Preoperative magnetic resonance imaging-guided localization of 131 breast lesions with modified embolization coils

OBJECTIVES: The objectives of this study were to assess practicability, outcome, and possible advantages of magnetic resonance imaging (MRI)-guided localizations with modified embolization coils for exclusively MRI-detected suspicious breast lesions. MATERIALS AND METHODS: We performed 131 MRI-guided preoperative localizations in 105 patients with exclusively MRI-detected breast lesions. Contrast-enhanced, T1-weighted, 3-dimensional gradient echo sequences were used for imaging. Breast fixation and needle guidance were achieved by a perforated plate. Lesion localization was performed with a modified embolization coil. The distance between coil and lesion was measured. Results of specimen radiography and histopathology were analyzed. RESULTS: Thirty-four of 131 lesions (26%) were malignant. Lesion localization and excision was successful in all patients. The mean distance between the coil and the lesion was 0.5 mm (+/-1.7 mm standard deviation). CONCLUSIONS: Exact MRI-guided preoperative localization of exclusively MRI-detected breast lesions by using a modified embolization coil is feasible with excellent precision. Advantages over wire localization procedures are the possibility of specimen x-ray and the independence from time and place of operation.     

A simple method to decrease surgical trauma in wire localization procedures

Minimally invasive breast biopsies of nonpalpable lesions are used for early diagnosis and treatment of breast cancer. This report describes a simple method to decrease surgical trauma in wire localization procedures. After wire localization with mammography or ultrasound, the course of the wire in the breast was marked on the skin to guide the surgeon. As a result, fewer tissue samples were taken and smaller hematomas occurred. This method is particularly useful in deep lesions and in large breasts, leading to shortened surgery time and improved cosmetic results. This technique can be used in any wire-guided procedure.     

Modified localization wire for breast lesions

We modified commercially available wires for localization of non-palpable breast leasions. The modified localizing wire was used in 16 women requiring excision of non-palpable breast lesions and comparison was made with non-localizing wires. The results indicated that the modified localizing wire provided technical ease to the surgeons in removing the breast lesion and significant help to the radiolgists in placing the wire and reporting the position of the wire in relation to the breast lesion.     

MRI-guided needle localization of suspicious breast lesions: results of a freehand technique

Magnetic resonance imaging (MRI) can detect clinically and mammographically occult breast lesions. In this study we report the results of MRI-guided needle localization of suspicious breast lesions by using a freehand technique. Preoperative MRI-guided single-needle localization was performed in 220 patients with 304 MRI-only breast lesions at our hospital between January 1997 and July 2004. Procedures were performed in an open 0.5-T Signa-SP imager allowing real-time monitoring, with patient in prone position, by using a dedicated breast coil. MRI-compatible hookwires were placed in a noncompressed breast by using a freehand technique. MRI findings were correlated with pathology and follow-up. MRI-guided needle localization was performed for a single lesion in 150 patients, for two lesions in 56 patients, and for three lesions in 14 patients. Histopathologic analysis of these 304 lesions showed 104 (34%) malignant lesions, 51 (17%) high-risk lesions, and 149 (49%) benign lesions. The overall lesion size ranged from 2.0–65.0 mm (mean 11.2 mm). No direct complications occurred. Follow-up MRI in 54 patients showed that two (3.7%) lesions were missed by surgical biopsy. MRI-guided freehand needle localization is accurate and allows localization of lesions anterior in the breast, the axillary region, and near the chest wall.     

X线立体穿刺钩针定位在乳腺微小病变中的应用

目的:探讨X线立体穿刺钩针定位对不可触及乳腺微小病变的诊断价值.方法:回顾分析87例乳腺钼靶X线立体穿刺钩针定位病例,均为临床触诊阴性而乳腺钼靶X线片显示有微小病变,采用钩针定位后,留置导丝于定位区,引导手术将病灶切除活检.结果:83位患者,乳腺X线检查发现病灶87例,导丝引导下手术活检均一次性成功定位与切除,定性诊断正确率为100%.病理检查结果:恶性病变8例,良性病变79例.结论:X线立体穿刺钩针定位简单易行,在乳腺微小病变的诊断中起着重要的作用.     

Preoperative localization of nonpalpable breast lesions.

Surgeons are increasingly required to resect nonpalpable breast lesions only detected by mammography. Methods for preoperative localization of such lesions were reviewed with emphasis on invasive radiologic techniques using injection, needle, and wire markers. Invasive localization of nonpalpable breast lesions is a relatively simple procedure that should be available wherever breast biopsies and mammography are performed. Its precision and success relate to the radiologist's experience in marker placement and to close cooperation between the radiologist and surgeon.     

Preoperative MR imaging-guided needle localization of breast lesions

OBJECTIVE: MR imaging of the breast can depict cancer that is occult on mammography and at physical examination. Our study was undertaken to determine the ease of performance and the outcome of MR imaging-guided needle localization and surgical excision of breast lesions. MATERIALS AND METHODS: Retrospective review revealed 101 consecutive breast lesions that had preoperative MR imaging-guided needle localization with commercially available equipment, including a 1.5-T magnet with a breast surface coil, a dedicated biopsy compression device, and MR imaging-compatible hookwires. Imaging studies and medical records were reviewed. RESULTS: Histologic findings in these 101 lesions were carcinoma in 31 (30.7%), high-risk lesions (atypical ductal hyperplasia or lobular carcinoma in situ) in nine (8.9%), and benign lesions in 61 (60.4%). Fifteen (48.4%) of 31 carcinomas were ductal carcinoma in situ, and 16 (51.6%) were infiltrating carcinoma (size range, 0.1-2.0 cm; median, 1.2 cm). Carcinoma was found in 16 (45.7%) of 35 lesions detected in women with synchronous cancer, 10 (32.3%) of 31 lesions detected on MR imaging for problem solving, and five (14.3%) of 35 lesions detected on MR screening. The time range to perform MR imaging-guided localization was 15-59 min (median time, 31 min). Complications encountered in three cases were retained wire fragments in two and breakage of the wire tip in one. CONCLUSION: MR imaging-guided needle localization can be performed quickly and safely with commercially available equipment. The positive predictive value of MR imaging-guided needle localization (30.7%) was comparable to that reported for mammographically guided needle localization and was highest in women with synchronous breast cancer.     

Imaging-guided preoperative hookwire localization of nonpalpable extramammary lesions

OBJECTIVE: Imaging-guided hookwire localization of nonpalpable lesions in the breast is frequently performed preoperatively. Outside the breast, this procedure is useful for planning resection of lesions in anatomic regions without intrinsic landmarks. The purpose of this study was to review an experience with hookwire localization of nonpalpable extramammary lesions. CONCLUSION: Preoperative imaging-guided hookwire localization is a useful technique that allows precise exploration and resection of nonpalpable lesions and increases confidence that the lesions have been entirely resected.     

乳腺钼靶X线立体定位穿刺活检和手术

1992年7月～1993年9月间,对56例乳腺疾病患者进行钼靶摄片,发现56例57处病灶,对其中54例55处病灶进行了立体定位细针穿刺细胞学检查。结果显示其敏感性为92.5％,特异性为100％,诊断符合率为96.3％。若将细胞学检查结果与钼靶摄片相结合,联合敏感性与特异性均可达100％。上述病灶中有12处为临床所不能扪及的隐匿性病灶,6处在立体定位引导下完成了切除术。     

数字化三维立体导丝定位穿刺技术在乳腺微小病灶中的应用

目的:探讨数字化三维立体导丝定位穿刺术对乳腺微小病灶的诊断价值。方法:回顾性分析临床触诊阴性而影像学表现异常的患者41例(乳腺微小病灶43处),41例均行乳腺数字化三维立体导丝定位穿刺切除并进行病理学检查。结果:43处微小病灶均定位成功,病变完全切除。病理检查:恶性病变8处,其中原位癌3处,浸润性导管癌Ⅰ～Ⅱ级3处,导管内癌伴早期浸润1处,浸润性导管癌伴腋下淋巴结转移1处;良性病变35处。结论:乳腺数字化三维立体导丝定位穿刺技术定位准确、损伤小、诊断符合率高,是治疗乳腺微小病变的重要手段,也是发现早期乳腺癌的重要方法。     

Differential bore sheath breast biopsy--a pilot study of a new technique

The increasing requirement for core biopsy in the diagnosis of early breast disease puts additional demands on radiologists' time and expertise. We present a new approach to percutaneous breast biopsy of impalpable lesions with core biopsy and simultaneous hook wire localization. The technique allows accurate localization of breast lesions and is unique in that it facilitates simultaneous hook wire localization. Percutaneous biopsy by this method was accurate in 9 of 11 patients.     

不可触及乳腺包块切除术中高频超声引导下导丝定位的应用价值

目的：探讨高频超声引导下导丝定位在不可触及乳腺包块切除术中的临床应用价值。方法：对63例超声提示乳腺包块,而临床不可触及,或触诊不满意,又均需手术切除的病例,在超声引导下行导丝定位,后行外科手术切除,送病理检查。结果：63个病灶均一次成功定位,且导丝均位于病灶内。所有病灶在手术中均被准确完整切除,无血肿、导丝脱落及折断等并发症发生。导丝定位时间3-10min,平均5min。外科手术时间15-40min,平均25min。结论：对于不可触及乳腺包块的手术切除,超声引导下导丝定位简单易行,定位准确,可有效缩短手术时间,并减少术中腺体损伤。     

Preoperative needle localization of lesions in the lower half of the breast: needle entry from below

For preoperative localization of lesions in the lower part of the breast, an inferior approach provides the shortest skin-to-lesion distance. This paper describes the successful inferior approach in 48 of 49 consecutive localizations. No special grid localization device is needed. This technique permits accurate localization of small foci of microcalcifications and other nonpalpable breast lesions.     

Targeting difficult accessible breast lesions: MRI-guided needle localization using a freehand technique in a 3.0 T closed bore magnet

PURPOSE: To report the accuracy of magnetic resonance imaging (MRI)-guided needle localization for diagnosis of MRI detected suspicious breast lesions located in difficult accessible regions of the breast, using the freehand method in a 3.0 T closed bore magnet. MATERIALS AND METHODS: In five patients with five MRI-only breast lesions underwent MRI-guided needle localization for histopathologic evaluation of the lesions. All interventional procedures were performed in a 3.0 T MRI system with the patient in prone position and by using a dedicated phased array breast coil. MRI-guided needle localizations were performed by using a freehand technique. In our study, the high-resolution scan allowed preprocedural localization of all lesions without use of contrast enhancement. In all cases contrast-enhanced MRI was performed after insertion of the wire to confirm the tip of the wire in direct contact with the enhancing lesion. RESULTS: Needle localizations were performed in five patients. Histopathologic evaluation of tissue after surgery excision biopsy revealed one lymph node, three invasive ductal carcinoma and one ductal carcinoma in situ. Lesion size varied from 6 to 30 mm. Mean duration time was 25 min. No complications occurred during the intervention method. In the patient with the benign lesion control MRI of the breast after 6 months confirmed lesion removal. CONCLUSIONS: MRI-guided needle localization by using a freehand technique in a 3.0 T closed bore magnet is a safe and accurate method for diagnosis of difficult accessible breast lesions only visible on MRI.     

MR-guided interventional breast procedures considering vacuum biopsy in particular

Histologic work-up of just MR-detected breast lesions has become essential with increasing use of contrast-enhanced MR imaging. In the present article an overview is given about the different MR-guided breast interventions, performed since 1990. Presently, for reasons of costs and image quality closed magnets are most widely used. The following approaches have been described: MR-guided freehand localization in supine position, stereotaxic localization in supine position and most frequently used localization in the prone position by means of a compression device that immobilises the breast to prevent tissue shift during intervention. Only limited experience exists with interventions on open magnets. MR-guided wire localization is a well-established procedure. Recently, percutaneous vacuum biopsy of enhancing breast lesions has become possible under MR guidance. The new system allows accurate and safe access to lesions in any location of the breast and direct check-up of representative excision by visualisation of the cavity. Thus reliable histologic evaluation of lesions smaller than 10 mm is possible with this approach.     

全数字化乳腺X线三维定位创新技术在不可触及性病变术前定位的应用

目的 探讨全数字化乳腺X线引导下的三维立体定位创新技术对不可触及性乳腺病变术前定位的临床价值.方法 回顾性分析乳腺不可触及性病变并行术前定位的106例患者,根据乳房X线片(0°及90°)人工计算进针深度,定位时利用全数字化乳腺X线三维立体定位系统(GE Senogrphe DS)自动计算进针深度,将此值与人工计算的进针深度值相结合,再结合患者,定位前皮肤弹性以及腺体结构情况,调整进针深度,置入定位针,临床根据定位导丝位置对病变进行切除,术后再行X线摄影与术前对比,判断病变是否被完整切除.结果 全数字化乳腺X线引导下的三维立体定位系统对不可触及性乳腺病变的定位准确率达到100%,手术均能完整切除,11例出现不良反应,主要表现为晕厥,经休息、心理安抚及输液处理后均能较快恢复.结论 术前行乳腺X线引导下的三维立体定位可以提高乳腺不可触及性病变切除的准确性,简单易行,具有推广价值.     

导丝定位在经乳晕旁切口切除乳腺隐匿性病灶中的应用

目的:探讨术前超声引导下导丝定位在经乳晕旁切口切除乳腺隐匿性病灶中的价值。方法:96例女性患者共175枚病灶,术前超声引导下选择乳晕旁穿刺点行乳腺病灶导丝定位,术中做乳晕旁弧形切口,沿导丝切除病灶。结果:175枚乳腺病灶超声引导下导丝定位成功率100%。术中一次性沿导丝成功切除病灶169枚(96.57%),6枚(3.43%)病灶滑脱,通过进一步探察或术中超声最终全部切除。最终病理证实良性病灶174枚,恶性1枚。结论:术前超声引导下选择乳晕旁穿刺点导丝定位,使一些触诊困难的乳腺病灶行乳晕旁切口成为可能,并且手术时间短、腺体损伤小、病理取材方便,为一种新的技术手段。     

Internal mammary node lymphoscintigraphy and biopsy in breast cancer.

BACKGROUND: In patients with breast cancer, sentinel nodes (SNs) are detected outside the axilla in 1-2% of cases after superficial injection of radiocolloid in the breast. We investigated whether deep injection of tracer visualized internal mammary chain lymph (IMC) nodes more often, and assessed the impact of IMC status on disease staging. METHODS: A total of 400 patients were enrolled in this trial. The study group included 200 patients with T1-T2 N0 breast cancer in an inner quadrant. Radio tracer was injected superficially in 100 (group A), and deeply under the tumor in the others (group B). If an IMC took up tracer in group B patients it was biopsied. An additional 200 patients with outer quadrant lesions were also studied lymphoscintigraphically following superficial (100 patients) or deep (100 patients) injection, but IMC nodes were not biopsied as this would have required an additional surgical excision. RESULTS: An SN was visualized in the IMC in 65.6% of inner quadrant patients after deep injection and in 2.1% after superficial injection. In outer quadrant patients, deep injection visualized an SN in the IMC in 10% of cases. The IMC SN was located mainly in the 2nd and 3rd intercostal spaces. Radioguided IMC biopsy was performed in 62 patients. Node removal proved simple and risks insignificant. Stage migration occurred in 8% of cases. CONCLUSIONS: Deep injection allows SN localization in the IMC in 65% of inner quadrant breast lesions. Biopsy of the axillary plus IMC resulted in stage migration in 8% of patients. It is unclear whether this additional information can lead to better survival.     

Immersion ultrasonography of excised nonpalpable breast lesion specimens after ultrasound-guided needle localization

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.     

The use of carbon marking after stereotactic large-core-needle breast biopsy

PURPOSE: To investigate the use of activated charcoal to mark the biopsy site and needle track after large-core-needle breast biopsy. MATERIALS AND METHODS: Three hundred seventy-six consecutive patients (with 383 lesions) were referred for stereotactic breast biopsy. Two hundred forty-seven lesions were carbon marked when the need for surgery was likely. Patients who underwent marking were followed up for the results of surgery or mammography performed at our institution. Specimen sizes obtained by using the carbon mark were compared with sizes of consecutive biopsy specimens obtained after hook-wire localization. RESULTS: Carbon marking was well tolerated in all cases. All 132 surgeries performed at the authors' institution were successful in removing the marked target. Specimen sizes compared favorably with sizes of comparison hook-wire localization specimens. All 68 lesions followed mammographically revealed no changes that were attributable to the use of carbon. Two minor complications were observed. Two small cancers were completely removed at needle biopsy. CONCLUSION: Carbon marking is safe and effective for marking the biopsy site and needle track created by stereotactic large-core-needle biopsy of the breast. Marking eliminates the need for postprocedural needle localization. It remains effective when small lesions have been completely removed. This technique should be considered in properly selected cases by those performing large-core-needle biopsy of the breast.