Sono-mammography assisted wire guided localization of non- palpable breast lesions | ||||
Minia Journal of Medical Research | ||||
Article 14, Volume 34, Issue 3, July 2023, Page 123-131 PDF (476.2 K) | ||||
Document Type: Original Article | ||||
DOI: 10.21608/mjmr.2023.220270.1441 | ||||
View on SCiNiTO | ||||
Authors | ||||
Nashwa Mohamed Adel1; Mohamed Mokhtar Ali2; Heba Allah Mansour Mohamed 1; Mahmoud Mounir Higazi1 | ||||
1Department of Diagnostic Radiology, Faculty of Medicine, Minya University, Egypt | ||||
2Department of Surgical Oncology, Minya Oncology Center, Egypt | ||||
Abstract | ||||
Background: Breast cancer is the most cancer type in females .The preferred method of treatment for early breast cancer is breast conserving surgery. In order to achieve satisfactory oncological and aesthetic effects, accurate preoperative lesion localization is essential. This resulted in the development of wire-guided breast lesion localization. in this study we describe our experience in localization of non palpable breast lesions with the aid of wire by using ultrasound , Mammography for localization of architectural distortion as well as combined technique for more characterization . Methods: 20 patients with breast lesions that were non palpable were enrolled in this study. They were pathologically proven breast cancer. Results: Wire localization was successful in about 18 patients (90%) and was failed in about 2 patients(10%) Conclusion: Image guided wire localization is feasible , accurate and help the surgeon to perform the surgery with adequate safety margin and reduce the complication of breast surgery | ||||
Highlights | ||||
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Keywords | ||||
Breast conserving surgery; Breast cancer; Wire localization | ||||
Full Text | ||||
Introduction Non palpable breast lesions seems to be a challenge to the surgeon in treatment. For excision, preoperative guidance is necessary. The difficult part of the procedure is removing the lesion with negative margins while preserving as much healthy tissue as you can.
Wire guided localization (WGL) and non-wire localization (NWL) are the two forms of localization. The most established and popular technique for removing non-palpable lesions is wire-guided localization (WGL). Although the method has developed over time, it still faces numerous challenges.(1) The localizing wire is typically inserted with ultrasound guidance, though occasionally stereotactic localization may be necessary.(2,3) This is often done in the radiology department with the wire secured to prevent movement or displacement when the patient is transferred to the operation room. Rarely, the surgery could result in a pneumothorax. The location of the wire's entry point may affect how the incision is made and how the lesion is removed. The patient's appoint-tment requires close coordination (4,5)
Standard WGL has been described with good results, and this procedure is simple to carry out with ultrasound or mammography guidance. The ultrasound assisted WGL method, with real-time control of the wire-needle position, allows for good visuali-zation by positioning the probe above the lesion and clearly introducing the guide wire.(6,7,8)
In this study, we describe our initial experience in radiology department Minya university Hospital using sono-mammo-graphy assisted wire guided localization in non-palpable breast lesions, to facilitate breast surgery and minimize complications
Aim of the work To explore the feasibility and optimizing our protocol in detecting non-palpable breast lesions in Radiology Department, Minya university hospital.
Patient and Methods The hospital's medical ethics committee gave the study permission to proceed (Approval No.332:6/2022 Date: 17 June 2022) and All patients gave their informed consent. A multidisciplinary team (MDT) referred 20 patients with non-palpable breast lesions to the Diagnostic Radiology Department for assessment as part of the study.
Patients with non palpable breast lesions collected from Minya University hospital and Minya Oncology center, The study was conducted in Radiology department of Minya university hospital from the period of August 2022 to June 2023.
Some patients were confirmed locally advanced breast cancer and received neo-adjuvant chemotherapy with clip insertion pre neoadjuvant therapy.
Other patients with non palpable breast lesions either presented architectural distortion or micro calcification
Patients were distributed as shown in table (1) as follows: The study involved 20 female patients with non palpable breast lesions. The range of the age of our study patients was (32- 67) years with median (IQR) was (47.5) years.
In our study (10% of patients were unmarried and 90% were married), (20% were nulli para and were 80% were multipara), (80% were breast feeders and 20% were non breast feeders) and (40% had a family history of breast cancer and 60% had not history of breast cancer). BMI more than 25 kg/m2 noted in one patient.
Inclusion criteria:
Exclusion criteria:
Methods and image analysis Each patient underwent the following steps:
Wire localization To decrease the likelihood of wire migration, sono-mammography reassess-ments are performed one day prior to surgery, sometimes even the same day. In patients with non-palpable masses, wire localization is used, and a detailed report is written by the radiologist with feedback on the wire's place of entry, direction, distance between it and the lesion, distance between the lesion and skin, and finally, distance between the location of entry and skin, as shown in (figure. 1)
Breast conservative surgery All patients received breast conservative surgery, which included the excision of the tumor as well as the surrounding safety
margins. and margins of excised lesions were assessed and evaluated intra operative by frozen section and radiologically to assess wire retrieval and safety margins as (figure. 2)
Statistical analysis The data was put into a computer and analyzed utilizing IBM SPSS software edition 20.0 (Armonk, NY: IBM Corp). To describe qualitative data, percentages as well as numbers were used. To verify that the distribution was normal, the Shapiro-Wilk test was carried out. The outcomes obtained were determined to be meaningful at a 5% level.
The following tests were used: 1 - The Chi-square tests To compare various sets of categorical variables 2-Monte Carlo adjustment is used whenever more than 20% of the cells have an expected count of less than 5 3-Mann Whitney test For quantitative variables with unusual distributions
Results
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