Localization Methods for Excisional Biopsy in Women With Nonpalpable Mammographic Abnormalities.

INTRODUCTION: With the advent and proliferation of breast cancer screening programs, more women are being diagnosed with mammographic abnormalities that require tissue diagnosis. If imaged-guided biopsy is not possible or previous image-guided biopsies reveal pathologies that require more extensive surgery, guided excisional biopsy/lumpectomy may be necessary. METHODS: Fifteen women were enrolled in the study of the feasibility of off-site or day-before wire-localization excisional biopsy of the breast with mammographic abnormalities. Five patients had their localization wire placed the day before, whereas 10 patients had their localization the same day with surgery in a distant procedure room under straight local anesthesia. RESULTS: Two of the 15 patients had an eventual cancer diagnosis from their wire-localized excisional breast biopsy. All patients had their mammographic abnormality removed with the previously placed core biopsy clip, and there was 100% radiologic/clinical correlation. All patients' wounds healed primarily without any surgical site infections. CONCLUSION: The protocol answers 2 questions concerning the wire-localized excisional breast biopsy technique. The series shows that the wire-localization technique can be performed the night before or in a location away from the procedure room that would allow better synchronization with surgical schedules or allow the procedure to take place in low-cost settings away from the expense of the hospital operating room.

Breast Lymphatic Mapping and Sentinel Lymph Node Biopsy: State of the Art: 2015.

Lymphatic mapping with sentinel lymph node biopsy (SLNB) was introduced in the 1990s as a method to stage the nodal axilla in women with breast cancer. Very quickly the technique became the standard of care because pathologic staging was more accurate and sensitive and the surgical procedure resulted in low morbidity. SLNB has continued to evolve, and the applications in breast cancer have been expanded. A review of the published data was performed to update the lymphatic mapping technique and identify key issues and trends in the application of SLNB in women with breast cancer in 2015. The importance of axillary staging continues to effect the surgical treatment of patients with breast cancer. Originally described for patients with invasive cancer, the technique now plays an important role in staging women with ductal carcinoma in situ or recurrent breast cancer and patients with advanced breast cancer who are receiving neoadjuvant chemotherapy. Histologic examinations have incorporated multiple sectioning and immunostains. The morbidity has been low, and techniques for limiting lymphedema are being introduced. Lymphatic mapping will continue to play an important role in the treatment of women with breast cancer. The SLNB will evolve by eliminating the need for radioactivity in the operating room, and the technique will become more accurate and used in expanded indications by incorporating preoperative imaging and intraoperative guidance procedures.