Techniques for overcoming a missing clip during pre-operative needle localization for lumpectomy: case report
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".