Breast cancer is the most common type of cancer in women, accounting for 30% of all cancers. It is responsible for one-fifth of cancer-related deaths in women, making early diagnosis and treatment crucial. Periodic physical examinations and widespread use of screening mammography have played a significant role in early detection of breast cancer (1,2,3).
In recent decades, significant advancements have been observed in the diagnosis of breast cancer. While 50-70% of breast cancer cases were previously diagnosed through physical examination, today, many subclinical, non-palpable lesions suspected of malignancy are detected using screening mammography. These lesions are marked with wires for minimal tissue damage during removal, enabling earlier detection of breast cancer cases (4,5).
In our study, we evaluated stereotactic biopsy results in patients with non-palpable breast lesions.
Materials and Methods
From January 2003 to June 2008, 124 cases were selected at the 2nd General Surgery outpatient clinic of Şişli Etfal Training and Research Hospital. These patients had non-palpable lesions less than 1 cm in diameter with malignancy risk detected via mammography or breast ultrasonography. Biopsy was performed using wire localization.
On the morning of surgery, localization was performed by a radiologist under local anesthesia using mammography or ultrasonographic guidance. After localization, the patient was taken to the operating room. A suitable incision was made under general anesthesia, following the wire to its tip. A 2 cm tissue sample surrounding the wire tip was excised. The tumor bed was marked with metal clips, and the incision was closed.
Radiological and histopathological findings, postoperative complications, and surgical interventions in cases with malignancy were evaluated. The results were expressed as percentages and means ± standard deviations.
Results
The mean age of the 124 patients was 51.4 years (range: 28-73 years). Mammographic findings included microcalcifications in 56 patients, mass lesions in 51 patients, asymmetrical density changes in 11 patients, and spiculated lesions in 6 patients (Table 1). Wire localization was performed under mammographic guidance in patients with microcalcifications (56 patients) and under ultrasonographic guidance in the remaining 68 patients. Specimen mammography was performed to confirm complete lesion removal in all cases with microcalcifications.
Histopathological analysis revealed benign lesions in 100 patients (80.64%) and malignant lesions in 24 patients (19.36%).
Among benign lesions, 54 were fibroadenomas, 32 fibrocystic diseases, 10 intraductal papillomas, and 4 granulomatous mastitis. Among malignant lesions, 15 were invasive ductal carcinomas, 6 lobular carcinomas, and 3 in situ carcinomas (Table 2). Surgical treatments for malignant cases included breast-conserving surgery with sentinel lymph node biopsy in 3 patients, breast-conserving surgery with axillary curettage in 2 patients, mastectomy in 6 patients, and modified radical mastectomy in 13 patients.
Discussion
Awareness of periodic examinations and widespread use of screening mammography in recent years have increased the detection of non-palpable breast lesions (6). Suspicious lesions such as masses, microcalcifications, parenchymal distortions, and asymmetrical structures detected via mammography can be addressed with wire localization biopsy. This approach facilitates early-stage breast cancer detection, reduces excised tissue size, and achieves better cosmetic outcomes (7,8).
Studies report malignancy detection rates ranging from 10% to 36% with wire localization biopsy (9,10). This method also enables the identification of in situ cancers, with detection rates of 18%-34% in various studies. In our study, malignancy incidence was 19.36%, consistent with the literature. DCIS constitutes 15%-20% of all breast cancers and is primarily detected via mammography (4). Similarly, 12.5% of malignant cases in our study had DCIS.
Patients with non-palpable lesions diagnosed with malignancy have a 98% 5-year disease-free survival rate. Early-stage detection improves quality of life (11,12).
While wire localization and excision are effective for non-palpable lesions, disadvantages include the inability to excise the targeted lesion, particularly in microcalcifications. Therefore, we used specimen radiography to confirm lesion removal in these cases. Although this extended surgery duration, it improved success rates, particularly for microcalcifications.
Wire localization increases the applicability of breast-conserving surgery for non-palpable lesions. However, treatment selection requires a multidisciplinary approach, involving mammographic evaluation, tumor histopathology, and patient preference (13,14). In our study, surgical treatments included breast-conserving surgery in 3 patients, simple mastectomy in 6, and modified radical mastectomy in 13.
In conclusion, wire localization biopsy is a valuable method for detecting malignancy in non-palpable breast lesions and guiding subsequent surgical decisions.
