Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion
CPT4 code
Name of the Procedure:
Placement of soft tissue localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion.
Summary
In this procedure, a device such as a clip, metallic pellet, wire/needle, or radioactive seed is placed into soft tissue to mark a specific lesion. Imaging guidance is used to ensure accurate placement. This is typically done through the skin (percutaneous).
Purpose
This procedure is used to accurately mark the location of a lesion within soft tissue. It assists in identifying the lesion for future surgical procedures or treatments, such as biopsies or radiotherapy. The goal is precise localization, which improves the effectiveness and accuracy of subsequent interventions.
Indications
- Presence of a suspicious lesion that requires further investigation or treatment.
- Difficulty locating the lesion through physical examination alone.
- Planning for surgical removal or radiotherapy requires precise localization.
Preparation
- Patients may be advised to fast for several hours prior to the procedure.
- Medications, especially blood thinners, may need to be adjusted under medical supervision.
- A detailed medical history and physical exam will be conducted.
- Imaging tests such as ultrasound, mammography, or MRI may be done beforehand to plan the procedure.
Procedure Description
- The patient is positioned comfortably, and imaging equipment is set up.
- Local anesthesia is administered to numb the area.
- Using imaging guidance (e.g., ultrasound, mammography), the healthcare professional identifies the lesion.
- A small incision may be made if necessary.
- The localization device (clip, metallic pellet, wire/needle, or radioactive seed) is carefully inserted into the lesion.
- Imaging is used throughout to ensure the device is placed accurately.
- The site is cleaned, and a dressing is applied.
Duration
The procedure typically takes about 30 minutes to 1 hour, depending on the complexity and the location of the lesion.
Setting
This procedure is usually performed in a hospital radiology department or outpatient clinic equipped with imaging facilities.
Personnel
- Radiologist or surgeon to perform the procedure.
- Radiology technician to operate imaging equipment.
- Nursing staff to assist and provide care before and after the procedure.
Risks and Complications
- Minor bleeding or bruising at the insertion site.
- Infection at the insertion site.
- Displacement of the localization device.
- Rarely, allergic reaction to anesthetic or imaging contrast material.
Benefits
- Precise marking of the lesion increases the accuracy of subsequent procedures.
- Minimally invasive with typically quick recovery time.
- Improved planning for surgery or radiotherapy, potentially leading to better outcomes.
Recovery
- Patients can usually go home the same day.
- Avoid strenuous activity for a short period as advised.
- Keep the insertion site clean and dry.
- Follow-up appointments may be scheduled to monitor the site and ensure the device has not moved.
Alternatives
- Physical examination and palpation for lesion localization, which may be less accurate.
- Direct surgical exploration, which is more invasive.
Observation without marking in cases where immediate intervention is not necessary.
Pros of soft tissue localization include minimal invasiveness and improved accuracy, while the cons may include the minor risks associated with the procedure.
Patient Experience
- The patient might feel some pressure or slight discomfort during the insertion but should not feel pain due to local anesthesia.
- After the procedure, there may be some soreness or minor discomfort at the site.
- Pain management options include over-the-counter pain relievers if needed.