjusting the volume of excision and for avoiding local recurrences, although the precise definition of an adequate margins width remains controversial. Moreover, other factors such as the biological behaviour of the tumor and subsequent proper systemic therapies may influence the local recurrence rate (LRR). However, a successful BCS requires preoperative localization techniques or margin assessment techniques. Carbon marking, wire-guided, biopsy clips, radio-guided, ultrasound-guided, frozen section analysis, imprint cytology, and cavity shave margins are commonly used, but from the literature review, no single technique proved to be better among the various ones. Thus, an association of two or more methods could result in a decrease in rates of involved margins. Each institute should adopt its most congenial techniques, based on the senologic equipe experience, skills, and technologies.

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Section: Margin Assessment Techniquesmentioning

confidence: 99%

Preoperative Localization and Surgical Margins in Conservative Breast Surgery

Corsi

Sorrentino

Bossi

et al. 2013

International Journal of Surgical Oncology

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“…However, when breast lesions are identified by preoperative US, US-guided needle localization is desirable. Furthermore, when a breast lesion is detected by mammography and US, US is the preferred modality for imaging guidance as the use of breast US has advantages over mammography in terms of needle localization or skin marking (3-5). For example, US-guided needle localization allows the needle to be observed in real time and allows insertion of the needle directly through the lesion.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the distance between the skin and a breast lesion is usually less for US-guided needle localization than for mammography-guided needle localization. Therefore, US-guided needle localization can be performed more rapidly and produce better cosmetic results (4, 5). …”

Section: Discussionmentioning

confidence: 99%

“…Studies by Fornage et al (5) and Feld et al (8) used saline to perform US of specimens as in the present study. However, in the study by Fornage et al (5), a relatively small number of cases (18 cases) were evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the study by Fornage et al (5), a relatively small number of cases (18 cases) were evaluated. Moreover, the study by Feld et al (8) included palpable and nonpalpable breast masses.…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Seo

et al. 2008

Korean J Radiol

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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

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