Origin of Metallic Particles Resembling Microcalcifications on Mammograms after Use of Abrasive Cautery-Tip Cleaning Pads during Breast Surgery:

Experimental Demonstration1

Philip I. Haigh, MD, FRCS(C), R. James Brenner, MD, JD and Armando E. Giuliano, MD
1 From the Division of Surgical Oncology (P.I.H., A.E.G.), and the Joyce Eisenberg Keefer Breast Center (R.J.B.), John Wayne Cancer Institute at Saint John’s Health Center, 2200 Santa Monica Blvd, Santa Monica, CA 90404. Received September 17, 1999; revision requested October 14; revision received November 12; accepted December 6. Supported in part by the Ben B. and Joyce E. Eisenberg Foundation and the Fashion Footwear Association of New York. Address correspondence to A.E.G. (e-mail: giulianoa@jwci.org).

ABSTRACT

 
PURPOSE: To determine if the act of cleaning a cautery tip with an abrasive pad dislodges radiopaque particles that can be transferred to breast tissue during surgery, thereby mimicking microcalcifications at mammography.

MATERIALS AND METHODS: Mock breast surgery was performed by cauterizing bovine liver or fresh, normal, human breast tissue. The cautery tip was rubbed against a cleaning pad five to 20 times in the manner used intraoperatively and was touched on separate breast tissue specimens two to six times. Specimen radiography was then performed. Thirty-six breast specimens were used in three experiments, including 28 used for the experimental conditions and eight control specimens.

RESULTS: Particles collected from the cleaning pads resembled microcalcifications. After cauterization of liver, breast tissue, or both, in series, particles transferred from the cautery tip to breast tissue specimens could be identified on specimen radiographs. Transfer of particles after cautery of breast tissue occurred with increased numbers of rubs and specimen contacts.

CONCLUSION: Radiopaque aluminum oxide particles from abrasive cautery-tip cleaning pads can be dislodged and transferred to breast tissue during surgery. Scrutiny of high-detail, spot-compression, magnification mammograms will help identify these particles. Simple measures to mitigate particle transfer during breast surgery can prevent this problem and obviate a potential second procedure to remove particles mistaken for microcalcifications.

Index terms: Breast neoplasms, experimental studies, 00.459, 00.46 • Breast neoplasms, radiography, 00.46, 00.93 • Breast neoplasms, surgery, 00.459, 00.46