Breast cancer workup with ultrasound hookwire localization

Case contributed by Dr Craig Hacking

Presentation

For hookwire localisation prior to WLE right breast lesion. Screening detected architectural distortion.

Patient Data

Age: 55 years
Gender: Female
Mammography

Initial screening mammogram

Architectural distortion in the right upper breast in the MLO (12:30).

Patient recalled by the screening service for further workup - US showed a suspicious hypoechoic lesion at 12:30 5mm in size. This was biopsied under US guidance and histology confirm invasive carcinoma, NOS. The patient was referred for surgical management.

Ultrasound

Pre hookwire localization ultrasound

At 12 o'clock there is a deep poorly defined hypoechoic lesion measuring 6 x 8 mm.

Ultrasound

Hookwire localization

A hook wire was advanced from the lateral aspect of the right breast through the deep hypoechoic lesion with the tip of the wire protruding 11.5mm beyond the edge of the lesion.

Mammography

Post hookwire insertion

Mammogram confirms the hookwire through the lesion.

Mammography

Post op specimen mammogram

Mammogram confirms the targeted and wired lesion within the superomedial aspect of the specimen.

Ultrasound

Post op specimen ultrasound

Ultrasound confirms targeted lesion within the specimen.

Standard hookwire within the entry needle.

Case Discussion

Histology = Grade 2 Invasive carcinoma, no special type with involved margins; intermediate and high-grade DCIS; 0/7 lymph nodes, ER/PR+ve.

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Case information

rID: 65435
Published: 9th Jan 2019
Last edited: 14th Aug 2019
System: Breast, Oncology
Inclusion in quiz mode: Included

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