- Breast cancer,
- breast surgery,
- clip,
- localization,
- case report
Breast conservation therapy (BCT) has become the standard of care for treating low-stage breast lesions. The principle of this therapy is to conserve as much normal breast tissue as allowable while still achieving a proper oncologic resection. These breast-sparing dissections would be difficult if not impossible without any intra-operative guidance. For this reason a wire is typically placed near the lesion pre-operatively to serve in directing the surgeon. To accurately place a wire, a lesion must be identifiable on imaging. This creates a potential dilemma as candidates for breast-conserving therapy typically have low-stage lesions which can be illusive at times. Thus, fiduciary markers such as clips have become integral in the treatment of low-stage breast lesions as they can serve as a reference point for identifying non-palpable breast lesions. In fact, cases in which a clip serves as the only identifiable landmark for an occult breast lesion are not uncommon. While undoubtedly useful, the heavy reliance we place on these markers creates a potential for significant dilemma when they cannot be visualized. We present a case that demonstrates one of the potential pitfalls that can occur when relying on a fiduciary marker, specifically, the inability to perform pre-operative wire-guided localization (WGL) for lumpectomy due to a lack of clip visualization. We discuss the potential causes for lost markers such as clip migration as well as several techniques available for attempting a “blind” lumpectomy with particular focus on intra-operative fluoroscopy. By utilizing this technique we were able to successfully complete an unexpected blind lumpectomy without any sacrifice in regards to oncologic margins or cosmesis.