Stereotactic-guided localisation before open biopsy of occult breast lesions

Objective: To evaluate the accuracy of stereotactic coal injection and wire localisation followed by excisional biopsy for occult breast lesions. Experimental design: Prospective study Setting: University Hospital Patients: Forty-five patients with abnormal mammographic findings out of 6543 women undergoing screening mammography. Patients with palpable or ultrasonographically detectable lesions were excluded from the study. Interventions: Pre-biopsy stereotactic coal injection and stereotactic wire localisation of the suspicious mammographic lesions. Microcalcifications were the most common indication for biopsy (58%). Stereotactic localisation was accomplished by using vertical, lateral and oblique projections. Surgery was carried out under local anaesthesia and on an outpatient basis. Radiological study of the specimen was performed for each patient. Results: Overall, radiological studies of the specimens showed complete removal of the lesions in 44 patients (98%). In 1 patient with deep doubtful microcalcifications marked only with coal, a partial excision was performed (fibrocystic disease with ductal hyperplasia). The positive predictive value of mammography for cancer was 49%. Microcalcifications were associated with cancer in 10 patients. Conclusions: Preoperative stereotactic localisation proved to be an effective and accurate procedure, allowing a complete excision of the lesion in 98% of patients and a correct histologic diagnosis in all patients.