Haematoma-directed ultrasound guidewire localisation of breast lesions

Introduction

The standard technique for surgical excision of mammographically detected, ultrasound invisible, non-palpable breast lesions is by pre-operative stereotactic guidewire localization (SGL). Disadvantages of SGL include patient discomfort, ionizing radiation, the requirement for more staff and longer procedure time. Ultrasound visible clips are used for localisation after vacuum-assisted core biopsies (VACB) but clip migration and visibility are problems. Post-VACB, the biopsy cavity fills with haematoma, which is ultrasonographi-cally visible and can be used as a 'marker' for guidewire localisation. Centres in America have successfully used ultrasound intraoperatively to identify the post-biopsy haematoma and guide surgical excision; but no centres have attempted to use ultrasound pre-operatively to locate the post-biopsy haematoma and direct guidewire placement. We aim to describe this new technique of haematoma-directed ultrasound guidewire localisation (HUGL) and compare its accuracy with SGL.

Methods

Between September 2007 and June 2009, 15 patients with mammographically detected, non-palpable, ultrasound invisible breast lesions had VACB followed by HUGL. We compared this technique with 15 consecutive patients who underwent SGL.

Results

Both techniques located all lesions successfully. The mean skin to hook distance and wire overthrow for HUGL were 47.5 mm and 10.4 mm, respectively; the corresponding values for SGL were 67.5 mm and 15.3 mm, respectively. Histology of the final surgical specimen confirmed the presence of targeted lesions in all cases.

Conclusion

This study demonstrates the effectiveness of HUGL of breast lesions. As this technique is potentially more comfortable, technically easier, faster and cheaper than SGL, consideration should be given to routinely employing this as a first line technique.