SS  Vol.6 No.7 , July 2015
Wire-Guided Localization Biopsy for Non-Palpable Suspicious Breast Lesions
Background: About 25% - 35% of breast cancers are non-palpable at the time of diagnosis. Wire guided localization (WGL) had been considered as the standard technique for many years for excision of theses breast lesions. The aim of this study is to assess the efficacy of WGL biopsy in the management of non-palpable suspicious breast masses. Patients & Methods: This retrospective study concerned thirty female patients who were presented by non-palpable breast lesions as proved by mammography and complimentary ultrasonography between February 2013 and September 2014. According to BIRADS classification system, all the lesions were BIRADS III, IV and V. However, BIRADS I and II lesions and lesions proved to be benign were excluded from this study. The patients were submitted to WGL under local anesthesia. Then, they were shifted to the operating theatre, where they underwent WGL biopsy. The removed specimens were sent for radiological confirmation of complete excision. Then, it was sent for histopathological examination. Results: The mean age was 52.63 years. Eighteen patients (60%) were asymptomatic, 7 (23.3%) patients were with breast pain, and 5 patients (16.7%) had nipple discharge. Ten lesions (33.3%) were BIRADS III, 17 lesions (56.7%) were BIRADS IV, and 3 lesions (10%) were BIRADS V. The WGL was done by mammography in 19 patients (63.3%) and under ultrasonographic guidance in 11 patients (36.7%). No post-operative complications were reported. The mean tumor size was 11.23 mm and the mean safety margin of excision was 6.7 mm. IDC was found in 56.7% or cases, DCIS in 30%, and ILC in 13.3% of cases. 40% of the lesions were of grade I, 30% were of grade II, and 30% were of grade III. There were positive resection margins in 11 patients (36.7%). Conclusion: WGL biopsy is a safe and reliable surgical technique for management of non-palpable suspicious breast lesions. Special care should be paid for proper margin excision. However, WGL biopsy is technically demanding and needs learning curve for both the surgeon and the radiologist.

Cite this paper
El-Bakary, T. , Abdelazim, S. , Mawolood, B. and Hashish, M. (2015) Wire-Guided Localization Biopsy for Non-Palpable Suspicious Breast Lesions. Surgical Science, 6, 292-297. doi: 10.4236/ss.2015.67043.

[1]   Skinner, K.A., Silberman, H., Sposto, R., et al. (2001) Palpable Breast Cancers Are Inherently Different from Non-Palpable Breast Cancers. Annals of Surgical Oncology, 8, 705-710.

[2]   Lovrics, P.J., Cornacci, S.D., Forrokhyar, F., et al. (2009) The Relationship between Surgical Factors and Margin Status after Breast Conservation Surgery for Early Stage Breast Cancer. The American Journal of Surgery, 197, 740-746.

[3]   Sajid, M.S., Paramplli, U., Haider, Z. and Bonomi, R. (2012) Comparison of Radio-Active Occult Lesion Localization (ROLL) and Wire Localization for Non-Palpable Breast Cancers: A Meta-Analysis. Journal of Surgical Oncology, 105, 852-858.

[4]   Symmonds, R.E. and Roberts, J.W. (1987) Management of Non-Palpable Breast Abnormalities. Annals of Surgery, 205, 520-528.

[5]   Lovrics, P.J., Cornacci, S.D., Vora, R., et al. (2011) Systematic Review of Radio-Guided Surgery for Non-Palpable Breast Cancer. European Journal of Surgical Oncology, 37, 388-397.

[6]   Acosta, J.A., Greenlee, J.A., Gubler, K.D., et al. (1995) Surgical Margins after Needle-Localization Breast Biopsy. The American Journal of Surgery, 170, 643-645.

[7]   Postma, E.L., Witkamp, A.J., van den Bosch, M.A.A.J., et al. (2011) Localization of Non-Palpable Breast Lesions. pert Review of Anticancer Therapy, 1, 1295-1302.

[8]   Frank, H.A., Hall, F.M. and Steer, M.L. (1976) Pre-Operative Localization of Non-Palpable Breast Lesions Demonstrated by Mammography. World Journal of Surgery, 295, 259-260.

[9]   Muneer, A., Mieke, V.H. and Michael, D. (2013) Systematic Review of Radio-Guided versus Wire-Guided Localization in the Treatment of Non-Palpable Breast Cancers. Breast Cancer Research and Treatment, 140, 241-252.

[10]   Masroor, I., Afzal, S., Shafqat, G. and Rehman, H. (2012) Usefulness of Hook Wire Localization Biopsy under Imaging Guidance for Non-Palpable Breast Lesions Detected Radiologically. International Journal of Women’s Health, 4, 445-449.

[11]   de Roos, M.A.J., Wevaart, W.N. and Ong, K.H. (2013) Should We Abandon Wire-Guided Localization for Nonpalpable Breast Cancer? A Plea for Wire-Guided Localization. Scandinavian Journal of Surgery, 102, 106-109.

[12]   Raza, S., Chikarmane, S.A., Neilsen, S.S., et al. (2008) BI-RADS 3, 4, and 5 Lesions: Value of US in Management— Follow-Up and Outcome. Radiology, 248, 773-781.

[13]   Mendez, A., Cabanillas, F., Echenique, M., et al. (2004) Mammographic Features and Correlation with Biopsy Findings Using 11-Gauge Stereotactic Vaccum-Assisted Breast Biopsy (SVABB). Annals of Oncology, 15, 450-454.

[14]   Dogan, L., Gulcelik, M.A., Yuksel, M., et al. (2012) Wire-Guided Localization Biopsy to Determine Surgical Margin Status in Patients with Non-Palpable Suspicious Breast Lesions. Asian Pacific Journal of Cancer Prevention, 13, 4989-4992.

[15]   Singletary, S.E. (2002) Surgical Margins in Patients with Early-Stage Breast Cancer Treated with Breast Conservation Therapy. The American Journal of Surgery, 184, 383-393.

[16]   Azu, M., Abrahamse, P., Katz, S.J., et al. (2010) What Is an Adequate Margin for Breast-Conserving Surgery? Surgeon Attitude and Correlates. Annals of Surgical Oncology, 17, 558-563.

[17]   Gray, R.J., Salud, C., Nguyen, K., et al. (2001) Randomized Prospective Evaluation of a Novel Technique for Biopsy or Lumpectomy of Non Palpable Breast Lesions, Radioactive Seed versus Wire Localization. Annals of Surgical Oncology, 8, 711-715.

[18]   Strnad, P., Rob, L., Halaska, M.G., et al. (2006) Radioguided Occult Lesion Localization in Combination with Detection of Sentinel Lymph Node in Non-Palpable Breast Cancer Tumors. European Journal of Gynaecological Oncology, 27, 236-238.

[19]   Zgajner, J., Hocevar, M. and Frkovic-Grazio, S. (2004) Radioguided Occult Lesion Localization (ROLL) of the Nonpalpable Breast Lesions. Neoplasma, 51, 385-389.

[20]   Thind, C.R., Desmond, S. and Harris, O. (2005) Radio-Guided Localization of Clinically Occult Breast Lesions (ROLL): A DGH Experience. Clinical Radiology, 60, 681-686.

[21]   Ocal, K., Dag, A., Turkmenoglu, O., et al. (2011) Radioguided Occult Lesion Localization versus Wire-Guided Localization for Non-Palpable Breast Lesions: Randomized Controlled Trial. Clinics, 66, 1003-1007.

[22]   Gajdos, C., Tartter, P.I., Bleiweiss, I.J., et al. (2002) Mammographic Appearance of Nonpalpable Breast Cancer Reflects Pathologic Characteristics. Annals of Surgery, 235, 246-251.

[23]   Lovrics, P.J., Goldsmith, C.H., Hodgson, N., et al. (2011) A Multicentered Randomized Controlled Trial Comparing Radio-Guided Seed Localization to Standard Wire Localization for Nonpalpable Invasive and In Situ Breast Carcinomas. Annals of Surgical Oncology, 18, 3407-3414.

[24]   Sanchez, C., Brem, R.F., McSwain, A.P., et al. (2010) Factors Associated with Re-Excision in Patients with Early-Stage Breast Cancer Treated with Breast Conservation Therapy. The American Surgeon, 76, 331-334.

[25]   Coopey, S., Smith, B.L., Hanson, S., et al. (2011) The Safety of Multiple Re-Excisions after Lumpectomy for Breast Cancer. Annals of Surgical Oncology, 18, 3797-3801.