Preoperative needle localization to detect early breast cancer

A retrospective review of 200 consecutive female patients who had undergone mammographically controlled needle localizations was performed to assess the effectiveness of the technique and to analyze the number and characteristics of malignancies found in this group. Fine-needle localization was recommended if one of the following criteria was present: (1) evidence of a mass, (2) microcalcifications, (3) architectural distortion. Of the 200 localizations, 192 specimen radiographs were analyzed: 186 contained the lesion, 6 (3 percent) missed the lesion. Forty-eight cancers were detected (24 percent). The reasons for biopsy were microcalcification, 61 percent; presence of a mass, 25 percent; abnormal architecture, 14 percent. Histologically the cancers included 38 invasive plus 10 in-situ tumors. The predominant histologic cell type was ductal in origin with only four having lobular characteristics. In the definitive treatment of these patients, pathologic findings of the lymph nodes showed 2 of the 38 were positive for metastases. In summary, the technique of preoperative needle localization in this series indicates a 93 percent success rate. An analysis of the surgical intervention indicates that conservative breast surgery is the treatment of choice. Another result is the detection of high-risk malignant lesions such as duct and lobular hyperplasia that require close follow-up.