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

Lee KY, Seo BK, Yi A, Je BK, Cho KR, Woo OH, Kim MY, Cha SH, Kim YS, Son GS, Kim YS - Korean J Radiol (2008 Jul-Aug)

Bottom Line: Follow-up ultrasound examinations showed no residual mass in the surgical field in any patient.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea.

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.

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Related in: MedlinePlus

36-year-old woman with fibroadenoma.A. US image shows 14 mm-sized, angular marginated, oval, hypoechoic mass (arrows).B. US-guided needle localization was performed for excision, and needle was directly passed through mass (arrowheads).C. After excision, immersion-US was performed and mass (arrows) was found to be successfully removed.D. Gross pathological examination shows whitish gray multilobulated solid mass (arrows).E. Microscopic pathological examination shows well-defined mass with fibrous stroma and elongated tubules (Hematoxylin & Eosin staining; original magnification, ×100).
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Figure 2: 36-year-old woman with fibroadenoma.A. US image shows 14 mm-sized, angular marginated, oval, hypoechoic mass (arrows).B. US-guided needle localization was performed for excision, and needle was directly passed through mass (arrowheads).C. After excision, immersion-US was performed and mass (arrows) was found to be successfully removed.D. Gross pathological examination shows whitish gray multilobulated solid mass (arrows).E. Microscopic pathological examination shows well-defined mass with fibrous stroma and elongated tubules (Hematoxylin & Eosin staining; original magnification, ×100).

Mentions: On pathological examinations, the specimen sizes ranged from 10 mm to 53 mm (mean size, 31 mm), and the lesions ranged in size from 3 mm to 25 mm (mean size, 12 mm). The pathological diagnoses of the 72 lesions were a benign lesion in 34 cases (47%) (Fig. 2), a high-risk lesion in 30 cases (42%) (Fig. 3) and a malignant lesion in eight cases (11%) (Figs. 4, 5) (Table 2). In the eight malignant lesions and nine high-risk lesions, re-excision was performed after US-guided localization with focal excision, and follow-up US images were obtained before re-excision. There was no residual lesion seen at an excision site on a follow-up US examination for these 17 lesions. All eight malignant lesions were treated surgically with the use of a modified radical mastectomy in four cases and with breast conserving surgery in four cases. Four of the eight malignant were identified as residual carcinomas by a pathological examination after surgery. These four malignant lesions with residual carcinomas were further characterized as three ductal carcinomas in situ and one invasive carcinoma, with sizes ranging from 3 to 9 mm (mean size, 5 mm). Eleven high-risk lesions (seven atypical ductal hyperplasic lesions, two radial scars and two intraductal papillomas) that underwent re-excision showed no residual lesions as seen on US or pathological examinations during follow-up.


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

Lee KY, Seo BK, Yi A, Je BK, Cho KR, Woo OH, Kim MY, Cha SH, Kim YS, Son GS, Kim YS - Korean J Radiol (2008 Jul-Aug)

36-year-old woman with fibroadenoma.A. US image shows 14 mm-sized, angular marginated, oval, hypoechoic mass (arrows).B. US-guided needle localization was performed for excision, and needle was directly passed through mass (arrowheads).C. After excision, immersion-US was performed and mass (arrows) was found to be successfully removed.D. Gross pathological examination shows whitish gray multilobulated solid mass (arrows).E. Microscopic pathological examination shows well-defined mass with fibrous stroma and elongated tubules (Hematoxylin & Eosin staining; original magnification, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627267&req=5

Figure 2: 36-year-old woman with fibroadenoma.A. US image shows 14 mm-sized, angular marginated, oval, hypoechoic mass (arrows).B. US-guided needle localization was performed for excision, and needle was directly passed through mass (arrowheads).C. After excision, immersion-US was performed and mass (arrows) was found to be successfully removed.D. Gross pathological examination shows whitish gray multilobulated solid mass (arrows).E. Microscopic pathological examination shows well-defined mass with fibrous stroma and elongated tubules (Hematoxylin & Eosin staining; original magnification, ×100).
Mentions: On pathological examinations, the specimen sizes ranged from 10 mm to 53 mm (mean size, 31 mm), and the lesions ranged in size from 3 mm to 25 mm (mean size, 12 mm). The pathological diagnoses of the 72 lesions were a benign lesion in 34 cases (47%) (Fig. 2), a high-risk lesion in 30 cases (42%) (Fig. 3) and a malignant lesion in eight cases (11%) (Figs. 4, 5) (Table 2). In the eight malignant lesions and nine high-risk lesions, re-excision was performed after US-guided localization with focal excision, and follow-up US images were obtained before re-excision. There was no residual lesion seen at an excision site on a follow-up US examination for these 17 lesions. All eight malignant lesions were treated surgically with the use of a modified radical mastectomy in four cases and with breast conserving surgery in four cases. Four of the eight malignant were identified as residual carcinomas by a pathological examination after surgery. These four malignant lesions with residual carcinomas were further characterized as three ductal carcinomas in situ and one invasive carcinoma, with sizes ranging from 3 to 9 mm (mean size, 5 mm). Eleven high-risk lesions (seven atypical ductal hyperplasic lesions, two radial scars and two intraductal papillomas) that underwent re-excision showed no residual lesions as seen on US or pathological examinations during follow-up.

Bottom Line: Follow-up ultrasound examinations showed no residual mass in the surgical field in any patient.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea.

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.

Show MeSH
Related in: MedlinePlus