Abstract
Guide-wire localization (GWL) has been a standard technique for many years. Excision of non- palpable malignant breast lesions with clear surgical margins reduces the risk of undergoing re-excision. The objective of the present study was to evaluate the efficacy of GWL biopsy for assessing surgical margins. This retrospective study concerned 53 patients who underwent GWL biopsy for non-palpable breast lesions and breast carcinoma diagnosed by histological examination. Age of the patients, tumour size, radiographic findings, breast density specifications, specimen volumes, menopausal status and family history of the patients and surgical margin status were recorded. Median age was 53.3 years, median tumour size was 1.5 cm and median specimen volume was 71.5 cm3. In fifteen patients (28%) DCIS and in 38 patients (72%) invasive ductal carcinoma was diagnosed. There was positive surgical margins in twenty eight (52.8%) patients. The median distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denser breast specifications were found as statistically significant factors for surgical margin status. Median age of the patients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins (p=0.04). 79% of the patients with positive margins had type 3-4 pattern breast density according to BIRADS classification as compared to 48% in the patients who had negative margins (p=0.03). Some 38 patients who had positive or close surgical margins received re-excision (72%). Positive margin rates may be higher because of inherent biological differences and diffuse growth patterns in younger patients. There are also technical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excision rates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.
Highlights
Due to the widespread implementation of breast screening programs and improvements in diagnostic imaging, approximately 25-35% of breast cancers are non-palpable at diagnosis (Skinner et al, 2001)
The objective of the present study is to evaluate the achievement of Wire-guided localization (WGL) biopsy thechnique about surgical margins and the effective factors on positive margins
Fifty three patients who had the diagnosis of in-situ and invasive carcinoma are reviewed among the BIRADS 4-5 breast lesions which are excised by WGL thechnique in the year 2011
Summary
Due to the widespread implementation of breast screening programs and improvements in diagnostic imaging, approximately 25-35% of breast cancers are non-palpable at diagnosis (Skinner et al, 2001) Because of these breast screening programs and improvements there is an increase in the incidence of breast lesions which have to be clarified histopathologically. Positive prediction of mammography in malign lesions (diagnosed malignancy/number of biopsy) is 30% and 90% for BIRADS 4 and BIRADS 5 lesions respectively. These lesions have to be clarified histopathologically. In palpable lesions fine needle or core biopsies are good standart diagnostic procedures and in nonpalpable lesions the aim is to establish histopatological diagnosis as well as complete excision of the lesion for local definitive treatment at the same time. The objective of the present study is to evaluate the achievement of WGL biopsy thechnique about surgical margins and the effective factors on positive margins
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