title: Hematoma-directed ultrasound-guided (HUG) breast lumpectomy.
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.
authors.affiliation: Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Thompson
authors.forename: Ronda
authors.initials: R
authors.lastname: Henry-Tillman
authors.forename: Aaron
authors.initials: A
authors.lastname: Margulies
authors.forename: Jeff
authors.initials: J
authors.lastname: Thostenson
authors.forename: Gwen
authors.initials: G
authors.lastname: Bryant-Smith
authors.forename: Robert
authors.initials: R
authors.lastname: Fincher
authors.forename: Soheila
authors.initials: S
authors.lastname: Korourian
authors.forename: V Suzanne
authors.initials: VS
authors.lastname: Klimberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006406:Hematoma; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D013238:Stereotaxic Techniques; D018084:Ultrasonography, Interventional; D016217:Ultrasonography, Mammary; D014618:Vacuum