title: Ultrasound-Guided Segmental Mastectomy and Excisional Biopsy Using Hydrogel-Encapsulated Clip Localization as an Alternative to Wire Localization.
abstract: Wire localization is currently the most widely used localization strategy for excision of nonpalpable breast lesions. Its disadvantages include patient discomfort, wire-related complications such as wire displacement/fracture, and operating room delays related to difficulties during wire placement. We have implemented the technique of intraoperative ultrasound-guided excision using hydrogel-encapsulated (HydroMARK) biopsy clips for lesion localization. We hypothesize that this method is as effective as wire localization for breast conserving therapy.
  
  
  
  This is a retrospective review of 220 consecutive patients who underwent segmental mastectomy or excisional biopsy using wire localization or hydrogel-encapsulated clip localization from January 2014 to July 2015. Data were collected and analyzed. Statistical analyses for differences between groups were performed using t tests and Mann-Whitney rank-sum analyses.
  
  
  
  A total of 107 excisions were performed using hydrogel-encapsulated clip localization, and 113 excisions were performed using the traditional wire localization technique; 68 % of our patients underwent excision for malignant pathology. Wire placement took a mean of 46 minutes (range 20-180 min), compared with 5 minutes for ultrasound localization (p <  .001). Successful intraoperative ultrasound localization and excision was performed on 100 % of patients. There was no difference in re-excision rates for positive margins or overall specimen size between the two groups.
  
  
  
  Intraoperative ultrasound-guided excision of nonpalpable breast lesions using a hydrogel-encapsulated biopsy clip for breast conserving therapy is a safe and feasible alternative to the traditional preoperative wire localized excision. This technique will lead to improvement in patient experience, operative efficiency, and alleviate wire-related complications.
authors.affiliation: Department of Surgery, University of Florida, Gainesville, Florida, USA.
authors.forename: Lori F
authors.initials: LF
authors.lastname: Gentile
authors.affiliation: Department of Surgery, University of Florida, Gainesville, Florida, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Himmler
authors.affiliation: Department of Surgery, University of Florida, Gainesville, Florida, USA.
authors.forename: Christiana M
authors.initials: CM
authors.lastname: Shaw
authors.affiliation: Department of Surgery, University of Florida, Gainesville, Florida, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Bouton
authors.affiliation: Department of Radiology, University of Florida, Gainesville, Florida, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Vorhis
authors.affiliation: Department of Radiology, University of Florida, Gainesville, Florida, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Marshall
authors.affiliation: Department of Surgery, University of Florida, Gainesville, Florida, USA. lisa.spiguel@surgery.ufl.edu.
authors.forename: Lisa R P
authors.initials: LR
authors.lastname: Spiguel
mesh_terms: D001706:Biopsy / Q000295:instrumentation / Q000379:methods; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D020100:Hydrogels; D015412:Mastectomy, Segmental / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D013525:Surgical Instruments; D016217:Ultrasonography, Mammary
chemical_list: D020100:Hydrogels