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Sonographically Guided Marker Placement for Confirmation of Removal of Mammographically Occult Lesions After Localization

¹ Department of Radiology, New York University School of Medicine, New York University Cancer Institute, 160 E 34th St., 3rd Fl., New York, NY 10016.
² Department of Surgery, New York University School of Medicine, New York, NY.
³ Department of Pathology, New York University School of Medicine, New York, NY.

OBJECTIVE. We evaluated the benefit of placing a marker under sonographic guidance at the time of localization to aid in identifying mammographically occult lesions within the specimen at the time of surgical excision and to evaluate margin status.

MATERIALS AND METHODS. We reviewed 135 sonographically guided needle localizations performed on mammographically occult lesions. Imaging during the localization procedure, marker placement, and specimen radiographs were reviewed, and the findings were correlated with the histopathologic findings.

RESULTS. Of the 135 mammographically occult lesions, 77 were localized without marker placement and 58 with marker placement. The 58 localizations with marker placement were for masses with a mean lesion size of 9 mm. Specimen radiography of these lesions showed a marker within the specimen in 56 cases (97%) and visualization of the lesion in only seven cases (12%). Specimen radiography of localizations without marker placement showed visualization of the lesion in 18 cases (23%). Of the 11 malignant lesions (19%) localized with marker placement, none had a positive inked margin, but five (46%) had close margins necessitating reexcision. Of the 26 malignant lesions (34%) localized without marker placement, two (8%) had a positive inked margin, and eight (31%) had close margins necessitating reexcision.

CONCLUSION. At needle localization of breast lesions, marker placement under sonographic guidance is beneficial because it enables immediate confirmation of accurate surgical removal of the localized lesion at surgical excision. Use of marker placement, however, does not reduce the percentage of cases with close margins necessitating reexcision.

Keywords: breast • breast specimen • mammography • sonography

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