[Preoperative wire localisation of breast lesions by tissue harmonic imaging (THI) sonography]

To obtain a fast and reliable preoperative wire localisation of occult lesions in dense breast tissue by tissue harmonic imaging (THI) sonography when localisation by mammography is not reliable enough.

In addition to biplane mammography for breast screening or for follow-up examination after breast-saving therapy, ultrasound was performed by two independent radiologists in 350 patients with mastopathic or fibrotic breast tissue. Using a multifrequency probe (5 - 10 MHz), lesions were documented by conventional B-mode and by THI in similar projections. In 25 lesions not precisely identified in mammography sonographically guided puncture with wire localisation was performed.

In 22 of 350 patients 25 circumscribed suspicious lesions with an average diameter of 8 mm were identified, regarded suspicious by ultrasound but not by mammography. Nineteen of 25 lesions found by M-Mode and THI, an additional 6 only by THI. Guided puncture and wire localisation was achieved in 10 minutes on the average. In B-mode, the course of needle and wire was reliably seen in 16 of 25 cases, in THI in all cases. After surgical removal of tissue, histopathology revealed a ductal or lobular carcinoma in 19 cases, metastasis in three cases and benign complicated cysts with fibrotic tissue in the remaining three cases.

THI is superior to B-mode ultrasound in differentiating suspicious lesions in dense glandular breast tissue. If tumor signs in mammography are not reliable enough or if a precise localisation is not possible, sonographically guided puncture by THI can give reliable results and, furthermore, is faster and more comfortable for the patient than localisation by mammography.