19282 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure)

Name of the Procedure:

Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance

Common Names: Breast localization, Breast marking, Needle localization, Localization wire placement

Summary

Breast localization involves placing a small device (such as a clip, metallic pellet, wire/needle, or radioactive seed) in the breast to mark the exact location of a lesion. This assists surgeons in precisely identifying and removing the abnormal tissue during surgery. Mammographic guidance is used to ensure the device is accurately placed.

Purpose

This procedure is performed to pinpoint the location of a breast lesion that may not be palpable but is visible on imaging studies like mammograms. The primary goal is to assist surgeons in targeting the lesion during a subsequent surgical biopsy or lumpectomy, ensuring complete removal while minimizing the impact on surrounding healthy tissue.

Indications

• Non-palpable breast lesions identified on mammograms or other imaging techniques.
• Suspicious areas requiring surgical biopsy.
• Pre-surgical planning where precise lesion localization is crucial.
• Patients with dense breast tissue where lesions are difficult to detect manually.

Preparation

• Patients may be advised to avoid eating or drinking for a few hours before the procedure.
• Discuss any medications with your doctor, as some may need to be paused or adjusted.
• Diagnostic imaging tests such as mammograms or MRIs will be conducted to assist in planning the procedure.
• Wear comfortable clothing and avoid using deodorants, powders, or lotions under the arms or on breasts.

Procedure Description

1. Preparation:

   • The patient will lie on an examination table.
   • The breast area is cleaned and sterilized.

2. Imaging and Localization:

   • Mammographic guidance is used to pinpoint the lesion.
   • Local anesthesia is administered to numb the area.

3. Device Placement:

   • A needle or guide wire is inserted through the skin into the breast tissue.
   • The localization device (e.g., clip, pellet, wire, or seed) is placed at the lesion site.
   • Imaging confirms accurate placement of the device.

4. Completion:

   • The needle or guide wire is removed.
   • A small bandage is placed over the insertion site.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the lesion's location and the number of devices being placed.

Setting

This procedure is generally performed in a hospital radiology department, breast care center, or outpatient clinic with mammographic equipment.

Personnel

• Radiologist
• Radiologic technologist
• Nurses

Risks and Complications

• Minor bleeding or bruising at the insertion site.
• Infection.
• Discomfort or pain during and after the procedure.
• Rarely, misplacement of the localization device requiring repositioning.

Benefits

• Accurate localization of breast lesions for surgical removal.
• Minimally invasive procedure with quick recovery.
• Enhances the surgeon's ability to completely remove the lesion with minimal disruption to surrounding tissue.

Recovery

• Patients can usually resume normal activities immediately or within a few hours.
• Mild pain or discomfort can be managed with over-the-counter pain relievers.
• Follow-up appointment with the surgeon to discuss surgical plans and review post-procedure imaging.

Alternatives

• Observation: Monitoring the lesion with periodic imaging.
• Surgical biopsy without localization: Less precise and may remove more healthy tissue.

• Advanced imaging techniques: MRI or other imaging modalities for pre-surgical planning.

  Each alternative has its own set of risks and benefits, which should be discussed with the healthcare provider.

Patient Experience

• During the procedure, patients might feel pressure but should not feel pain due to the local anesthesia.
• Post-procedure, minor discomfort and bruising are common but manageable.
• Proper supportive care and instructions will be provided to ensure a comfortable and quick recovery.