CASES OF THE WEEK - “Pre-operative wire localisation of a deep non-palpable breast lump followed by surgical excision” by Dr Priya Devadas, Specialist, General Surgery & Dr Menatallah Tawfik, Specialist, Breast Radiology, NMC Royal Hospital Sharjah

CASES OF THE WEEK - “Pre-operative wire localisation of a deep non-palpable breast lump followed by surgical excision” by Dr Priya Devadas, Specialist, General Surgery & Dr Menatallah Tawfik, Specialist, Breast Radiology, NMC Royal Hospital Sharjah

Pre-operative wire localization is one of the techniques used to localize solid breast lumps before surgery particularly when these lesions are non-palpable and locate deep with the breast. This helps to guide the surgeon during the operative procedure. By doing so it helps to reduce the surgery time dramatically, improves patient safety and also minimises the size on any scars that will form.

Our patient, a 44 years old lady, presented with lump in the right breast. She was investigated in our facility by a combination of the state of the low dose 3D mammography and breast ultrasound. These investigations showed a mass in the breast. The mass was located in lower outer quadrant of the right breast. It was fairly wellcircumscribed oval mass with a lobulated margin and medium density. Ultrasound measurements showed it to be 3.7 x 5.2 cm in MLO view. With respect to its size a lobulated appearance it was deemed BI-RADS 4a to ascribe it a histological correlation

An US guided Core biopsy was done by Dr Menatallah. Following the review of the histology Dr Priya elected to proceed with lumpectomy. To aid in this procedure Dr Menatallah was requested to insert a guide wire to aid in the intraoperative localisation.

Technique:

A modified hook wire system (fig A) with a reinforced 2 cm segment 1.2 cm from its hook (fig B) was used for localization. Passage of the wire to the mass was performed under sonographic guidance. The breast is positioned such that the lesion to be localized is closest to the skin surface. This allows us to pass the needle-wire combination parallel to the chest wall and at the point on the skin closest to the lesion. Under realtime guidance the needle wire is advanced 1 cm beyond the lesion and once position is determined to be satisfactory the wire is advanced over the needle to the correct location. The needle can now be carefully withdrawn leaving the wire behind. An image with wire in satisfactory position is obtained and sent with the patient for the surgeon (fig C)

Dr. Menatallah carried out the US guided wire localization on the same day as the surgery. Surgery was performed by Dr. Priya. The lesion was excised successfully (fig D), it took only 20 mins and resulted in a minimal scar.

Unique Cases 060b Unique Cases 060c Unique Cases 060d