Application Of Stereotactic Needle Localized Biopsy Guided By Digital Mammography In Non-palpable Breast Lesions

Objective:To evaluate the clinical value of stereotactic needle localized biopsy guided by digital mammography in non-palpable breast lesions.Materials and Methods:About 6600 patients had taken mammography examination in our hospital from January to June in 2010.40 cases of them with non-palpable breast lesions were retrospectively. Their mammograms demonstrated malignant signs such as clusters of calcifications, poorly-demarcated nodules or regional structural irregularities. All the patients took the stereotactic needle localized biopsy guided by digital mammography before the surgery and the removed tissues were confiremed by pathologic diagnosis. The machines we used were Hologic selenia and accordant stereotactic puncture device. At first, we took the CC and MLO view mammograms of the patients to make sure the direction and depth of the puncture wire and make a mark on the skin. The patient took a sitting posture, put the lesion of the breast in the center of the window and take a mammogram. If the lesion was not in the center, it should be adjusted. Then make the puncture device reset and put the wire move to the pre-puncture position. To routine disinfect the puncture skin and then the local anesthesia may be used by 1% lidocaine. After computerized stereotactic puncture of the lesions were done, a guide wire was indwelled in the suspected spot.The guides most commonly used feature a wire with a hook on the end. The hookwires can be passed through a needle; the hook reforms when the needle is withdrawn over the wire, anchoring the wire in the tissue. The needle was first positioned (or repositioned) to achieve a satisfactory relationship to the lesion; then the wire was engaged in the appropriate tissue volume. These devices can also be stiffened when a cannula is slid over them in the operating room. The length of the wire should exceed by two centimeters the distance from the end of the hookweire to the lesion. With the guidance of the wire, surgical resections of the suspected tissues were made. The surgeon should try to minimize the amount of dissection needed by choosing the shortest distance to the lesion that is feasible. The range of general surgical dissection was about 10cm around the lesion. Mammograms of the resected specimen were again undertaken after surgical resection to confirm whether the lesions were completely removed. Pathologic diagnosis of removed tissues was obtained. Careful surgical dissection will avoid dislodging needles or cutting wires.Results:40 patients with mammography examination showed 41 lesions, indwelling 41 wires to guide the surgical biopsy.33 cases are cluster or irregular calcification (80.5%),5 cases are mass (12.2%),2 cases are mass with calcification(4.9%),1 partial structural disorder(2.4%).Pathological findings:16 cases were breast carcinoma(39.0%), concluding 13 cases of intraductal carcinoma(31.7%)and 3 cases of invasive ductal carcinoma(7.3%);2 serious atypical hyperplasia(4.9%); 23 cases were benign lesion(56.1%), concluding 6 fibroadenoma(14.6%),2 intraductal papillary carcinoma(4.9%),15 hyperplasia(36.6%). The detectable rate of breast carcinoma was 39.0%. The lesions were 100% removed by wire location guidance procedure.Conclusion:Surgical biopsy with the guidance of indwelling wire placed through stereotactic full-field digital mammography puncture is very helpful in correctly localizing and removing small latent breast lesions. It can solve the surgical difficulties due to blind resection, and it is also less invasive and easy to perform. So it has significant value in detecting early breast carcinoma.