Purpose: Clip insertion into breast masses and enlarged lymph nodes prior to neoadjuvant chemotherapy (NAC) are a routine procedure. They enable accurate wire localization of the tumor bed prior to breast conserving surgery even if there is complete resolution of findings on imaging after therapy. In most cases, mammographic wire localization is a simple and accurate procedure to aid the surgeon in removing these marking clips and the underlaying tumor bed. Rarely, a clip which was inserted under US guidance into the center of a large tumor is too deep in the breast to be depicted on mammography, and therefore, mammographic wire localization is not feasible. We present an alternative approach of localizing very deep marking clips under CT guidance.
Patients and methods: We present 4 cases of patients who underwent clip marking of deep lesions, adjacent to the chest wall prior to NAC with complete imaging resolution of findings. In all 4 cases the clips were not visible on mammography or US and therefore pre-operative wire localization was performed under CT guidance. Imaging findings and the CT guided technique will be presented in detail.
Results: In all 4 patients, the marking clips were accurately localized and removed at surgery.
Summary: CT guided wire localization of deep clips in the breast are a feasible alternative to conventional mammographic or sonographic wire localization for deep lesions.
