Combined image guidance excision of non-palpable breast lesions

Wire- and Ultrasound-Guided Localization: A Novel Technique for Excision of Nonpalpable Breast Tumors

Background:

Excision of nonpalpable breast lesions requires intraoperative guidance. Wire-guided localization and intraoperative ultrasounds have been used successfully but suffer from some disadvantages. We describe a new modification of the standard technique using a combination of preoperative ultrasound in conjunction with standard wire-guided localization.

Methods:

Wire and ultrasound-guided localization (WUGL) technique was used for the excision of nonpalpable breast lesions.

Results:

Sixty-nine patients with nonpalpable breast lesions were subjected to excision using WUGL, out of whom 63 patients had a preoperative diagnosis of invasive/noninvasive breast cancer. Six patients had a preoperative diagnosis of benign lesions, out of which 3 patients were converted to invasive breast cancer on final pathology. Only 1 patient had positive margin.

Conclusions:

WUGL is a technique that uses a combination of well-accepted and easily available techniques. It has given good results and has the potential for widespread acceptance in resource-constrained situations.

Accuracy of prognostic and predictive markers in core needle breast biopsies compared with excisional specimens

BACKGROUND

Core needle biopsy (CNB) is widely accepted for preoperative diagnosis of breast cancer and sometimes can be the only way of providing a suitable specimen for prognostic and predictive marker studies prior to neoadjuvant treatment. The purpose of this study was to evaluate the accuracy of CNB by comparing histological tumor type and grade as well as estrogen receptor (ER), progesterone receptor (PR), p53, and HER2/ neu status by immunohistochemistry in CNB and excisional surgical specimens.

PATIENTS AND METHODS

During a 2.5-year study period, we identified 30 patients with breast cancer, who underwent CNB and definitive surgery. To evaluate the accuracy of CNB, tumor grade, ER, PR, HER2, and p53 status were immunohistochemically determined in both the CNB and the surgical specimens, and concordance of results between the 2 specimens was assessed.

RESULTS

The concordance rate was 100% for histological type, 66.6% for histological grade, and 96.7, 90, 76.7 and 93.3% for ER, PR, p53 and HER2/neu, respectively.

CONCLUSION

Our study showed that CNB has an excellent accuracy for tumor type, ER, and HER2/ neu; however, it should be used cautiously for tumor grade, PR, and p53 status. Thus, excisional biopsy is recommended for the determination of these factors.

Discordance in early breast cancer for tumour grade, estrogen receptor, progesteron receptors and human epidermal receptor-2 status between core needle biopsy and surgical excisional primary tumour

The aim of the present study was to compare the tumour grade, Estrogen Receptor (ER), Progesteron Receptor (PgR) and Human Epidermal Receptor-2 (HER-2) status in the core needle biopsy (CNB) with those observed in the subsequent excisional primary tumour (EPT). All patients diagnosed with an early breast cancer in our University Hospital Center between January 1, 2005 and December 31, 2006 were included but exclusion criteria of patients with large tumour requiring neoadjuvant chemotherapy and cases with more than one tumour (multicentricity/multifocality tumours). Histological tumour grade assessed according to Nottingham Grading System (SBRm), ER, Pgr and HER-2 tumoural status were assessed twice in CNB and in EPT. A total of 175 patients were assessed. The concordance between CNB and EPT for Grade, ER, PgR and HER2 status were 75.4% (p > 0.00001), 84% (p > 0.00002), 78.3% (p = 0.002) and 98.3% (p = 0.486) respectively. In conclusion CNB can be used with confidence for HER2 determination. For grade, PgR and ER due to substantial discordance results from CNB should be used with caution.

Improved accuracy of wire-guided breast surgery with supplementary ultrasound

Impalpable breast lesions have always been a challenge for breast surgeons. Stereotactic wire placement is frequently employed for lesion localisation. To improve the accuracy of preoperative localisation in these cases we introduced a supplementary ultrasound scan to identify the exact location of the wire tip. We studied two groups of 15 patients, from periods before and after the introduction of the new technique. Specimen mammograms from each case were examined to determine the proximity of the lesion to the centre of the specimen. The excision of the lesion was graded into excellent, accurate, satisfactory and inaccurate depending on the location of centre of the lesion with respect to the centre of the excised specimen. Our study shows an increase in the accuracy of localisation of screen detected breast lesions, following the introduction of the supplementary ultrasound scan. Furthermore, there is evidence of a benefit in terms of ease of surgery and reduced operation time. Theoretically the technique should also improve clearance margins and reduce the need for further surgery in therapeutic operations.

BREAST INTRAOPERATIVE ULTRASOUND: PROSPECTIVE STUDY IN 112 PATIENTS WITH IMPALPABLE LESIONS

BACKGROUND

Preoperative hookwire localizations have been used for some years to guide excision of subclinical breast lesions. With the availability of ultrasonography in the operating theatre, these localizations can be done intraoperatively.

METHODS

One hundred and thirty lesions in 112 consecutive patients with impalpable breast lesions were intraoperatively localized and excised, obviating the need for preoperative localizations.

RESULTS

All 130 lesions were detected intraoperatively and excised. Forty-four patients elected to have their benign lesions excised and there were 32 cancers removed. Ultrasonography was used to ensure complete local excisions in the majority of the cancers.

CONCLUSION

Intraoperative breast ultrasound is a reliable, rapid and cost-effective adjunct in the management of both benign and malignant breast lesions.