Localization of impalpable breast masses: value of sonography in the operating room and scanning of excised specimens.

OBJECTIVE: Despite the variety of techniques available, mammographically guided preoperative localization of impalpable masses in the breast can be a difficult procedure for radiologists. Furthermore, in a few cases, an impalpable lesion is clearly seen on sonograms and yet poorly seen or not visible on mammograms. Accordingly, we studied the value of localizing impalpable masses with sonography in the operating room and of scanning excised specimens to confirm successful removal of the mass. All of the lesions were visible on preoperative sonograms.

SUBJECTS AND METHODS: Twenty-six patients had sonographic examination of the breast in the operating room to guide the localization of an impalpable mass previously seen on sonograms. In eight patients, the lesion was poorly seen or not seen on conventional mammograms. Localizing techniques included one or more of the following: insertion of a needle, injection of dye, or simple marking on the skin. In 18 cases, sonography of the freshly excised specimen was done in the operating room. The sizes of the masses (13 fibroadenomas, 10 carcinomas, two cysts, and one tubular adenoma) measured on the sonograms ranged from 0.6 to 2.7 cm (mean +/- SD, 1.2 +/- 0.5 cm).

RESULTS: In all 26 cases, the mass was clearly identified on sonograms obtained in the operating room. In all 18 cases in which it was used, sonography of the specimen correctly showed the presence or absence of the lesion. In two cases, sonographic determination of the absence of the lesion in the specimen prompted immediate reexcision, which was successful.

CONCLUSION: Our experience shows that sonography in the operating room is a rapid and efficient method of localizing impalpable breast masses that have been seen on sonograms. Sonography of the specimen can indicate within seconds whether the excision has been successful. This technique is particularly valuable for masses that are not visible or only poorly visible on mammograms.