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Advanced Ultrasound in Diagnosis and Therapy ›› 2023, Vol. 7 ›› Issue (3): 267-271.doi: 10.37015/AUDT.2023.220033

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  • 收稿日期:2022-09-01 修回日期:2023-02-03 接受日期:2023-02-21 出版日期:2023-09-30 发布日期:2023-10-09

Localization of Nonpalpable Breast Lumps by Ultrasound Local Coordinates and Skin Inking: A Randomized Controlled Trial

Leila Bayani, MDa, Donya Goodarzi, BSb, Reza Mardani, MDa, Bita Eslami, PhDc, Sadaf Alipour, MDc,d,*()   

  1. a Department of Radiology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
    b Department of Nursing, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
    c Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
    d Department of Surgery, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Received:2022-09-01 Revised:2023-02-03 Accepted:2023-02-21 Online:2023-09-30 Published:2023-10-09
  • Contact: Sadaf Alipour, MD E-mail:sadafalipour@yahoo.com

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Abstract:

Background and Purpose: Surgery of ultrasound-detected non-palpable breast lesions should be guided by ultrasound. Commonly radiologists localize the lesion under ultrasound preoperatively, which necessitates the availability of a localization device and may involve a substantial cost. We performed a study to prospectively assess the feasibility of ultrasound-guided localization without any special device.
Methods: Women with non-palpable benign breast masses were assigned to the “guide wire insertion” (GWI) or the “local coordinates and skin inking” (LOCSI) groups. In both groups, the tumor was marked as a shadow on the skin by the radiologist under ultrasound. In the GWI group, a guidewire was inserted, and in the LOCSI group, the local coordinates of the lesion relative to the skin and the nipple as well as its clockwise placement were reported.
Results: Overall, 29 cases were included in the study, 11 in the GWI and 18 in the LOCSI groups. In all cases, the specimen was correctly excised. The weights of the resected specimens were significantly higher with GWI; LOCSI prevented excessive tissue extraction. Clinicians reported LOCSI as “very easy” more frequently, and surgery took less time.
Conclusions: Overall, our study showed that LOCSI was feasible and can be a suitable method in areas with limited resources. We propose similar studies with a larger sample size, inclusion of malignant cases for margin assessment, and estimation of the cost-effectiveness of the technique.

Key words: Breast ultrasound, Image-guided, Non-palpable breast lesions, Preoperative localization

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Variables LCSD Group GWI Group P value
Ultrasound BIRADS 2.00 2 (18.2%) 0 (0%) 0.169 a
3.00 7 (63.6%) 3 (42.9%)
4.00 2 (18.2%) 4 (57.1%)
Mean localization time b (minutes) 7.17 ± 3.62 7.10 ± 1.87 0.949 b
Mean excision time b (minutes) 10.56 ± 4.72 15.10 ± 9.14 0.088 b
Mean surgical specimen weight (milligrams) 15.24 ± 10.43 37.60 ± 19.24 0.001 b
Mean surgical specimen size b (cm3) 34.89 ± 19.51 45.78 ± 26.72 0.223 b
Mean mass largest diameter b (cm) 1.19 ± 0.78 1.58 ± 0.65 0.230 b
Histology of resected lesion (number) Fibroadenoma 7 2 -----
Complex fibroadenoma 3 3
Fibroadenomatoid mastopathy 2 1
Intraductal papilloma 3 2
Papilloma with atypia 0 1
Sclerosing adenosis 1 0
Adenosis tumor 1 0
Benign phyllodes 0 1
Apocrine hydrocystoma d 0 1
Sarcoidosis e 1 0
Procedure ease, radiologist’s view Very easy 10 (55.6%) 3 (27.3%) 0.342 a
Easy 2 (11.1%) 4 (36.4%)
Hard 3 (16.7%) 2 (18.2%)
Very hard 3 (16.7%) 2 (18.2%)
Procedure ease, surgeon’s view Very easy 11 (61.1%) 4 (36.4%) 0.157 a
Easy 3 (16.7%) 6 (54.5%)
Hard 2 (11.1%) 1 (9.1%)
Very hard 2 (11.1%) 0 (0%)
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