Non-palpable lesions of the breast. Diagnostic and therapeutic observations

Background. The wide use of mammography in diagnostics and in screening programmes has increased the number of detection of non palpable lesions of the breast. The problems that arise are the correct differential diagnosis between benign and malignant lesions and a correct preoperative localization. Methods. Between 1990 and 1995 at the Surgery and Oncology Institute, University of Cagliari, 223 patients underwent a needle localized biopsy of the breast using a 21 Gauge 'Self-retaining Anchor Wire'. Mammographic suspect findings were microcalcifications in 59% of cases, masses in 33% and masses with microcalcifications in 8%. Results. In 6 patients a second excision was required; in one patient needle dislodgement occurred. Success rate was 96.9%; missed lesions rate was 0.5%. Cancer was identified in 69 patients (30.9%): 59 were invasive carcinomas and 10 in situ. Six patients (10.1%) had one or more positive axillary nodes. 154 patients (69.1%) showed histopathologic benign changes. Conclusions. Needle localized breast biopsy is an accurate and safe procedure to detect non-palpable breast carcinomas; it can be carried out using local anesthesia without severe discomfort for patients and with a modest complication rate; it permits a significant diagnostic anticipation with a probable favourable impact on survival even though not yet supported by perspective studies; it remains to evaluate the need and/or utility of axillary dissection in small breast tumors.