Hematoma-directed ultrasound-guided (HUG) breast lumpectomy

Margaret Thompson, Ronda Henry-Tillman, Aaron Margulies, Jeff Thostenson, Gwen Bryant-Smith, Robert Fincher, Soheila Korourian, Vicki Klimberg

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)148-156
Number of pages9
JournalAnnals of Surgical Oncology
Volume14
Issue number1
DOIs
StatePublished - Jan 2007
Externally publishedYes

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Segmental Mastectomy
Hematoma
Breast
Needles
Biopsy
Vacuum
Thoracic Wall
Retrospective Studies

Keywords

  • Biopsy
  • Breast
  • Hematoma
  • Lumpectomy
  • Ultrasound

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Thompson, M., Henry-Tillman, R., Margulies, A., Thostenson, J., Bryant-Smith, G., Fincher, R., ... Klimberg, V. (2007). Hematoma-directed ultrasound-guided (HUG) breast lumpectomy. Annals of Surgical Oncology, 14(1), 148-156. https://doi.org/10.1245/s10434-006-9076-y

Hematoma-directed ultrasound-guided (HUG) breast lumpectomy. / Thompson, Margaret; Henry-Tillman, Ronda; Margulies, Aaron; Thostenson, Jeff; Bryant-Smith, Gwen; Fincher, Robert; Korourian, Soheila; Klimberg, Vicki.

In: Annals of Surgical Oncology, Vol. 14, No. 1, 01.2007, p. 148-156.

Research output: Contribution to journalArticle

Thompson, M, Henry-Tillman, R, Margulies, A, Thostenson, J, Bryant-Smith, G, Fincher, R, Korourian, S & Klimberg, V 2007, 'Hematoma-directed ultrasound-guided (HUG) breast lumpectomy', Annals of Surgical Oncology, vol. 14, no. 1, pp. 148-156. https://doi.org/10.1245/s10434-006-9076-y
Thompson M, Henry-Tillman R, Margulies A, Thostenson J, Bryant-Smith G, Fincher R et al. Hematoma-directed ultrasound-guided (HUG) breast lumpectomy. Annals of Surgical Oncology. 2007 Jan;14(1):148-156. https://doi.org/10.1245/s10434-006-9076-y
Thompson, Margaret ; Henry-Tillman, Ronda ; Margulies, Aaron ; Thostenson, Jeff ; Bryant-Smith, Gwen ; Fincher, Robert ; Korourian, Soheila ; Klimberg, Vicki. / Hematoma-directed ultrasound-guided (HUG) breast lumpectomy. In: Annals of Surgical Oncology. 2007 ; Vol. 14, No. 1. pp. 148-156.
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abstract = "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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