Evaluation of a hydrogel based breast biopsy marker (HydroMARK®) as an alternative to wire and radioactive seed localization for non-palpable breast lesions.

BACKGROUND AND OBJECTIVES: HydroMARK® is a newly available biopsy marker for image-guided needle biopsies of non-palpable breast lesions. Objective was to determine if the marker could be utilized independently for lesion localization using intra-operative ultrasound alone. METHODS: A single institution retrospective review identified patients who underwent surgical excision of breast lesions after placement of the HydroMARK®. Endpoints included intra-operative visualization of the marker, successful excision of the lesion, and presence of the marker on specimen radiograph. RESULTS: The study included 31 lesions in 25 patients. Twenty-nine (93.6%) HydroMARKSs® were adequately visualized by intra-operative ultrasound. Intra-operative ultrasound without pre-operative placement of a localizing device was successful for localization in six cases (19.4%). Intra-operative difficulties were encountered in 16 of 31 (51.6%) procedures. This included either extrusion of the marker when the biopsy tract was transected in 14 (45.2%) cases or migration of the marker prior to the procedure in two (6.4%) cases. The marker was visualized on specimen radiograph in 15 (48.4%) cases. CONCLUSIONS: While intraoperative sonographic visibility was excellent, a large number of excisions were associated with extrusion of the marker. Modifications are needed to improve acceptability of this marker for intra-operative localization independent of pre-operative wire or seed localization.

Ovarian cancer metastatic to the breast presenting as inflammatory breast cancer: a case report and literature review.

Background. Primary ovarian carcinoma with metastasis to the breast is rare, with only 39 cases reported in the current literature. Ovarian metastasis to the breast presenting as inflammatory breast carcinoma is even more infrequent, with only 6 cases reported.Case. We present a patient who developed metastatic inflammatory cancer of the breast from a stage IIIC papillary serous ovarian adenocarcinoma approximately 1 year after the original diagnosis. Pathologic analysis confirmed the origin of the tumor: a high-grade adenocarcinoma morphologically similar to the previously diagnosed ovarian cancer. In addition, the tumor was strongly positive on immunohistochemistry for CA-125, identical to the ovarian primary. The patient died of diffuse metastasis 5 months after the breast tumor was noted.Conclusion. Although ovarian metastasis to the breast presenting as inflammatory breast cancer is rare, it should be included in the differential diagnosis for any patient with a personal history of ovarian cancer. Accurate differentiation is necessary because treatment differs significantly for patients with ovarian metastasis to the breast, as compared with patients with primary inflammatory breast cancer. Ovarian metastasis to the breast confers a poor prognosis: patient survival ranged from 3 to 18 months, with a median survival of 6 months after the diagnosis of the breast metastasis.