A Simple Technique for Image-Guided Excision of Non-Palpable Breast Lesions without Needle Localisation in a Low-Resource Environment – a Preliminary Report of 10 Patients

Caribbean Medical Journal ◽

10.48107/cmj2021.04.006 ◽

2021 ◽

Author(s):

Jameel Ali

Keyword(s):

Reference Points ◽

Breast Lesions ◽

Ultrasound Images ◽

Breast Cancers ◽

Complete Excision ◽

Low Resource ◽

Surgical Incisions ◽

Clinical Orientation ◽

Palpable Breast ◽

Resource Environment

Focus on early diagnosis of non-palpable breast cancers has frequently led to expensive interventions that are more challenging in low-resource environments. We examined the use of a simple, inexpensive technique more suited for these environments, presenting preliminary data on its applicability. In 10 consecutive patients with radiologically suspicious non-palpable breast lesions, we used skin markers and breast reference points generated through ultrasound images and clinical orientation to guide location of surgical incisions for excising these lesions in the operating room. This resulted in accurate localisation and complete excision of these lesions without the need for more sophisticated, expensive interventions, making this technique potentially more applicable in low-resource environments, such as ours.

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201Tl Scintigraphy in the Evaluation of Palpable and Nonpalpable Breast Lesions: Correlation with Mammography and Ultrasonography

Nuklearmedizin ◽

10.1055/s-0038-1629848 ◽

1997 ◽

Vol 36 (08) ◽

pp. 282-288 ◽

Cited By ~ 8

Author(s):

T. Atasever ◽

A. Özdemir ◽

I. Öznur ◽

N. I. Karabacak ◽

N. Gökçora ◽

...

Keyword(s):

Final Diagnosis ◽

Lower Sensitivity ◽

Breast Lesions ◽

Breast Cancers ◽

Combined Use ◽

Malignant Breast ◽

Malignant Lesions ◽

Benign Breast Lesions ◽

Palpable Breast ◽

Metastatic Sites

Summary Aim: Our goal was to determine the clinical usefulness of TI-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings. Methods: TI-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of TI-201. Visual and semiquantitative interpretation was performed. Results: Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. TI-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by TI-201 scintigraphy. The smallest mass lesion detected by TI-201 measured 1.5x1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. TI-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed TI-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated TI-201. TI-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by TI-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 ± 0.38 (mean ± SD) and 1.48 ± 0.32 (p >0.05), 1.87 ± 0.65 and 1.34 ± 0.20 (p<0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p>0.05). Conclusion: Overall, TI-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of TI-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

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Predictive factors for complete excision and underestimation of one-pass en bloc excision of non-palpable breast lesions with the Intact® breast lesion excision system

European Journal of Radiology ◽

10.1016/j.ejrad.2011.01.049 ◽

2012 ◽

Vol 81 (4) ◽

pp. 719-724 ◽

Cited By ~ 33

Author(s):

Jean-Yves Seror ◽

Bénédicte Lesieur ◽

Birgit Scheuer-Niro ◽

Laurent Zerat ◽

Roman Rouzier ◽

...

Keyword(s):

Predictive Factors ◽

Breast Lesion ◽

Breast Lesions ◽

En Bloc ◽

Complete Excision ◽

En Bloc Excision ◽

Palpable Breast ◽

Bloc Excision

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Complementary use of scintimammography with 99m-Tc-MIBI to triple diagnostic procedure in palpable and non-palpable breast lesions

Acta Radiologica ◽

10.1080/j.1600-0455.2003.00054.x ◽

2003 ◽

Vol 44 (3) ◽

pp. 288-293 ◽

Cited By ~ 2

Author(s):

B. Wilczek ◽

P. Aspelin ◽

B. Boné ◽

A. Pegerfalk ◽

J. Frisell ◽

...

Keyword(s):

Diagnostic Procedure ◽

Needle Aspiration ◽

Breast Lesions ◽

Breast Cancers ◽

Clinical Value ◽

Complementary Method ◽

Non Palpable Lesions ◽

Palpable Breast ◽

Additional Value ◽

A Prospective Study

Purpose: The aim of this study was to determine the clinical value of scintimammography with 99m-Tc-MIBI ( Sc) as a complementary method to the triple diagnostic procedure in the diagnosis of breast lesions. Material and Methods: Ninety-six consecutive patients with 65 palpable and 54 non-palpable breast lesions were included in a prospective study. All lesions were evaluated by clinical examination, mammography and fine-needle-aspiration cytology (FNAC), called triple diagnostic procedure ( TD). Prone planar scintimammography with 99m-Tc-MIBI was performed in all patients. Five groups were defined for diagnosis: 1 = normal; 2 = benign; 3 = probably benign; 4 = highly suspect of malignancy; and 5 = malignant. In the calculations, groups 1–3 were considered benign, and 4–5 malignant. All lesions were excised and examined histologically. The additional value of Sc + TD procedure was studied separately for palpable and non-palpable lesions. Results: Histologically, 83 malignant and 36 benign lesions were found in the 119 breast lesions. Sensitivity for malignancy in palpable lesions of TD alone and of the combination TD + Sc were 95.6% and 100%, respectively. Sensitivity for malignancy in non-palpable lesions of TD and TD + Sc was 89.1% and 97.2%, respectively. Conclusion: Adding scintimammography to the triple diagnostic procedure increased the sensitivity for the detection of both palpable and non-palpable breast cancers, but decreased the specificity.

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The LOCalizer Radiofrequency Identification System: An Effective New Technology for Localizing Non-Palpable Breast Lesions for Surgery

Surgical Innovation ◽

10.1177/1553350620967853 ◽

2020 ◽

pp. 155335062096785

Author(s):

Carolyn M. Cullinane ◽

James Byrne ◽

Liga Akmenkalne ◽

Donal P. O’ Leary ◽

Alissa M. Connors ◽

...

Keyword(s):

Complication Rate ◽

Breast Conserving Surgery ◽

Identification System ◽

Surgical Removal ◽

Breast Lesions ◽

Breast Cancers ◽

Index Lesion ◽

Rfid Tag ◽

Radiofrequency Identification ◽

Palpable Breast

Background. Breast screening has decreased morbidity and mortality due to detection of early, non-palpable breast cancers. One of the challenges of performing breast-conserving surgery on non-palpable breast tumours is accurate localization of the cancer. We aimed to perform a feasibility study to examine the outcomes associated with the introduction of a novel radiofrequency identification system (RFID) called LOCalizer as an alternative to traditional wire-guided localization. Methods. Data were prospectively collected on all patients undergoing breast-conserving surgery using the LOCalizer RFID system in a regional cancer centre between July 2019 and March 2020. Patients had a RFID tag placed preoperatively and underwent surgical removal of the tag with the index lesion guided by a handheld LOCalizer probe. The primary aim was successful placement and retrieval of the RFID tag. Re-excision rates, specimen size, specimen weight, cancer subtype and complication rate were all recorded. Results. Sixty-nine patients aged between 50 and 69 years had a LOCalizer tag inserted between July 2019 and March 2020. Of these, 6 (8.7%) were diagnostic and 63 (91.3%) were therapeutic. There was no migration of RFID tags, and all tags were retrieved with the index lesion. The overall re-excision of margin rate was 17.4% (12/69). All re-excision of margins was due to positive radial margins. The overall complication rate was 1.4% with one grade 1 Clavien-Dindo morbidity. Conclusion. The LOCalizer RFID is an effective and safe wire-free localization method for non-palpable breast lesions.

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