Research ArticleOpen Access

Image-Guided Pre-Operative Localisation of Impalpable Breast Lesions: Analysis of the Hook-Wire Localisation Technique

Volume 3 - Issue 3

**Alya Binmahfouz^1,2, Marita K Prior*¹, Sai Navya Purchuri¹ and Shohreh Rezai¹**

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- ¹Department of Medical Imaging, Royal Brisbane and Women’s Hospital, Australia
- ²Department of Medical Imaging, King Abdul-Aziz University Hospital, Saudi Arabia
*Corresponding author: Marita K Prior, Department of Medical Imaging, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

Received: March 15, 2018; Published: March 28, 2018

DOI: 10.26717/BJSTR.2018.03.000893

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Abstract

Introduction: Hook-wire localisation (HWL) under sonographic, tomosynthesis or MRI guidance is the most common technique used to localize impalpable breast lesions. We retrospectively review and discuss HWL success and complication rate, and the number of breast lesions that required re-excision at our institution. We compare our results with other centres, identifying alternative methods for localizing impalpable breast lesions.

Methods: The medical records of 141 patients who underwent HWL at our institution over a 36 month period were retrospectively reviewed. Only impalpable lesions were targeted. Post-surgical specimen radiography was performed to verify retrieval of the target and wire, and to radio logically assess surgical margins. Surgical margins were deemed positive if malignancy extended to the edge of specimen, and close if malignancy extended to less than 3mm.

Results: Altogether 40 patients had tomosynthesis-guided HWL and 101 patients had ultrasound-guided HWL. 106 excisions were therapeutic and 35 were diagnostic. Pathology identified 115 lesions as malignant, 6 as high-risk and 20 as benign lesions. Seven patients had complications related to the hook-wire. Post-localisation waiting time ranged from 1-10 hours (median, 4.5 hours). 52 patients required re-excision due to involved margins and of these patients, 18 had a complete mastectomy. Conclusion: Hook-wire localisation is a valuable technique for targeting breast lesions; however, direct and indirect complications associated with this technique do exist. In accordance with the findings of this study, and the literature, it would be of value for our clinicians to be aware of these complications and to consider alternative, more reliable localisation techniques.

Keywords: Breast carcinoma; Lobular; Ductal; Mammography; Tomo synthesis; Hook-wire localization

Abbreviations: HWL: Hook-Wire Localisation; RBWH: Royal Brisbane & Women’s Hospital; DCIS: Ductal Carcinoma In Situ; EIC: Extensive Intra-ductal Component; RSL: Radioactive Seed Localisation; ROLL: Radio-Guided Occult Lesion Localisaion; IOUS: Labelled Colloid and Intra- Operative Ultra-Sound