Hematoma-directed ultrasound-guided breast biopsy

Objective and Summary Background Data The standard technique for removal of nonpalpable breast lesions is needle localization breast biopsy, Because t raumatic hematomas can often be seen with ultrasound, the authors hypothesi zed that iatrogenically induced hematomas could be used to guide the excisi on of nonpalpable lesions using ultrasound. Methods Twenty patients with nonpalpable breast lesions detected by magneti c resonance imaging only were enrolled in this single-institution trial, ap proved by the institutional review board. A hematoma consisting of 2 to 5 m L of the patient's own blood was injected into the breast to target the non palpable lesion. Intraoperative ultrasound of the hematoma was used to dire ct the excisional biopsy. Results The average age of women was 53.8 +/- 10 years. Ninety-five percent of lesions detected by magnetic resonance imaging were localized by hemato ma injection. All the hematomas used to recognize targeted lesions were ide ntified at surgery by ultrasound and removed without complication. Eight (4 0%) of the lesions were malignant, with an average tumor size of 12 +/- 6 m m (range 4-25). The remaining 12 lesions (60%) comprised papillomas, sclero sing adenosis, radial scar, fibroadenoma, and areas of atypical ductal hype rplasia. Conclusion The results of this pilot study show the effectiveness of hemato ma-directed ultrasound-guided breast biopsy for nonpalpable lesions seen by magnetic resonance imaging. This new procedure is potentially more comfort able for the patient because no wire or needle is left in the breast. It is technically faster and easier because ultrasound is used to visualize dire ctly the location of the hematoma at surgery and to confirm lesion removal in the operating room by specimen ultrasound. The hematoma can be placed se veral days before biopsy, easing scheduling, and without fear of the migrat ion that may occur with needle localization. This method may have ready app lication to mammographically detected lesions.