The treatment of nonpalpable carcinoma of the breast

Screening programs have discovered an increasing number of non-palpable breast cancers. There are several methods of locating these lesions by measuring the distance from the nipple and either excising an adequate margin around the measured point or more accurately locating it with a needle and further x-rays. The lesion, one excised, should be submitted for specimen radiography and compared with the mammogram to ascertain that the lesion has been excised. Many times, it is wise to submit the whole excised area for permanent sectioning to improve the reliability of diagnosis. For minimal carcinoma (0.5 cm or less), a total mastectomy with dissection of the level one nodes and with immediate pathological examination is done. If there is no metastasis or if metastasis in the nodes is two millimeters or less, it is probably adequate treatment. If larger metastases are present, a Patey Modified Mastectomy should be done. When the lesion is in the medial half of the breast, radiation to the parasternal area should be given.