19281 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance

Name of the Procedure:

Placement of Breast Localization Device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), Percutaneous; First Lesion, with Mammographic Guidance

Summary

This procedure involves placing a small device in the breast to accurately locate a lesion or abnormal area. It is done using a needle and guided by mammographic imaging to ensure precise positioning.

Purpose

The procedure is used to identify the exact location of a breast abnormality, often a lump or suspicious area detected in a mammogram, to guide subsequent surgical biopsy or treatment. This ensures that the surgeon can accurately remove or sample the correct tissue.

Indications

• Presence of a suspicious lump or abnormality detected in a mammogram.
• Conditions such as breast cancer or precancerous lesions requiring precise location for biopsy or surgery.
• Patients with dense breast tissue making lesion identification challenging.

Preparation

• No special fasting is typically required.
• Patients may need to pause certain medications that affect bleeding, as advised by their healthcare provider.
• Mammograms and possibly other imaging tests will be conducted beforehand.

Procedure Description

1. The patient lies face up on an examination table.
2. Mammographic images of the breast are taken to locate the lesion.
3. The skin is disinfected, and local anesthesia is administered to numb the area.
4. A needle containing the localization device (e.g., clip, wire) is inserted through the skin and guided to the lesion using mammographic images.
5. Once positioned correctly, the device is deployed inside the breast to mark the location of the lesion.
6. Mammographic images confirm the accurate placement of the device.
7. The needle is removed, and a small bandage is placed over the insertion site.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is generally performed in a radiology or imaging department within a hospital or outpatient clinic.

Personnel

• Radiologist or breast imaging specialist
• Radiologic technologist or nurse
• Sometimes, a breast surgeon is consulted

Risks and Complications

• Mild discomfort or pain at the insertion site
• Minor bleeding or bruising
• Infection at the insertion site
• Rarely, the device might move or fail to stay in place, requiring repositioning.

Benefits

• Enables precise localization of breast abnormalities, facilitating accurate surgical biopsy or treatment.
• Minimizes the removal of healthy tissue.
• Enhances diagnostic accuracy and treatment outcomes.

Recovery

• Most patients can resume normal activities immediately.
• Mild discomfort may be managed with over-the-counter pain relievers.
• Instructions for wound care and signs of infection to watch for will be provided.
• Follow-up imaging or appointment may be scheduled to assess the condition.

Alternatives

• Watchful waiting with regular imaging follow-ups for some patients.
• Ultrasound-guided localization for certain lesions.
• MRI-guided localization for lesions not visible on mammography.
• Surgeon palpation during surgery, though less precise.

Patient Experience

The patient may feel slight pressure or a pinch when the needle is inserted. Local anesthesia ensures minimal pain. Post-procedure, there might be mild soreness or bruising, manageable with pain relief measures. Comfort measures like relaxing music or a calming environment might be provided to ease anxiety.