Diagnosis of Nonpalpable Breast Cancer Using Hematoma Localization Under Ultrasound Guidance In A Low-Resource Center. A Case Report

Abstract

Background: Ultrasound technology may bridge gaps in breast cancer detection and treatment in Africa. The lack of facilities for  diagnosing and treating nonpalpable lesions is a significant obstacle to treatment of breast cancer in Africa. We report the successful use  of Hematoma localization under Ultrasound Guidance with direct vision Excision (HUGE) to surmount some of the challenges of  managing nonpalpable breast lesions in a low-resource center. HUGE is a modification of the Haematoma-Directed Ultrasound-Guided  (HUG) breast biopsy. In HUG, magnetic resonance imaging identifies the lesion, and intraoperative ultrasound directs excision. A 26-year- old lady complained of bloody left nipple discharge of three days duration. Clinical review and sonography suggested fibroadenoma and  nonpalpable intraductal papilloma. The cytology raised suspicion of malignancy, recommending excision. The nonpalpable lesion was  localized by injection with autologous venous blood under ultrasound guidance and excised under direct vision using the HUGE  technique. Histologic diagnosis returned as carcinoma in situ. Based on multidisciplinary team recommendations, the patient had a skin- sparing mastectomy with immediate reconstruction. The HUGE technique is a feasible and cheap modification of the HUG technique,  which can support the management of nonpalpable breast tumours in low-resource centers where the facilities for mammography and  magnetic resonance imaging are unavailable.