Wire-guided Localization Biopsy to Determine Surgical Margin Status in Patients with Non-palpable Suspicious Breast Lesions


Purpose: Guide-wire localization (GWL) has been a standard technique for many years. Excision of nonpalpablemalignant breast lesions with clear surgical margins reduces the risk of undergoing re-excision. Theobjective of the present study was to evaluate the efficacy of GWL biopsy for assessing surgical margins.
Methods:This retrospective study concerned 53 patients who underwent GWL biopsy for non-palpable breast lesionsand breast carcinoma diagnosed by histological examination. Age of the patients, tumour size, radiographicfindings, breast density specifications, specimen volumes, menopausal status and family history of the patientsand surgical margin status were recorded.
Results: Median age was 53.3 years, median tumour size was 1.5 cmand median specimen volume was 71.5 cm3. In fifteen patients (28%) DCIS and in 38 patients (72%) invasiveductal carcinoma was diagnosed. There was positive surgical margins in twenty eight (52.8%) patients. Themedian distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denserbreast specifications were found as statistically significant factors for surgical margin status. Median age of thepatients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins(p=0.04). 79% of the patients with positive margins had type 3-4 pattern breast density according to BIRADSclassification as compared to 48% in the patients who had negative margins (p=0.03). Some 38 patients whohad positive or close surgical margins received re-excision (72%).
Conclusion: Positive margin rates may behigher because of inherent biological differences and diffuse growth patterns in younger patients. There are alsotechnical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excisionrates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.