Diagnostic effectiveness of wire-guided localization for non-palpable breast lesions and its importance in breast cancer management: Diagnosis of non-palpable breast lesions

Orhan Aslan; Ramazan Topcu; Ömer  Şakrak

doi:10.5281/zenodo.13377799

Authors

Orhan Aslan Hitit University Faculty of Medicine, Department of General Surgery, Çorum, Turkey https://orcid.org/0000-0002-1982-0792
Ramazan Topcu Hitit University Faculty of Medicine, Department of General Surgery, Çorum, Turkey https://orcid.org/0000-0001-6214-4868
Ömer Şakrak Gazi University Faculty of Medicine, Department of General Surgery , Ankara, Turkey https://orcid.org/0000-0002-8834-0928

DOI:

https://doi.org/10.5281/zenodo.13377799

Keywords:

Breast cancer, mammography, reexcision, surgery, ultrasound, wire guided localization

Abstract

Objective: Breast cancer represents the most prevalent malignant disease among women globally, accounting for approximately 30% of all female cancers. Wire-guided localization is now a commonly utilized method for diagnosing breast lesions that are not palpable on clinical examination but can be identified through the use of mammography (MG) and/or ultrasound (US). The objective of the study was to determine the cancer prediction rate of the method in patients with non-palpable breast lesions who underwent excisional biopsy with wire guided localization and to evaluate the diagnostic significance of the method by comparing age, size, family history, radiomorphologic type, Breast Imaging and Data System (BI-RADS) category, location, and histopathologic features. Furthermore, the objective was to elucidate the advantages of the method in breast cancer treatment by determining the re-excision rates and types according to the surgical margin status of malignant lesions.

Methods: The study was planned retrospectively. A total of 228 histopathologically examined lesions that underwent US or MG-guided wire-guided excisional biopsy for non-palpable breast lesions between June 2006 and December 2011 were included in the study.

Results: Of all lesions, 58 (25.4%) were diagnosed as malignant, while 170 (74.6%) were diagnosed as benign pathologies. The cancer prediction rate of the method was determined to be 25.4%. The malignancy rate demonstrated a statistically significant correlation with age, with an increasing trend observed with advancing age (p=0.006). No statistically significant differences were observed between malignant and benign lesions with respect to size, localization, or family history. With regard to lesion type, the malignancy rate was higher in lesions comprising microcalcification clusters (p=0.005). Malignancy rates were significantly higher in the BI-RADS 4b (OR:6.06) and BI-RADS 4c (OR:6.77) groups compared to the other BI-RADS categories. In cases where the surgical margins were positive for malignancy (28/58), the rate of mastectomy was significantly higher than in cases where the margins were negative (p=0.006). The majority of malignant lesions (79.3%) were classified as stage 0 or 1 cancers.

Conclusion: Wire-guided localization is still an effective method for early diagnosis of breast cancer and identification of suspicious non-palpable lesions. Developing new techniques in pathology, radiology, and surgery to better localize suspicious non-palpable lesions and reduce surgical margin positivity rates will facilitate the fight against breast cancer.

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