Breast cancer workup with ultrasound hookwire localization

Case contributed by Assoc Prof Craig Hacking

Presentation

For hookwire localization prior to WLE right breast lesion. Screening detected architectural distortion.

Patient Data

Age: 55 years
Gender: Female

Initial screening mammogram

Mammography

Architectural distortion in the right upper breast in the MLO (12:30).

Patient recalled by the screening service for further workup - US showed a suspicious hypoechoic lesion at 12:30 5mm in size. This was biopsied under US guidance and histology confirm invasive carcinoma, NOS. The patient was referred for surgical management.

Pre hookwire localization ultrasound

Ultrasound

At 12 o'clock there is a deep poorly defined hypoechoic lesion measuring 6 x 8 mm.

Hookwire localization

Ultrasound

A hook wire was advanced from the lateral aspect of the right breast through the deep hypoechoic lesion with the tip of the wire protruding 11.5mm beyond the edge of the lesion.

Post hookwire insertion

Mammography

Mammogram confirms the hookwire through the lesion.

Post op specimen mammogram

Mammography

Mammogram confirms the targeted and wired lesion within the superomedial aspect of the specimen.

Post op specimen ultrasound

Ultrasound

Ultrasound confirms targeted lesion within the specimen.

Standard hookwire within the entry needle.

Case Discussion

Histology = Grade 2 Invasive carcinoma, no special type with involved margins; intermediate and high-grade DCIS; 0/7 lymph nodes, ER/PR+ve.

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