Management of nonpalpable breast abnormalities

From January 1982 to June 1986, 444 patients had localization of 500 nonpalpable mammographically suspicious lesions using the Kopans hook wire technique. Four hundred ninety-nine biopsies were performed in 443 patients. Cancer was identified in 12% of the biopsies performed for a suspicious mass or density and in 20% of biopsies performed for suspicious calcifications. Carcinoma was identified in a total of 72 biopsies (14%) performed in 65 patients; 82% of the malignant lesions were invasive. All lesions were small; 76% of the cancers were 1.0 cm or less in diameter. Sixty-two axillary dissections were performed of which seven (11%) had positive nodes. Advantages of preoperative needle localization include precise localization of the lesion, a small incision, and removal of a small amount of breast tissue with no cosmetic deformity. Outpatient biopsy of these lesions can be easily performed under local anesthesia. Identification and treatment of these small preclinical cancers should lead to improved survival from breast cancer.