To our knowledge, this is the first study tailored exclusively to US guided cases of charcoal marking. However, there are no reports of the use of a charcoal suspension under US guidance. Svane ( 6) introduced the use of a charcoal suspension for preoperative marking of nonpalpable breast lesions using stereotactic techniques. However, a charcoal suspension is so stable that surgery can be delayed for days or even weeks. Localization with a needle and wire system and dying with toluidine blue or methylene blue should be performed on the day of the operation regardless of the radiologist's schedule because of the risk of needle displacement and fast dye dispersion ( 2, 5). These include localization with a needle and wire system and the use of a colored dye as a visual marker. A simple and stable localization method is essential for the removal of these lesions, and there are many methods currently available. In Korea, the incidence of US-only detected nonpalpable breast lesions has been increasing with the increasing use of screening breast US. The complications and failure rates has been reported to range from 1 to 10% due to a lack of communication between the radiologist and surgeon, inadequate wire localization to the dermal calcifications and wire shifting between localization and surgery ( 3, 7- 10). Needle localization is widely used but the procedure is quite complicated. Several techniques such as needle localization or dye injection such as toludine blue or methylene blue have been used to localize nonpalpable breast lesions ( 2- 6). However, these lesions tend to be an indication for surgery when high-risk lesions such as a papilloma or radial scar are observed by a core needle biopsy, when the patients or surgeons hope for complete removal of the lesions, or when additional lesions are detected in the other quadrant in a breast cancer patient scheduled to undergo conserving surgery.Ī preoperative localization is very important for a minimal but accurate excision of a nonpalpable lesion. A nonsurgical core needle biopsy helps decrease the frequency of unnecessary surgery by obtaining a histological diagnosis of imaging-detected lesions. The rate of imaging-detected nonpalpable breast lesions has increased with the advent of routine screening for breast cancer ( 1).
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