Outcomes of multiple wire localization for larger breast cancers: when can mastectomy be avoided?
BACKGROUND
Mastectomy is often recommended when mammography shows a breast cancer with extensive calcifications. We wished to determine whether the use of multiple localizing wires to guide lumpectomy in this setting was associated with increased rates of breast conservation. We also wanted to identify factors that predicted a poor chance of successful lumpectomy, to avoid multiple lumpectomy attempts in a patient who would ultimately require mastectomy.


METHODS
Records of 153 women with breast cancer who underwent lumpectomy for larger lesions that required multiple wire localization and 196 controls who required only single wire localization were reviewed retrospectively. The number of localizing wires, specimen volume, largest specimen dimension, number of surgical procedures, and rates of breast conservation were scored.


RESULTS
Seventy-seven percent of patients requiring multiple wire localization had successful breast conservation, compared with 90% of those needing only single wire localization. Only 28% of multiple wire patients required more than 1 excision to achieve clear margins, compared with 36% of single wire patients (p < 0.01).


CONCLUSIONS
Breast conservation is possible in the great majority of breast cancer patients whose mammographic lesions require multiple localizing wires for excision. The use of multiple wires can decrease the number of procedures required to obtain clear lumpectomy margins.
Kirstein
Laurie J
LJ
Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA 02115, USA.
Rafferty
Elizabeth
E
Specht
Michelle C
MC
Moore
Richard H
RH
Taghian
Alphonse G
AG
Hughes
Kevin S
KS
Gadd
Michele A
MA
Smith
Barbara L
BL
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery*; D044584:Carcinoma, Ductal / Q000000981:diagnostic imaging / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008327:Mammography; D008408:Mastectomy; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies