Download PDF
Ultraschall Med 2007; 28(3): 283-290
DOI: 10.1055/s-2006-927238
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

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

Sonografische und mammografische Drahtmarkierung nichtpalpabler Mammatumoren: Analyse von 741 FällenJ. Köhler1 , B. Krause2 , S. Grunwald1 , A. Thomas3 , G. Köhler1 , G. Schwesinger4 , A. Schimming5 , B. Jäger6 , S. Paepke7 , R. Ohlinger1
  • 1Ernst-Moritz-Arndt-University of Greifswald, Department of Gynecology and Obstetrics, Germany
  • 2IVF-Zentrum Münster, Germany
  • 3Berlin Central University Hospital, Department of Gynecology and Obstetrics, Charité, Germany
  • 4Ernst-Moritz-Arndt-University of Greifswald, Institute of Pathology, Germany
  • 5Ernst-Moritz-Arndt-University of Greifswald Institute of Diagnostic Radiology and Neuroradiology, Germany
  • 6Ernst-Moritz-Arndt-University of Greifswald, Institute of Biomathematics and Medical Informatics, Germany
  • 7Technical University of Munich, Department of Gynecology and Obstetrics, Germany
Further Information

Publication History

received: 15.2.2006

accepted: 15.9.2006

Publication Date:
21 February 2007 (online)

Also available at
    Permissions and Reprints

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

References

  • 1 Kaufman C S, Jacobson L, Bachman B. et al . Intraoperative ultrasonography guidance is accurate and efficient according to results in 100 breast cancer patients.  Am J Surg. 2003;  186 378-382
    CrossrefPubMedSearch in Google Scholar
  • 2 Engel J, Nagel G, Breuer E. et al . Primary Breast Cancer Therapy in Six Regions of Germany.  Eur J Cancer. 2001;  38 578-585
    PubMedSearch in Google Scholar
  • 3 National Cancer Institute SEER .Cancer Statistics Review 1973 - 1997. 2000
    Search in Google Scholar
  • 4 Boyle P, Ferlay J. Cancer incidence and mortality in Europe 2004.  Annals of Oncology. 2005;  16 481-488
    CrossrefPubMedSearch in Google Scholar
  • 5 Denning D P, Farha G J, Mc Bouyle M F. Role of needle localization of nonpalpable breast lesions.  Am J Surg. 1987;  154 593-596
    CrossrefPubMedSearch in Google Scholar
  • 6 Verkooijen H M, Peeters P HM, Pijnappel R M. et al . Diagnostic accuracy of needle-localized breast biopsy for impalpable breast disease.  Br J Surg. 2000;  87 344-347
    CrossrefPubMedSearch in Google Scholar
  • 7 Dodd G D, Fry K, Delany W. Pre-operative localization of occult carcinoma of the breast. Nealon TF Management of the patient with cancer Philadelphia; Saunders 1966
    Search in Google Scholar
  • 8 Frank H A, Hall F M, Steer M L. Preoperative localization of non-palpable breast lesions demonstrated by mammography.  N Engl J Med. 1976;  295 259-260
    PubMedSearch in Google Scholar
  • 9 Kopans D B, Meyer J E, Lindfors K K. et al . Breast sonography to guide cyst aspiration and wire localization of occult solid lesions.  AJR. 1984;  143 489-492
    PubMedSearch in Google Scholar
  • 10 Laing F L, Jeffrey R B, Minagi H. Ultrasound localization of occult breast lesions.  Radiology. 1984;  151 795-796
    PubMedSearch in Google Scholar
  • 11 Hawasli A, Zonca S, Watt C. et al . Should needle localization breast biopsy give way to the new technology, the advanced breast biopsy instrumentation.  Am Surg. 2000;  66 648-652
    PubMedSearch in Google Scholar
  • 12 Jackmann R J, Marzoni F A. Needle-localized breast biopsy: why do we fail?.  Radiology. 1997;  204 677
    PubMedSearch in Google Scholar
  • 13 Abrahamson P E, Dunlap L A, Amamoo M A. et al . Factors predicting successful needle-localized breast biopsy.  Acad Radiol. 2003;  10 601-606
    CrossrefPubMedSearch in Google Scholar
  • 14 Albert U S, Schulz K D. Short Version of the Guideline: Early Detection of Breast Cancer in Germany.  J Cancer Res Clin Oncol. 2004;  130 527-536
    PubMedSearch in Google Scholar
  • 15 Israel P Z, Fine R E. Stereotactic needle biopsy for occult breast lesions: a minimally invasive alternative.  Am Surg. 1995;  61 87-91
    PubMedSearch in Google Scholar
  • 16 Hasselgren P, Hummel R P, Gerogian-Smith D. et al . Breast biopsy with needle localization. Accuracy of specimen x-ray and management of missed lesions.  Surgery. 1993;  114 836-842
    PubMedSearch in Google Scholar
  • 17 Graham R A, Homer M J, Sigler C J. et al . The efficacy of specimen radiography in evaluating the surgical margings of impalpable breast carcinoma.  AJR. 1994;  162 33-36
    PubMedSearch in Google Scholar
  • 18 Christensen J, Nielsen S M. Ultrasongraphic in vitro examination of nonpalpable breast masses.  Acta Radiologica. 1995;  36 671-673
    PubMedSearch in Google Scholar
  • 19 Fornage B D, Ross M I, Singletary S E. et al . Localization of impalpable breast masses: value of sonography in the operating room and scanning of excised specimens.  AJR. 1994;  163 659-573
    PubMedSearch in Google Scholar
  • 20 Mokbel K, Ahmed M, Nash A. et al . Reexcision Operations in nonpalpble breast cancer.  Journ of Surgical Oncology. 1995;  58 225-228
    PubMedSearch in Google Scholar
  • 21 Davies A H, Cowan A, Jones P. et al . Ultrasound localization of screen detected impalpable breast tumors.  J R Coll Surg Edinb. 1994;  39 353-354
    PubMedSearch in Google Scholar
  • 22 Rissanen T J, Mäkäräinen H P, Kiviniemi H O. et al . Ultrasonographically guided wire localization of nonpalpable breast lesions.  J Ultrasound Med. 1194;  13 183-188
    PubMedSearch in Google Scholar
  • 23 Weber W N, Sickles E A, Callen P W. et al . Nonpalpable breast lesion localization: Limited efficacy of sonography.  Radiology. 1985;  155 783-784
    PubMedSearch in Google Scholar
  • 24 Yim J H, Barton P, Weber B. Mammographically detected breast cancer: benifits of stereotactic core versus wire localization biopsy.  Ann Surg. 1996;  223 688-700
    CrossrefPubMedSearch in Google Scholar
  • 25 Feld R I, Rosenberg A L, Nazarian L N. et al . Intraoperative Sonographic Localization of Breast Masses.  J Ultrasound Med. 2001;  20 959-966
    PubMedSearch in Google Scholar
  • 26 Hall F M, Frank H A. Preoperative localization of nonpalpable breast lesions.  AJR. 1979;  132 101-105
    PubMedSearch in Google Scholar
  • 27 Blichert-Toft M, Dyreborg V, Bogh L. Nonpalpable breast lesions: Mammographic wire-guided biopsy and radiologic histologic correlation.  World J Surg. 1982;  6 119-125
    CrossrefPubMedSearch in Google Scholar
  • 28 Hemmer P H, Klaase J M, Mastboom W J. et al . The continued utility of needle localised biopsy for non-palpable breast lesions.  Eur J Surg Oncol. 2004;  30 10-14
    CrossrefPubMedSearch in Google Scholar
  • 29 Libshitz H I, Feig S A, Fetouh S. Needle localization of nonpalpable breast lesions.  Radiology. 1976;  121 557-560
    PubMedSearch in Google Scholar
  • 30 Daniel B L, Birdwell R L, Ikeda D M. et al . Breast lesion localization: a freehand, interactive MR imaging-guided technique.  Radiology. 1998;  207 455-463
    PubMedSearch in Google Scholar
  • 31 Morris E A, Lieberman L, Dershaw D D. et al . Peroperative MR Imaging-guided neddle localization of breast lesions.  AJR. 2002;  178 1211-1220
    PubMedSearch in Google Scholar
  • 32 Teh W, Singhal H, Lewin J M. et al .Breast, Needle Localization; www.emedicine.com/radio/topic911.htm 10.3.2005. 
  • 33 Perre C l, De Hooge P, Hoynch-Papendrecht A A. et al . Locating and marking non-palpable mammographically suspicious breast lesions with the aid of ultrasound.  Eur J Surg Oncol. 1991;  17 477-479
    PubMedSearch in Google Scholar
  • 34 Yankaskas B C, Knelson M H, Abernethy M L. et al . Needle localization biopsy of occult lesions of the breast - experience in 199 cases.  Investigative Radiology. 1988;  23 729-733
    CrossrefPubMedSearch in Google Scholar
  • 35 Soo M S, Baker J A, Rosen E L. et al . Sonographically guided biopsy of suspicious microcalcifications of the breast: A pilot study.  AJR. 2002;  178 1007-1015
    PubMedSearch in Google Scholar
  • 36 Memon M A, Berstock D A. Ultrasound-guided excision of impalpable mass breast lesion.  Am R Coll Surg Engl. 1996;  78 61-62
    PubMedSearch in Google Scholar
  • 37 Helvie M A, Ikeda D M, Adler D D. Localization and needle aspiration of breast lesions: A review of breast lesions: Complications in 370 cases.  AJR. 1991;  157 711-714
    PubMedSearch in Google Scholar
  • 38 Owen A W, Kumar E N. Migration of localizing wires used in guided biopsy of the breast.  Clin Radiol. 1991;  43 251
    CrossrefPubMedSearch in Google Scholar
  • 39 Davis S A, Wechsler R J, Feig P S. et al . Migration of breast biopsy localization wire.  AJR. 1988;  150 787-788
    PubMedSearch in Google Scholar
  • 40 Bristol J B, Jones P A. Transgression of localizing wire into the pleural cavity prior to mammography.  Br J Radiol. 1981;  54 139-140
    PubMedSearch in Google Scholar
  • 41 Grassi van R, Romano S, Massimo M. et al . Unusual migration in abdomen of a wire for surgical localization of breast lesions.  Acta Radiol. 2004;  45 247
    CrossrefPubMedSearch in Google Scholar
  • 42 Mitus J, Kolodziejski L, Dyezek S. et al . Localisation wire migration into the hilum of the lung during wire-guided breast biopsy.  Breast J. 2004;  10 165-166
    CrossrefPubMedSearch in Google Scholar
  • 43 Martinez S R, Gelfand M, Hourani H S. et al . Cardiac injury during needle localized surgical breast biopsy.  J Surg Oncol. 2003;  82 261-265
    PubMedSearch in Google Scholar
  • 44 Sakorafas G H. Breast Cancer Surgery: Historical Evolution, Current Status and Future Perspectives.  Acta Oncologica. 2001;  40 5-18
    CrossrefPubMedSearch in Google Scholar
  • 45 Scottish Intercollegiate Guidelines Network .Breast Cancer in Women a national clinical guide. www.sign.ac.uk (10.3.2005). 
  • 46 Clinical practice guidelines for the management of early breast cancer: www.nhmrc.gov.au (10.3.2005). 
  • 47 Schulz-Wendtland R, Wenkel E, Imhoff K. et al . Interventional methods in diagnostic of the breast - a new vacuum biopsy system for the breast in routine clinical practice.  Ultraschall in Med. 2005;  26 411-414
    Thieme ConnectPubMedSearch in Google Scholar
  • 48 Kettritz U, Rotter K, Schreer I. et al . Stereotactic vacuum assisted breast biopsy in 2874 patients: a multicenter study.  Cancer. 2004;  100 245-251
    CrossrefPubMedSearch in Google Scholar
  • 49 Schulz-Wendtland R, Kramer S, Bautz W. First experiences with a new vacuum-assisted device for breast biopsy.  Fortschritt Röntgenstr. 2003;  175 1496-1499
    PubMedSearch in Google Scholar

1 European Community.

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

Ralf Ohlinger, MD

Ernst-Moritz-Arndt-University of Greifswald, Department of Gynecology and Obstetrics,  Breast Center

Wollweberstr. 1

17475 Greifswald

Germany

Phone: ++49/38 34/86 73 12

Fax: ++49/38 34/86 65 78

Email: ralf.ohlinger@uni-greifswald.de