Preoperative hookwire localization of a non-palpable breast lesion, under mammographic or ultrasound guidance
Preoperative breast wire localization in Casablanca
Some breast lesions are too small or too deep to be felt by touch. To remove them precisely, the surgeon needs a marker. Localization involves placing this marker against the lesion, under mammographic or ultrasound guidance: most often, a very thin metal wire called a hookwire. It is usually done on the day of surgery or the day before. During the operation, the surgeon removes the wire together with the area to be removed.
Duration, report and equipment
Duration
The procedure usually takes 15 to 45 minutes, depending on the guidance method and the number of markers.
Report turnaround
Report within 24 hours. In an emergency, during opening hours, the report is handed over immediately.
Equipment
GE Senographe Pristina
When is this exam needed?
- Non-palpable breast lesion (one that cannot be felt by touch) that is scheduled for removal.
- Cluster of microcalcifications (small calcium deposits visible on a mammogram) requiring surgery.
- Small cancer found during screening, before breast-conserving surgery.
- Lesion marked with a clip during a biopsy, for example when it is no longer visible after chemotherapy.
- Benign lesion, or one of uncertain nature, that your surgeon has decided to remove.
How the exam is done
The radiologist reviews your images and the surgeon's request, then explains the procedure to you. Depending on which method shows the lesion more clearly, guidance is done with ultrasound, lying down with your arm raised, or with mammography, with the breast held by a plate that has a window in it. After disinfection and local anesthesia, a fine needle is advanced to the lesion, then the wire is released and the needle withdrawn: only a small piece of wire sticks out of the skin.
A check mammogram, with gentler compression, confirms the position of the marker; these images are added to your file for the surgeon. The wire is secured under a dressing, and you then go to the operating room according to the arrangements made by your surgeon.
Preparation
- Do not apply deodorant, talc or cream to your breasts and armpits: these products leave marks on the mammogram.
- Wear a loose top that opens at the front, so you can get dressed without pulling on the wire.
- Arrange for someone to go with you to the clinic: it is better not to drive with the wire in place.
Fasting
No fasting in general: if your procedure requires it, the team will tell you when you book. However, surgery often follows shortly afterwards: follow the instructions given by the anesthesiologist or your surgeon.
Contrast injection
No contrast agent is used: only a local anesthetic is injected under the skin to numb the path of the needle.
Contraindications and precautions
- Tell us when you book about any anticoagulant or antiplatelet medication. Never stop it on your own: the radiologist will tell you whether it needs to be adjusted, together with the doctor who prescribed it and your surgeon.
- Allergy to a local anesthetic, an antiseptic, latex or adhesive tape.
- Current or possible pregnancy: as a precaution, please tell us, as the localization relies on mammogram images.
- Feeling faint with needles in the past, a breast implant or difficulty raising your arm: let the team know, the procedure will be adapted.
Documents to bring
- Your surgeon's localization request, specifying the breast and the lesion concerned
- Recent mammograms, breast ultrasounds and breast MRI, with their reports
- Biopsy report and the result of the sample analysis, if you have them
- List of your medications, especially anticoagulant and antiplatelet medications
- Clinic documents given to you by your surgeon
- Insurance or mutual insurance fund card
Price and insurance coverage
The center accepts coverage from insurance companies and the main mutual insurance funds. You submit the coverage request to your insurer or fund yourself. For AtlantaSanad and Sanlam, the center takes care of it.
No prices are shown on this site: Kenza gives you the exact price on WhatsApp, along with the coverage procedure for your situation.
Frequently asked questions
Is the localization painful?
The local anesthetic is given with a fine needle, similar to a blood draw. After that, most patients feel pressure rather than pain. Once in place, the wire is usually barely felt if you avoid large arm movements.
Can the wire move before surgery?
Its slightly curved tip hooks into the breast tissue, hence its name. It can still move if the wire is pulled. The dressing holds it in place: do not touch the dressing, and avoid carrying heavy loads and raising your arm above your head until the operation.
I already have a clip placed during the biopsy: why a wire?
The clip is a tiny metal marker that shows the location of the lesion on the images, but the surgeon cannot feel it. The wire, on the other hand, comes out through the skin and guides the surgeon to the area to be removed. It is often placed right next to the clip.
What is the mammogram after placement for?
These images confirm the position of the wire tip in relation to the lesion and guide the surgeon to the area to be removed. During surgery, the removed tissue is often X-rayed to check that it does contain the lesion or the clip.