19288 Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance 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 magnetic resonance guidance (List separately in addition to code for primary procedure)

Summary

The placement of breast localization devices is a minimally invasive procedure used to mark and identify specific lesions within the breast. This involves inserting a small device such as a clip, metallic pellet, wire, or radioactive seed into the breast tissue. Magnetic resonance imaging (MRI) is utilized to precisely guide the placement for each additional lesion.

Purpose

The procedure helps in accurately locating and targeting breast lesions, particularly those that are not palpable or visible on ultrasound or mammography. It is crucial for guiding surgeons during biopsies or surgical removal of suspicious tissues.

Indications

• Presence of non-palpable breast lesions or abnormalities detected on imaging studies.
• Requirement for accurate localization of lesions before biopsy or surgery.
• Patients with multiple breast lesions requiring precise identification and differentiation.

Preparation

• Patients may need to fast for several hours before the procedure.
• Instructions regarding medication adjustments, especially blood thinners, might be provided.
• Diagnostic tests such as MRI scans will be conducted beforehand to identify and locate the lesions.

Procedure Description

1. The patient is positioned for the MRI scan.
2. Local anesthesia is administered to numb the breast area.
3. Using MRI guidance, a fine needle or wire is inserted percutaneously into the breast to place the localization device near the target lesion.
4. For each additional lesion, this process is repeated.
5. The correct placement of devices is confirmed via MRI images.
6. The area may be bandaged post-procedure.

Duration

The procedure typically takes about 30 to 60 minutes, depending on the number of lesions being localized.

Setting

It is usually performed in a hospital's radiology department or an outpatient clinic with MRI facilities.

Personnel

• Radiologist or breast surgeon
• MRI technologist
• Nurses or medical assistants

Risks and Complications

• Minor bleeding or bruising at the insertion site
• Infection
• Discomfort or pain during or after the procedure
• Rarely, incorrect placement of the device

Benefits

• Accurate localization of breast lesions, aiding in precise surgical or biopsy procedures
• Minimally invasive with quick recovery
• Helps in avoiding unnecessary removal of healthy tissue

Recovery

• Patients can usually return home the same day.
• Instructions on caring for the insertion site will be provided.
• Mild pain or discomfort can typically be managed with over-the-counter pain relievers.
• Patients may be advised to avoid vigorous activities for a short period.

Alternatives

• Ultrasound-guided localization: useful for lesions visible on ultrasound.
• Stereotactic guidance: another imaging technique that can be used for localization.
• Palpation-guidance: not suitable for non-palpable lesions.

Patient Experience

• Patients might feel slight pressure or discomfort during needle insertion.
• Post-procedure, some soreness or bruising can be expected.
• Clear instructions and pain relief measures will help in managing any discomfort and ensure a smooth recovery.