Extraction of a Foreign Body from the Breast Using Radio-guided Occult Lesion Localization (ROLL): Metallic Foreign Body in the Breast

Abstract

IntroductionMetallic foreign bodies (MFB) within the breast develop out of surgical clips, broken pieces of guide-wires and gunshot injuries (GSI) (1). As such, metallic foreign bodies can cause local breast pain, abscess, cardiac tamponade, granuloma or pneumothorax, which are clinically significant (1-2). In this report, we aim to present a 35-year-old female patient diagnosed with a metallic foreign body in the left breast as the second case in the literature in which radio-guided occult lesion localization (ROLL) was used for the excision of the foreign body. Case PresentionA 35-year-old female patient presented to the general surgery department with pain in the left breast. She had a history of a gunshot wound in the breast four months ago, shortly after which the symptoms had started. The patient told that the bullet was still in her breast. Physical examination revealed tenderness in the upper outer quadrant of the left breast. The breast ultrasound indicated a 10 mm hyperechoic formation in the upper outer quadrant of the left breast. The mammography and chest x-ray confirmed the presence of a 10 mm hyperdense MFB within the breast. The object was not fragmented (Figure 1-2). It was decided to surgically remove the foreign body and written informed consent from the patient was obtained. On the morning of surgery, the MFB was marked using the ROLL technique in the radiology unit. The foreign body was excised along with the surrounding fibrosis and inflammatory breast tissue by applying a gamma probe through a 3 cm incision in a 20-minute operation. Specimen mammography was performed on the excision material to confirm that the MFB was located within the tissue (Figure 3). Discussion and ConclusionSince metallic foreign bodies can cause symptoms such as local breast pain, abscess, cardiac tamponade, granuloma or pneumothorax, they have clinical importance (1-2). Korbin et al. (3) reported broken guide-wire pieces in 5 of 3500 patients who underwent guide-wire biopsy. Montrey et al. (4) reported that the most common types of MFB in the breast are surgical clips and broken pieces of guide-wires. In that same study, the prevalence of MFB related to broken guide-wire pieces was found to be 0.2%. As reported in several studies addressing MFB in the breast, surgical clips, pieces of guide-wires and GSIs are the most common factors in etiology. Mammography is usually helpful for the diagnosis (1, 2, 5). In our case, the patient had a history of GSI as well as pain in the left breast as consistent with the literature. The MFB was clearly visualised in ultrasound, mammography and chest x-ray. Eur J Breast Health 2017; 13: 159-160 DOI: 10.5152/ejbh.2017.3428 159 Extraction of a Foreign ABSTRACTThe most common clinical causes of metallic foreign body in the breast are surgical clips, pieces of guide-wire and gunshot wounds. Metallic foreign bodies can lead to local breast pain, abscesses, pneumothorax after granulomas or migration, and cardiac tamponade. Mammotome biopsy, fluoroscopy, guide-wire biopsy and radi...

Glass shards masquerading as calcifications in the breast: A case report

“… [1] were the first to employ the radio-guided occult lesion localization (ROLL) technique to localize a non-palpable metallic breast foreign body, using perilesional injection of 0.2 mL 99Tcm-labeled macroaggregate albumin (MAA) under mammography guidance. This technique has since been applied to the localization of other types of foreign material [2] . The ROLL technique can be useful in patients with deeper nonpalpable targets, tends to be more comfortable for the patient, and can be performed the day prior to surgery, allowing for more flexibility.…”

“…The most common foreign materials found in the breast are iatrogenically acquired metallic bodies, such as clips placed during/after biopsy or surgical procedures, or fragments of localization wires [1] . Other foreign bodies that have been encountered occasionally in the breast include gunshot material, sewing needles, pencil lead fragments, and pieces of broken glass [1] , [2] , [3] , [4] . While the Radiology literature mentions glass as a potential foreign body in the breast, there are few reports that provide patient examples.…”

Bizarre foreign body of the breast secondary to gender-based violence

“…In some cases, surgical material (e.g., markers/clips transected localising wires, surgical swabs or biopsy needle tips) may unintentionally be left in the breast following diagnostic or therapeutic procedures. 1,2 Bizarre, non-iatrogenic FBs of the breast are uncommon and may be introduced as a result of physical trauma, 3 such as gender-based violence (GBV), or may be self-inflicted in patients with psychiatric disorders. 3 These injuries are often incidentally found during routine mammography.…”

Recurrent breast abscess secondary to imbedded Thomas A. Swift's Electric Rifle dart

“…There are no documented cases of TASER probes embedded in the breast; however, common metallic foreign bodies of the breast include surgical clips, guidewire and bullets. These can clinically manifest with pain, infection/abscess, pneumothorax, granuloma and cardiac tamponade 1 . Albeit TASER‐associated injury is uncommon in Australia and New Zealand, TASER embedment is a unique presentation without clear management guidelines.…”

“…These can clinically manifest with pain, infection/abscess, pneumothorax, granuloma and cardiac tamponade. 1 Albeit TASER-associated injury is uncommon in Australia and New Zealand, TASER embedment is a unique presentation without clear management guidelines.…”