Techniques for Overcoming a Missing Clip During Pre-Operative Needle Localization for Lumpectomy
Breast cancer, breast surgery, clip, localization, case report
Neoplasms | Obstetrics and Gynecology | Surgery
Breast conservation therapy (BCT) has become the standard of care for treating low-stage breast lesions. The principle of this therapy is to conserve as much normal breast tissue as allowable while still achieving a proper oncologic resection. These breast-sparing dissections would be difficult if not impossible without any intra-operative guidance. For this reason a wire is typically placed near the lesion pre-operatively to serve in directing the surgeon. To accurately place a wire, a lesion must be identifiable on imaging. This creates a potential dilemma as candidates for breast-conserving therapy typically have low-stage lesions which can be illusive at times. Thus, fiduciary markers such as clips have become integral in the treatment of low-stage breast lesions as they can serve as a reference point for identifying non-palpable breast lesions. In fact, cases in which a clip serves as the only identifiable landmark for an occult breast lesion are not uncommon. While undoubtedly useful, the heavy reliance we place on these markers creates a potential for significant dilemma when they cannot be visualized. We present a case that demonstrates one of the potential pitfalls that can occur when relying on a fiduciary marker, specifically, the inability to perform pre-operative wire-guided localization (WGL) for lumpectomy due to a lack of clip visualization. We discuss the potential causes for lost markers such as clip migration as well as several techniques available for attempting a “blind” lumpectomy with particular focus on intra-operative fluoroscopy. By utilizing this technique we were able to successfully complete an unexpected blind lumpectomy without any sacrifice in regards to oncologic margins or cosmesis.
Publisher or Conference
Annals of Breast Surgery
Johnson D, Higginbotham M, Appiah L, et al. Techniques for overcoming a missing clip during pre-operative needle localization for lumpectomy: case report. Ann Breast Surg. 2021;():. http://dx.doi.org/10.21037/abs-20-112