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Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy

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Abstracts

Background

Needle localization breast biopsy (NLBB) is presently the primary means of localizing non-palpable lesions. Disadvantages of NLBB include vasovagal episodes, patient discomfort, and miss rates. Because hematomas naturally fill the cavity after vacuum-assisted breast biopsies (VABB), we hypothesized that ultrasound (US) could be used to find and accurately excise the actual biopsy site of non-palpable breast lesions without a needle.

Methods

This is a retrospective study from January 2000 to July 2005. Electronic chart review identified patients with non-palpable breast lesions detected by means of mammogram who then underwent lumpectomy via NLBB or the hematoma-directed ultrasound-guided technique (HUG). HUG involved localizing the hematoma with a 7.5-MHz US probe and using the “line of sight” technique straight down toward the chest wall. A block of tissue encompassing the hematoma was then excised.

Results

Localization procedures were performed in 186 patients—63 (34%) via needle localization and 123 (66%) via HUG. The previous VABB site in 100% of patients was successfully excised using HUG, 65 of 123 (53%) were benign and 58 of 123 (47%) were malignant; margins were positive in 13 of these 58 (22%). NLBB was successful in 100% of patients, 44 of 63 (70%) were benign and 19 of 63 (30%) were malignant; margins were positive in 14 of these 19 (73%). Margin positivity was significantly higher for NLBB than HUG (P = 0.0001, Fisher Exact).

Conclusions

This study suggests that HUG is more accurate in localizing non-palpable lesions than NLBB. By eliminating the additional procedure needed for NLBB, HUG may also be more time- and cost efficient. HUG makes VABB not only a less invasive diagnostic procedure, but also a localization procedure.

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Author information

Authors and Affiliations

  1. Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States

    Margaret Thompson MD, Ronda Henry-Tillman MD, Aaron Margulies MD & V Suzanne Klimberg MD

  2. Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States

    Jeff Thostenson MS

  3. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States

    Gwen Bryant-Smith MD, Robert Fincher MD & V Suzanne Klimberg MD

  4. Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, United States

    Soheila Korourian MD & V Suzanne Klimberg MD

Authors
  1. Margaret Thompson MD
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  2. Ronda Henry-Tillman MD
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  3. Aaron Margulies MD
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  7. Soheila Korourian MD
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  8. V Suzanne Klimberg MD
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Corresponding author

Correspondence to V Suzanne Klimberg MD.

Additional information

Margaret Thompson: Supported by the Virginia Clinton Kelley/Fashion Footwear Association of New York Breast Cancer Research Fellowship

Aaron Margulies: Supported by the Susan G. Komen Breast Cancer Clinical Fellowship

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Thompson, M., Henry-Tillman, R., Margulies, A. et al. Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy. Ann Surg Oncol 14, 148–156 (2007). https://doi.org/10.1245/s10434-006-9076-y

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  • DOI: https://doi.org/10.1245/s10434-006-9076-y

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