Origin of metallic particles resembling microcalcifications on mammograms after use of abrasive cautery-tip cleaning pads during breast surgery: Experimental demonstration

PURPOSE: To determine if the act of cleaning a cautery tip with an abrasive pad dislodges radiopaque particles that can be transferred to breast tissu e during surgery, thereby mimicking microcalcifications at mammography. MATERIALS AND METHODS: Mock breast surgery was performed by cauterizing bov ine liver or fresh, normal, human breast tissue. The cautery tip was rubbed against a cleaning pad five to 20 times in the manner used intraoperativel y and was touched on separate breast tissue specimens two to six times. Spe cimen radiography was then performed. Thirty-six breast specimens were used in three experiments, including 28 used for the experimental conditions an d eight control specimens. RESULTS: Particles collected from the cleaning pads resembled microcalcific ations. After cauterization of liver, breast tissue, or both, in series, pa rticles transferred from the cautery tip to breast tissue specimens could b e identified on specimen radiographs. Transfer of particles after cautery o f breast tissue occurred with increased numbers of rubs and specimen contac ts. CONCLUSION: Radiopaque aluminum oxide particles from abrasive cautery-tip c leaning pads can be dislodged and transferred to breast tissue during surge ry. Scrutiny of high-detail, spot-compression, magnification mammograms wil l help identify these particles. Simple measures to mitigate particle trans fer during breast surgery can prevent this problem and obviate a potential second procedure to remove particles mistaken for microcalcifications.