19284 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic 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 stereotactic guidance

Summary

This procedure involves placing a small device in the breast to mark the location of abnormal tissues or lesions. This helps guide surgeons during biopsies or surgical excisions.

Purpose

The goal of this procedure is to precisely mark the location of abnormal tissue in the breast to aid in its future surgical removal. It is often used when abnormalities are too small to be felt or seen without assistance.

Indications

• Presence of abnormal mammogram or ultrasound findings
• Non-palpable lumps or areas of concern within the breast
• Pre-surgical marking for excision of lesions
• Evaluation of multiple lesions requiring differentiation

Preparation

• The patient may need to avoid eating or drinking for a few hours before the procedure.
• Patients should inform their doctor of any medications they are taking, as some may need to be paused.
• A mammogram, ultrasound, or MRI may be required to locate the lesion accurately prior to the procedure.

Procedure Description

1. The patient lies on a specialized table, and the breast is positioned for imaging (mammogram or ultrasound).
2. Local anesthesia is administered to numb the area.
3. Using imaging guidance, a thin needle or wire is inserted through the skin and guided to the lesion.
4. The localization device (clip, metallic pellet, wire, or radioactive seed) is placed at the lesion site.
5. Imaging is used to confirm the accurate placement of the device.
6. For each additional lesion, the procedure is repeated, ensuring each is appropriately marked.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the number of lesions and complexity.

Setting

This procedure is typically performed in a hospital radiology or outpatient surgical center.

Personnel

• Radiologist or Breast Surgeon
• Radiologic Technologist
• Nurse or Assistant
• Anesthesiologist (if sedation beyond local anesthesia is required)

Risks and Complications

• Localized pain or discomfort
• Bruising or bleeding at the insertion site
• Infection at the site
• Rarely, migration of the localization device
• Allergic reactions to anesthetic or other materials used

Benefits

• Accurate localization of lesions for surgical planning
• Minimally invasive with a quick recovery time
• High precision in marking abnormal tissues, reducing the risk of incomplete removal

Recovery

• Patients can usually go home shortly after the procedure.
• Mild discomfort or bruising may be experienced, manageable with over-the-counter pain relief.
• Normal activities can often be resumed within a day, except for heavy lifting or strenuous exercise, which should be avoided for a few days.
• Follow-up imaging or a surgical appointment will be scheduled to proceed with the next steps in treatment.

Alternatives

• Direct surgical excision without pre-localization, which might not be as precise
• Watchful waiting with regular monitoring for some types of small lesions
• MRI-guided localization, if conventional imaging is insufficient

Patient Experience

• The patient might feel pressure or a mild sting when the local anesthetic is administered.
• During the procedure, they might feel some pressure but should not feel pain.
• Post-procedure discomfort is usually minimal and short-lived.
• Pain management typically involves basic analgesics and cold compresses if needed.