Ultrasound and Mammography Guided Wire Marking of Non-Palpable Breast Lesions: Analysis of 741 Cases

Zusammenfassung

Ziel: Ziel dieser Studie war die mammografische und sonografische Drahtmarkierung non-palpabler Brustläsionen hinsichtlich ihrer Erfolgsraten, bezogen auf die Ergebnisse der Präparatmammo- bzw. -sonografie, Entfernung der Befunde im Gesunden und die Anzahl der Nachresektionen (intraoperativ als auch Zweitoperationen) zu analysieren. Material und Methoden: Zwischen Mai 1994 und Dezember 2004 wurden an der Universitätsfrauenklinik Greifswald 668 Patientinnen mit 741 nonpalpablen Brustbefunden operiert. 418-mal wurde die sonografisch gestützte Technik verwendet, 218-mal die mammografische und 39-mal beide Techniken. Ergebnisse: 88 sonografisch markierte Befunden waren maligne (21,1 %), bei den mammografischen 52 (18,3 %). Die Präparatsonographie ergab in 90,9 % die vollständige Entfernung des Befundes, die Präparatmammographie in 89,1 %. Histologisch konnten 19,3 % der malignen sonografisch markierten Befunde nicht im Gesunden entfernt werden, mammografisch waren es 36,5 %. Nachresektionen aufgrund intraoperativ unvollständiger Präparatkontrolle erfolgten bei der sonografischen Methode bei 10 Patientinnen, bei der mammografischen bei 25 Patientinnen. Eine erneute Operation war in 5,5 % nach sonografisch markierten Befunden und in 12,3 % nach mammografischen Markierungen nötig. Schlussfolgerung: Die sonografische Methode scheint der mammografischen überlegen zu sein. Mit Ausnahme des Vorliegens von Mikrokalk und einer Läsion, die ausschließlich in der Mammografie zu sehen ist, sollte der sonografischen Markierung bei entsprechendem Korrelat zur Mammographie der Vorzug gegeben werden.

Abstract

Purpose: Aim of the study were to evaluate the success of ultrasound and mammography guided wire marking of non-palpable breast leasions and the results of specimen mammography/ultrasonography, completeness of resection, and number of secondary resections (during the initial surgical session and as a separate intervention) were analysed. Materials and Methods:Between May 1994 and December 2004, 668 women with 741 non-palpable breast lesions underwent surgery at the Greifswald University Department of Gynaecology and Obstetrics. Ultrasound directed wire marking was used in 418, mammography directed marking in 284 cases. In 39 lesions, both techniques were combined. Results: Out of all lesions approached with ultrasound directed wire marking, 88 (21.1 %) were malignant. Among lesions marked during mammography, 52 (19.3 %) were malignant. Specimen ultrasonography indicated that 90.9 % of lesions were resected completely. Specimen mammography demonstrated complete resection in 89.1 %. On histological examination, 19.5 % of the malignant lesions marked with sonographic guiding and 36.5 % of the malignant lesions marked with mammographic guiding did not have clear margins. Secondary resections (during the first procedure) for incomplete specimens were needed in 10 patients in whom sonographic localisation had been used, and in 25 patients in whom mammographic localisation had been employed. A second surgical session for secondary resection was required in 5.5 % of lesions marked with ultrasound and in 12.3 % of lesions marked with mammography guidance. Conclusion: Sonography directed wire localisation appears to be superior to the respective mammographic method. Ultrasound guided wire marking should be considered the preferred method for all mammographic lesions with an ultrasonographic equivalent and no micro-calcifications.

Key words

non-palpable - wire localisation - ultrasound - breast - mammography - breast lesion - specimen mammography - specimen ultrasonography

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1 European Community.

2 These are the pathologist’s measurements. Sonographically, the lesions measured 0.5 cm.