LOCALIZATION OF IMPALPABLE BREAST MASSES - VALUE OF SONOGRAPHY IN THEOPERATING-ROOM AND SCANNING OF EXCISED SPECIMENS

OBJECTIVE. Despite the variety of techniques available, mammographical ly guided preoperative localization of impalpable masses in the breast can be a difficult procedure for radiologists. Furthermore, in a few cases, an impalpable lesion is clearly seen on sonograms and yet poorl y seen or not visible on mammograms. Accordingly, we studied the value of localizing impalpable masses with sonography in the operating room and of scanning excised specimens to confirm successful removal of th e mass. All of the lesions were visible on preoperative sonograms. SUB JECTS AND METHODS. Twenty-six patients had sonographic examination of the breast in the operating room to guide the localization of an impal pable mass previously seen on sonograms. In eight patients, the lesion was poorly seen or not seen on conventional[ mammograms. Localizing t echniques included one or more of the following: insertion of a needle , injection of dye, or simple marking on the skin. In 18 cases, sonogr aphy of the freshly excised specimen was done in the operating room. T he sizes of the masses (13 fibroadenomas, 10 carcinomas, two cysts, an d one tubular adenoma) measured on the sonograms ranged from 0.6 to 2. 7 cm (mean +/- SD, 1.2 +/- 0.5 cm). RESULTS. In all 26 cases, the mass was clearly identified on sonograms obtained in the operating room. I n all 18 cases in which it was used, sonography of the specimen correc tly showed the presence or absence of the lesion. In two cases, sonogr aphic determination of the absence of the lesion in the specimen promp ted immediate reexcision, which was successful. CONCLUSION. Our experi ence shows that sonography in the operating room is a rapid and effici ent method of localizing impalpable breast masses that have been seen on sonograms. Sonography of the specimen can indicate within seconds w hether the excision has been successful. This technique is particularl y valuable for masses that are not visible or only poorly visible on m ammograms.