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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2007

01-01-2007

Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy

Authors: Margaret Thompson, MD, Ronda Henry-Tillman, MD, Aaron Margulies, MD, Jeff Thostenson, MS, Gwen Bryant-Smith, MD, Robert Fincher, MD, Soheila Korourian, MD, V Suzanne Klimberg, MD

Published in: Annals of Surgical Oncology | Issue 1/2007

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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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Metadata
Title
Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy
Authors
Margaret Thompson, MD
Ronda Henry-Tillman, MD
Aaron Margulies, MD
Jeff Thostenson, MS
Gwen Bryant-Smith, MD
Robert Fincher, MD
Soheila Korourian, MD
V Suzanne Klimberg, MD
Publication date
01-01-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9076-y

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