Percutaneous needle localisation of breast lesions prior to biopsy: analysis of failures

Mammography can detect clinically occult breast cancer. But with minimal or no physical findings the lesion can be quite difficult for the surgeon to find within the recumbent breast at biopsy. Percutaneous needle localisation, the placement of a needle in or in the vicinity of such a clinically silent lesion, provides an internal landmark to assist the surgeon. Review of our experience of 90 procedures using this technique disclosed a success rate of approximately 90%. The biopsies diagnosed 14 cancers before local or distant metastasis could be found. The eleven of the fourteen who had axillary dissection were found to have negative nodes. Identifiable causes of failure were sought and discussed in the 7 documented failures. Faulty needle placement was judged noncontributory in all but one case. Needle movement between time of placement and time of biopsy could never be excluded and is in fact suspected in two failures. Immediate re-sampling, or larger initial specimens would have salvaged the procedure in most instances of failure. We feel poor communication and poor mutual understanding of the localization procedure to be the major contributing cause of failure. Even so, we have been able to use the technique with 90% success. The development of mammography brought with it the opportunity to detect small non-palpable carcinomas and the surgical problem of removing them at biopsy. While the suspect lesions identified by mammography are frequently benign, the cancers found are usually small and some only microscopic in size. The literature contains many descriptions of various techniques for localising such lesions prior to biopsy. We are reporting our experience with percutaneous needle localisation. To our knowledge, we have the distinction of being the first to report difficulty with a localisation technique and will analyse possible reasons. Some of the problems are common to all the localisation techniques.