[Nonpalpable carcinoma of the breast - diagnosed by vacuum core breast biopsy and surgical management].
The wire-localized extirpation is the "gold standard" for the examination of nonpalpable lesions suspicious of malignancy. Less invasive techniques were introduced in the last years, offering also a high diagnostic reliability, e. g. stereotactic core needle biopsy, the "advanced breast biopsy" and the vacuum core biopsy. Based on an analysis of 40 vacuum core breast biopsies and the following interventions in the case of carcinoma recommendations for the management of the nonpalpable breast carcinoma diagnosed by vacuum core biopsy should be developed. In 12 patients (33 %) carcinomas were found necessitating further operations. These were 92 % pTis or pT1pN0M0-carcinomas and only in one case an occult pT2pN1M0-carcinoma. We recommend a short interval between core biopsy and operation, a preoperative localization of the clips e. g. the residual microcalcification, and the controlled placement of the hooked wire that should also be performed at the Mammotome(R) using the same way to the tumor. Furthermore it is necessary to excise the core biopsy localization channel en bloc together with a wide tumour excision. An intraoperative histological examination of the specimen should be performed to confirm tumour-free excision borders. For this, the position of specimen should be marked by a thread and a specimen radiography should be made for the orientation of the pathologist and for documentation. A long-term follow-up of these patients under study conditions should be considered. Patients with benign diagnosis, not undergoing general anesthesia and operation with the consequences for later radiological evaluation, mostly profit from vacuum core breast biopsy. For patients with carcinoma the costs of the perioperative management increase. This should have consequences for the quality assurance of this method.
Leinung
S
S
Chirurgische Klinik I, Universität Leipzig, Leipzig. leinungs@medizin.uni-leipzig.de
Keitel
R
R
Würl
P
P
Udelnow
A
A
Schneider
J P
JP
Schulz
T
T
Horn
L C
LC
Schönfelder
M
M
D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002277:Carcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008327:Mammography; D010173:Palpation