Origin of metallic particles resembling microcalcifications on mammograms after use of abrasive cautery-tip cleaning pads during breast surgery: experimental demonstration.
OBJECTIVE
To determine if the act of cleaning a cautery tip with an abrasive pad dislodges radiopaque particles that can be transferred to breast tissue during surgery, thereby mimicking microcalcifications at mammography.


METHODS
Mock breast surgery was performed by cauterizing bovine liver or fresh, normal, human breast tissue. The cautery tip was rubbed against a cleaning pad five to 20 times in the manner used intraoperatively and was touched on separate breast tissue specimens two to six times. Specimen radiography was then performed. Thirty-six breast specimens were used in three experiments, including 28 used for the experimental conditions and eight control specimens.


RESULTS
Particles collected from the cleaning pads resembled microcalcifications. After cauterization of liver, breast tissue, or both, in series, particles transferred from the cautery tip to breast tissue specimens could be identified on specimen radiographs. Transfer of particles after cautery of breast tissue occurred with increased numbers of rubs and specimen contacts.


CONCLUSIONS
Radiopaque aluminum oxide particles from abrasive cautery-tip cleaning pads can be dislodged and transferred to breast tissue during surgery. Scrutiny of high-detail, spot-compression, magnification mammograms will help identify these particles. Simple measures to mitigate particle transfer during breast surgery can prevent this problem and obviate a potential second procedure to remove particles mistaken for microcalcifications.
Division of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA 90404, USA.
P I
PI
Haigh
R J
RJ
Brenner
A E
AE
Giuliano
D000537:Aluminum Oxide; D000818:Animals; D001940:Breast / Q000601:surgery; D001941:Breast Diseases / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery; D002417:Cattle; D003902:Detergents / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004564:Electrocoagulation / Q000295:instrumentation*; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008099:Liver / Q000601:surgery; D008327:Mammography; D015412:Mastectomy, Segmental / Q000295:instrumentation*; D008670:Metals; D013499:Surface Properties
D003902:Detergents; D008670:Metals; D000537:Aluminum Oxide