Conservative excision of wire-bracketed breast carcinomas: a community hospital's experience

We report our experience with excision of hooked-wire bracketed breast carcinomas in a community hospital setting. The mammographic and pathology reports from 36 nonpalpable or minimally palpable breast cancers were retrieved from a single surgical oncologist's office records and a number of factors that might influence a successful initial surgical excision were examined. The median lesion size was 1 cm. The radiographic abnormalities were microcalcifications only in 14 cases (39%), combined mass/density and microcalcifications in 9 cases (25%), and mass/density without microcalcifications in 13 cases (36%). The median number of bracketing wires placed was two. A prior fine-needle aspiration (FNA) or core biopsy was performed in 29 of the 36 cases (81%). Of these, 27 were positive for malignancy. The tumor was considered to be inadequately excised if it was present within 5 mm of any surgical margin; this outcome occurred in 21 of the 36 cases (58%). Fifteen cases (42%) had tumor involving either the margin or extending to within 1 mm of the margin. Inadequately excised lesions were more commonly seen with increasing tumor size, a radiographic appearance of microcalcifications without an associated mass, and a pathologic diagnosis of ductal carcinoma in situ (DCIS). An intraoperative consult led to taking additional marginal tissue in 23 cases and was successful in achieving final clear histologic margins in 8 of these (35%). Our experience suggests that there are at least two ways to optimize the adequacy of conservative excision of nonpalpable or difficult-to-palpate breast cancers using standard modalities presently available in most community hospitals. These are (a) having the pathologist and radiologist available for intraoperative consultation and (b) obtaining a tissue diagnosis of malignancy preoperatively. The use of bracketing wires to better delineate the margins of tissue to be excised may also be helpful, but this needs to be further evaluated in a randomized study.