Learning objectives
Current preoperative localization techniques and how they are performed;
Rationale behind preoperative localization procedure planning and surgical approach;
How to deal with challenging cases;
Importance of discussing the case with the surgeon,
to achieve best therapeutic result.
Background
Breast cancer screening programs haveincreased the diagnosis of small,
nonpalpable lesions.
Surgical approach of nonpalpable breast lesions requires a previous imaging-guided lesion localization procedure.
Furthermore,
lesions that are palpable,
however extense,
may also require imagingguidance in order to be appropriately delimited and resected.
Preoperative procedures and surgical treatment mustpursue free surgical margins while optimizing cosmetic results.
Findings and procedure details
TABLE OF CONTENTS
1.
Preoperative procedures
2.
How to
3.
Preoperative planning
4.
Challenging cases
5.
Surgical specimen
6.
Outcome results
1.
PREOPERATIVE PROCEDURES
Various types of preoperative procedures are currently available.
The most established ones are wire localization (WL) and radioguided localization (RL).
More recently,
other methods are emerging,
such as radioactive seed localization (RSL) and magnetic seed localization (MSL).
The tableinFig. 2 shows a comparisonbetween these methods.
WIRE LOCALIZATION
Consists of the imaging-guided introduction of a Kopans' needleinto the breast; the extremity of...
Conclusion
Regardless of which preoperative localization method is preferred,
the major concern must beadequate excision.
In order to achieve the best results,
previous case discussion with the surgeon and complete evaluation of all case datais crucial.
Radiologists' familiarity with all procedures' limitations and specific technical refinements is mandatory,
as these apparently simple procedures imply very relevant clinical results.
Personal information
Dr.
Bárbara H.
Bresciani
Breast ImagingSection.
Department of Radiology,
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
São Paulo,
Brazil.
Breast Imaging Section.
Fleury Medicina e Saúde,
São Paulo,
Brazil.
contact author:
[email protected]
Dr.
Heni D.
Skaf
Resident in training.
Department of Radiology,
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
São Paulo,
Brazil.
Dr.
Cecilia S.
Goldman
Resident in training.
Department of Radiology,
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
São...
References
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Ahmed M,
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Sentinel node and occult lesion localization (SNOLL): A systematic review.
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2.
Chan B,
Wiseberg-Firtell J,
Jois R,
Jensen K,
Audisio R.
Localization techniques for guided surgical excision of non-palpable breast lesions.
Cochrane Database of Systematic Reviews.
2015.
3.
Cheang E,
Ha R,
Thornton C,
Mango V.
Innovations in image-guided preoperative breast lesion localization.
The British Journal of Radiology.
2018;:20170740.
4.
Dryden M,
Dogan B,
Fox P,
Wang C,
Black D,
Hunt K et al.
Imaging Factors That...