An improved technique for needle localized biopsy of occult lesions of the breast

The current retrospective study reports the results of the 98 outpatient procedures using a modified version of needle localized excisional biopsies of occult lesions of the breast at a community hospital. Intraoperative fluoroscopy is used to direct a second needle placement along the dissection tract to localize more accurately the intraglandular lesion. The medical records of 88 patients who underwent this procedure between 1989 and 1991 were reviewed. A detailed description of the procedure used as well as clinical data from roentgenographic, histologic and operative reports are given. Benign histologic findings were reported in 80.6 percent of the instances, with fibrocystic disease accounting for most (66 of 79) of the benign diagnoses. Primary malignancy was found in 18 biopsies, with noninfiltrating ductal carcinoma being the most prevalent (n = 8). Infiltrating ductal carcinoma was found six times, infiltrating lobular carcinoma was found three times and a combination of noninfiltrating ductal and noninfiltrating lobular carcinoma was found once. Metastasis to axillary lymph nodes was found twice. One lesion of the breast was large cell lymphoma. Mass lesions accounted for 46 of the 98 lesions and calcifications accounted for the remaining 52. Thirteen of the 18 primary lesions that proved to be malignant presented as calcifications, whereas five presented as a mass. Infiltrating carcinoma, however, was more likely to be associated with mass lesions than with calcifications--all five malignant mass lesions were infiltrating, whereas of the 13 lesions with calcifications, four were infiltrating. Failure to confirm the removal of the lesion roentgenographically occurred once, but there were no other complications to this technique. Additionally, a circumareolar incision was used in 64.7 percent of the procedures and 76.5 percent of the procedures were done using local anesthesia and intravenous sedation. We conclude that the technique introduced herein is a simple, highly reliable means to localize accurately nonpalpable lesions of the breast using a combination of fluoroscopy and needle localization that allows a better cosmetic result.