Intraoperative portable ultrasonography localization of clinically impalpable soft-tissue tumors
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WORLD JOURNAL OF SURGICAL ONCOLOGY
TECHNICAL INNOVATIONS
Open Access
Intraoperative portable ultrasonography localization of clinically impalpable soft-tissue tumors Jagajeevan Jagadeesan1, Jonathan A Davies1, Anna Raurell1 and Robert U Ashford1,2,3*
Abstract Background: Most soft-tissue tumors are clinically palpable; however, some can be impalpable to clinical examination making it difficult to plan surgical management. Methods: We present a simple method of perioperative tumor localization using a portable ultrasonography machine. Results: We used the technique for seven cases, on each occasion identifying the tumor and facilitating the optimal surgical approach. Conclusion: The technique is reproducible and readily available, and we recommend its use. Keywords: Soft-tissue sarcomas, Intraoperative localization, Portable ultrasonography, SonositeW
Background Most soft-tissue tumors are obvious on clinical examination, but some (typically small and deep tumors) can be impalpable, making it difficult to plan surgical resection. A vital step in obtaining local control of soft-tissue sarcomas is the proper placement of the initial biopsy site to obtain tissue diagnosis, followed by an appropriately planned incision to enable the biopsy tract to be excised en bloc with the whole surgical resection specimen, to eradicate the possibility of tumor seeding along the biopsy track. Poorly placed incisions and biopsy complications can considerably affect the ability to achieve local clearance [1], and can result in amputation rather than limb salvage [2]. This is a particular problem with impalpable limb tumors, which often require a scan on the day of the surgery by an experienced musculoskeletal radiologist. This involves planning, and potentially results in the cancellation of the procedure if not organized in advance. The alternative is to make the surgical approach guided by MRI scanning, which typically results in a more extensile * Correspondence: [email protected] 1 East Midlands Sarcoma Service, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK 2 East Midlands Sarcoma Service, Department of Orthopaedics, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK Full list of author information is available at the end of the article
approach, which is large relative to the size of the tumor. In breast surgery, impalpable tumors are commonly excised using fine-wire localization. Portable ultrasonography is readily available in most operating theatres across the UK. There is clear evidence and guidance on the use of ultrasonography to aid practitioners when performing nerve blocks and inserting central venous lines [3,4], and this has helped embed ultrasonography into anesthetic practice. Gaining competence in using ultrasonography is an essential part of anesthetic training in the UK, and it is guided by a joint working party of the Association of Anaesthetists of Great Britain and Ireland, the Royal College of Anaesthetists, and the Intensive Care Society [5]. Most anesthetists
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