Abstract:

Background: Diagnosing and treating impalpable breast lesions is one of the greatest gains of screening and it is a game changer in winning against breast cancer. Screening must be complemented with availability of methods to handle impalpable lesions. At the least, impact of screening is considerably diminished and at worst, screening will be counter-productive or downright unethical if detected lesions cannot be diagnosed and treated, yet standard methods of handling impalpable lesions are not available or not sustainable in low-income centers.

Objective: To make screening effective by finding cheap and sustainable method of localizing, diagnosing and treating impalpable breast lesions.

Method: Intra-operative ultrasound (USS) directed biopsy of impalpable breast lesions was modified so that the localization and operative procedure can be dissociated and performed with limited facility; Under USS-guidance at the radiology department, hematoma was formed around impalpable lesions by injecting 3-4mls of patient’s own blood into them and incision placement was planned at the same time. Two to 3 days later, during open surgical procedure without intra operative USS-facility, the iatrogenic hematomas were found and excised. Primary measures of outcome were achievement of successful excision and histological diagnosis.

Result: Following walk-in screening, 5 impalpable breast lesions visible to mammography and ultrasound were included. All 5 were successfully localized and excised. Histological diagnosis was reached in all 5 lesions.

Conclusion: This small volume pilot experience demonstrated how impalpable lesions can be handled in poor resource centers. The HUGE method allows flexibility of scheduling and lowers dependence on high technology.

Keywords: Hematoma localization, Impalpable, breast lesion, low-income

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