Ultrasound-Guided Segmental Mastectomy and Excisional Biopsy Using Hydrogel-Encapsulated Clip Localization as an Alternative to Wire Localization

Ann Surg Oncol. 2016 Oct;23(10):3284-9. doi: 10.1245/s10434-016-5325-x. Epub 2016 Jun 23.

Abstract

Background: Wire localization is currently the most widely used localization strategy for excision of nonpalpable breast lesions. Its disadvantages include patient discomfort, wire-related complications such as wire displacement/fracture, and operating room delays related to difficulties during wire placement. We have implemented the technique of intraoperative ultrasound-guided excision using hydrogel-encapsulated (HydroMARK) biopsy clips for lesion localization. We hypothesize that this method is as effective as wire localization for breast conserving therapy.

Methods: This is a retrospective review of 220 consecutive patients who underwent segmental mastectomy or excisional biopsy using wire localization or hydrogel-encapsulated clip localization from January 2014 to July 2015. Data were collected and analyzed. Statistical analyses for differences between groups were performed using t tests and Mann-Whitney rank-sum analyses.

Results: A total of 107 excisions were performed using hydrogel-encapsulated clip localization, and 113 excisions were performed using the traditional wire localization technique; 68 % of our patients underwent excision for malignant pathology. Wire placement took a mean of 46 minutes (range 20-180 min), compared with 5 minutes for ultrasound localization (p < .001). Successful intraoperative ultrasound localization and excision was performed on 100 % of patients. There was no difference in re-excision rates for positive margins or overall specimen size between the two groups.

Conclusions: Intraoperative ultrasound-guided excision of nonpalpable breast lesions using a hydrogel-encapsulated biopsy clip for breast conserving therapy is a safe and feasible alternative to the traditional preoperative wire localized excision. This technique will lead to improvement in patient experience, operative efficiency, and alleviate wire-related complications.

MeSH terms

  • Biopsy / instrumentation
  • Biopsy / methods
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery*
  • Female
  • Humans
  • Hydrogels
  • Mastectomy, Segmental / instrumentation
  • Mastectomy, Segmental / methods*
  • Middle Aged
  • Operative Time
  • Reoperation
  • Retrospective Studies
  • Surgery, Computer-Assisted*
  • Surgical Instruments
  • Ultrasonography, Mammary

Substances

  • Hydrogels