19283 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance

Name of the Procedure:

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

Summary

This procedure involves the precise placement of a localization device, such as a clip, wire, needle, or radioactive seed, into the breast tissue to mark the location of a specific lesion. Stereotactic guidance, a specialized imaging technique, is used to ensure accurate placement.

Purpose

This procedure is primarily performed to ensure precise localization of a breast lesion, aiding in subsequent biopsy or surgery. The goal is to mark the lesion accurately to guide surgeons or radiologists in the removal or further examination of the tissue.

Indications

• Suspicious or abnormal mammogram findings
• Dense breast tissue making lesion identification difficult
• Planning for surgical removal of a breast tumor
• Neoadjuvant chemotherapy planning to monitor response

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• All medications, particularly blood thinners, should be discussed with the healthcare provider.
• A pre-procedure mammogram or ultrasound may be required.

Procedure Description

1. The patient is positioned on a specialized table.
2. Local anesthesia is administered to numb the breast area.
3. Stereotactic guidance, often using mammography or 3D imaging, is utilized to locate the lesion.
4. A small incision is made, and the localization device (clip, wire, needle, or radioactive seed) is inserted percutaneously (through the skin) to mark the lesion.
5. Verification images are taken to ensure accurate placement of the device.
6. The incision is closed and dressed.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is commonly performed in a hospital's radiology department, outpatient clinic, or specialized surgical center.

Personnel

• Radiologist or breast surgeon
• Radiologic technologist
• Nursing staff
• Sometimes an anesthesiologist

Risks and Complications

• Infection at the insertion site
• Minor bleeding or bruising
• Pain or discomfort during or after the procedure
• Displacement of the localization device
• Allergic reactions to anesthetics

Benefits

• Accurate localization of breast lesions for effective surgical or biopsy procedures.
• Minimally invasive with a relatively quick recovery.
• Significant aid in the diagnosis and treatment of breast abnormalities.

Recovery

• Patients can usually go home the same day.
• Mild pain or discomfort at the incision site can be managed with over-the-counter pain relievers.
• Avoid strenuous activities for a day or two.
• Follow-up appointment may be scheduled to check the site and plan further treatment.

Alternatives

• MRI-guided localization
• Ultrasound-guided localization
• Conservative monitoring with repeated imaging

Each alternative has specific benefits and limitations. For instance, MRI-guided localization may provide better visualization for certain types of lesions, but it might be more expensive and less readily available compared to stereotactic guidance.

Patient Experience

• During the procedure: Patients may feel slight pressure or discomfort while being positioned and during the insertion of the localization device.
• After the procedure: Some soreness and tenderness at the insertion site can be expected, but severe pain is uncommon. Pain management typically includes over-the-counter medications and ice packs.