X-ray Detectable Thread for Orientating a Breast Specimen – An Affordable and Less Cumbersome Solution

BACKGROUND

Orientation of breast specimens excised for either the diagnosis or treatment of breast cancer is important in order to identify either close or involved resection margins and to aide subsequent histological assessment. Surgical silk sutures are often used for specimen orientation but they are radiolucent. Metal clips are radio-opaque but they can be difficult to locate in the specimen, may be dislodged during handling, and may damage a microtome. Orientation of specimens using various grids or templates has been described.¹ These templates are accurate but can be cumbersome and might obscure the lesion. Vaidya et al.² described a novel technique in which a silk suture soaked in radio-opaque contrast medium was used to orientate the specimen. However, this method may contaminate the breast specimen leaving artefact on the specimen radiograph. Furthermore, the contrast may not be distributed evenly throughout the suture material causing possible confusion with regard to the suture length.

TECHNIQUE

A simple solution is to make use of the radio-opaque thread, X-ray detectable thread, used in surgical gauze swabs. This can be obtained from swab manufacturers in any required length. Sterilised thread is tied to a silk suture and the suture needle is passed through the specimen. Since the silk suture is radiolucent, it can be cut, leaving the radio-opaque single thread visible at the specimen margin.

DISCUSSION

The radio-opaque thread can be seen in the specimen radiograph, allowing easy orientation without obscuring or contaminating the specimen. It is a simple, convenient and cost-effective alternative technique for specimen orientation (Fig. 1).

Figure 1.

This therapeutic, wire-guided, wide, local excision of breast specimen radiograph shows a short marker at the superior margin and a long marker at the lateral margin. Microcalcifications are seen near the medial margin.