Korean J Radiol.  2008 Aug;9(4):312-319. 10.3348/kjr.2008.9.4.312.

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

• KMID: 1076456
• DOI: http://doi.org/10.3348/kjr.2008.9.4.312

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.

Keyword

Breast; Breast neoplasms; Specimen handling; Ultrasound (US)

MeSH Terms

Adult
Biopsy, Needle/methods
Breast Neoplasms/*ultrasonography
Female
Humans
Immersion
Mammography
Mastectomy
Middle Aged
Prospective Studies
Ultrasonography/*methods
Ultrasonography, Mammary/methods

Figure

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  Fig. 1 Description of devised saline immersion technique for specimen US (immersion-US). Specimen is placed in plastic container filled with saline. With one hand holding specimen (A), sample is scanned with linear transducer with other hand (B).

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  Fig. 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).

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  Fig. 3 44-year-old woman with intraductal papilloma. A. US image demonstrates 6-mm sized complex echoic mass (arrows). B. Immersion-US image shows complete mass excision (arrows). C. Microscopic pathologic examination demonstrates ductal epithelial papillary projections (Hematoxylin & Eosin staining; original magnification, ×200).

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  Fig. 4 46-year-old woman with ductal carcinoma in situ. A. US image shows 11-mm sized, spiculated irregularly shaped, isoechoic mass (arrows). B. Immersion-US image demonstrates successful mass excision (arrows). C. Microscopic pathological examination demonstrates cribriform and solid type, low-grade ductal carcinoma in situ (Hematoxylin & Eosin staining; original magnification, ×200).

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  Fig. 5 26-year-old woman with ductal carcinoma in situ and mucocele-like tumor. A. US shows 13-mm sized complex echoic mass (arrows). B. Immersion-US image demonstrates successful mass excision (arrows). C. Microscopic pathological examination demonstrates mucin pool with floating mucin producing malignant cells (arrows) (Hematoxylin & Eosin staining; original magnification, ×100).

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