Wire localization of non-palpable breast lesions: out of date?

With the increasing use of screening mammography, more and more non-palpable lesions are found. As less invasive techniques like core needle biopsy are introduced, we evaluated our experience with the well-known standard procedure of surgical excision after wire localization.

We retrospectively evaluated the results of 479 wire localizations for non-palpable breast lesions between 1992 and 1999 in 465 patients. Feasibility and reliability of the procedure and the incidence of complications are reported.

The mean age of these patients was 57 years (range 22-81 years). The mammographic finding with the highest rate of malignancy was density combined with architectural distortion (72%). The removal of the lesion was radiologically confirmed in 93%; if the lesion appeared to be not removed, after 3 months mammography was repeated, in 14 patients a second localization procedure was done and in 10 patients still a malignancy was found. In 79%, the excision after initial fine-wire localization was irradical. Twenty-five patients developed a haematoma and five patients had a wound infection. The overall malignancy rate was 50%. With a mean follow-up of 18 months in 11 patients with a diagnosis of benign disease after an adequate procedure, still a malignancy was found at the original excision site.

In selected cases, especially as a part of the therapeutic procedure in breast-conserving therapy, there will remain a place for wire localization and excision biopsy. However, we have to reconsider its place as a diagnostic procedure as the results of less invasive procedures are promising.