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Feasibility of Peri-Areolar Wire Localization for
Non-Palpable, Ultrasound Visible Breast Lesions

*Sarah E Pesek1, David Edmonson1, *Heather King2, *Ashley Stuckey1, *Susan Koelliker1, Jennifer Gass1
1Women & Infants' Hospital of Rhode Island, Providence, RI;2Hartford Hospital, Hartford, CT

Objective: Image-guided wire placement is commonly used to localize non-palpable breast lesions for surgical excision. A peri-areolar incision can provide superior cosmetic results. Peri-areolar wire placement has been avoided given concernsfor hematoma, pain, wire migration, and pneumothorax. We hypothesize that a better approach may be to introduce the wire near the areolar border.
Design: Feasibility study
Setting: An academic breast health center
Patients: Women with ultrasound visible non-palpable breast lesions undergoing surgical excision
Interventions: The wire localizing the breast lesion is placed under ultrasound guidance with its entrance site within 2 cm of the areola. The surgical incision is made at the areolar border.
Main Outcome Measures: Ability to perform peri-areolar wire placement and incision, time to complete localization, pain, Harvard Cosmetic Scale score
Results: Twenty patients completed the study protocol out of 28 enrolled. One opted out and another was not known to be on study. Four had lesions that the radiologist determined to be too distant from the areola or too close to the chest wall. The surgeon felt the peri-areolar incision would not be optimal for another two. The mean time to complete the wire localization was 6.8 minutes. The mean pain score during the localization by PAS pain scale was 1.67. Six patients who completed the protocol required re-excision of margins. At one year, the mean cosmetic score was 1.5 per the surgeon and 1.9 per the patient.
Conclusions: For select patients, peri-areolar localization may be feasible and yield good cosmetic results with minimal pain. However, more patients are needed to determine if the high re-excision rate persists.

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