What to look for on a breast specimen radiograph: lessons learnt

Two women underwent stereotactic sampling of mammographically detected lesions with insertion of breast biopsy markers. Localisation of the malignant lesions was performed using iodine 125 seeds, with bracketing of the edges of the larger lesion. The seeds/lesions were located and excised using a γ probe. Liga clips attached to peripheral sutures at the edges of the specimen enabled radiographic orientation. Surgeon and radiologist found the specimen radiographs difficult to interpret. In one case the surgeon thought the lesion had been removed, mistaking the iodine seed for the biopsy marker. The radiologist noted absence of the biopsy marker and marginal calcifications but was concerned the seed was absent. Widening the window level allowed seed identification, revealing a characteristic rectangular radiolucent area in what had been interpreted as a Liga clip. Correct interpretation of the findings helped guide lesion removal, intraoperative margin re-excision and confirmed (125)I seed retrieval.