Hematoma Localization under Ultrasound-Guidance for Excision (HUGE) of Impalpable Breast Lesions, a Modification to make Screening Effective in Nigeria: Pilot study

Abstract

Modern surgical practice of breast cancer management is witnessing detection and diagnosis of majority of lesions when they are still impalpable (1-3). The gains of diagnosing impalpable lesions includes reduction in the cost of treatment, availability of wider array of surgical treatment, minimization of trauma of treatment and remarkable increment in the chances of cure. These are incentives which will make orthodox care attractive. Diagnosis and treatment of impalpable breast lesion is one of the major factors revolutionizing the outcome of breast cancer treatment in developed centers because of high rate of screening backed by facilities for excision of impalpable lesions such as wire localization biopsies, ultrasound guided biopsies, and various tissue marking guided biopsies(1-7). In contrast, centers in developing countries are deficient in the capability to detect, localize, diagnose or treat impalpable lesions(8). The unfortunate implication of not possessing the capability to handle impalpable lesion(s) is having to wait until the lesions are clinically palpable, at which time the treatment becomes more difficult, more expensive, more mutilating and unattractive to patients(8) thus fueling vicious cycle of late presentation(9-12). It is imperative that we find and demonstrate acceptable and attractive treatment options in order to reverse the trend of late presentation in developing centers(13). In addition to helping to tackle the poor trend of management outcomes, presence of effective and acceptable treatment options is a prerequisite before rolling out screening programs. Therefore, a pilot research was designed with the goal of finding a relatively cheap and sustainable method of localization, diagnosis and treatment of impalpable breast lesions in a resource poor center. Success in our quest will make screening more effective and orthodox care more appealing. This article is a report of our experience in the pilot research; Hematoma localization under Ultrasound Guidance for Excision (HUGE) of impalpable breast lesions, a modification of hematoma directed ultrasound guided biopsy.