Ultrasound-Guided Localization of Nonpalpable Lesions

  • Bruno D. Fornage


In the same way that it has revolutionized the detection and percutaneous biopsy of minute nonpalpable breast masses, ultrasound (US) has revolutionized the preoperative localization of these masses for the surgeon. Localization of nonpalpable breast lesions can be done preoperatively in the breast imaging section, immediately prior to surgery in the operating room, or even during surgery. This chapter covers the various US-guided localization techniques that are available today, which range from US-directed skin marking of the projection of a not-too-deep lesion or usage of a US scanner during surgery to sophisticated and expensive new technique, such as the preoperative US-guided insertion of radioactive or magnetic seeds.


Needle localization Wire localization Methylene blue India ink Carbon black suspension Radioactive seed localization Limitations Complications Skin marking Intraoperative ultrasound localization Ex vivo scanning of the specimen Cryoprobe-assisted lumpectomy Magnetic seed localization Savi SCOUT device Radiofrequency identification tag 

Supplementary material

Video 19.1

Insertion of a radioactive seed in a small T1 invasive ductal carcinoma prior to segmentectomy. The seed appears as a long linear echo casting some shadowing (see also Fig. 19.11). (MP4 10545 kb)

Video 19.2a

Intraoperative color Doppler US performed to identify the vascular pedicle of a transverse rectus abdominis myocutaneous flap, follow its course, and determine its relationship with a recurrent myoepithelial carcinoma prior to resection (see also Fig. 19.21). On longitudinal scanning, the artery is identified from its origin in the second intercostal space, is followed as it courses over the third rib, and is then followed inferiorly as it passes lateral to the tumor. (MP4 39305 kb)

Video 19.2b

Intraoperative color Doppler US performed to identify the vascular pedicle of a transverse rectus abdominis myocutaneous flap, follow its course, and determine its relationship with a recurrent myoepithelial carcinoma prior to resection (see also Fig. 19.21). On transverse scanning, the pedicle is followed from its origin in the second intercostal space downward and is seen coursing lateral to the tumor, at a distance of only a few millimeters. (MP4 17259 kb)


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Bruno D. Fornage
    • 1
  1. 1.The University of Texas MD Anderson Cancer CenterHoustonUSA

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