Abstract
The purposes of the present research were to evaluate (1)
the value of ultrasonographically guided fine-needle aspiration
biopsy (US-FNAB) in nonpalpable suspicious breast lesions, (2)
the preoperative use of methylene blue staining in nonpalpable
galactographically suspicious breast lesions, (3) the determinants
of positive histologic margins and residual cancer in wire-guided
biopsy (WGB) of nonpalpable breast cancer and in lumpectomy for
early breast cancer and the determinants of positive radiologic
margins and the correlation between radiologic and histologic margins
and residual disease in WGB of nonpalpable breast cancer, (4) the
assessment of lumpectomy margins by touch preparation cytology
in early breast cancer, and (5) the cosmetic outcome of WGB performed
for benign breast lesions.
The sensitivity and specificity of US-FNAB in 90 nonpalpable
breast lesions were 84% and 93%, respectively.
Preoperative methylene blue staining was successful in 22 out of
30 (73%) cases, making subsequent selective minimal volume
microdochectomy easy to perform. Multivariate analysis of 21 prospectively
evaluated variables was done after 71 WGBs of nonpalpable breast
cancer followed by 54 re-excisions. Large mammographic lesions
had more often positive radiologic margins. Multifocality, large
pathologic size and superficial excision were related to positive histologic
margins and multifocality to residual disease in re-excisions.
The sensitivity and specificity of specimen radiography for predicting
histologic margins were 38% and 81% and those
for residual disease 27% and 79%, respectively.
The corresponding figures for histologic margins in predicting
residual disease were 85% and 59%, respectively.
In a prospective series of 55 consecutive lumpectomies for early
breast cancer, positive histologic margins were found more often in
the presence of intraductal cancer and if the pathologic size of
the index tumor was large. Residual disease was found in 38% of
the cases with positive and in 15% of the cases with negative
histologic margins. A multifocal and nonpalpable index tumor predicted
residual cancer in 34 re-excision specimens. The sensitivity and
specificity of touch preparation cytology in predicting histologic margins
were 38% and 85%, respectively. In WGB, the overall
cosmesis 6 months after surgery was satisfactory in 75 % of
the 101 prospectively evaluated patients with benign proven lesions. Cosmesis
was poorer after deep excisions and complications.
The results indicate that US-FNAB is a useful tool in evaluating
nonpalpable suspicious breast lesions. Preoperative methylene blue
staining crucially facilitates selective minimal volume microdochectomy
in three-quarters of cases. To obtain free margins in WGB, mammographically
and pathologically large lesions should be removed with wider excisions
extending down to the fascia. However, radiologic margins in WGB
and histologic margins both in WGB and in lumpectomy for early
breast cancer may be misleading. Re-excision of the biopsy site
of multifocal tumors after WGB and lumpectomy should be considered.
This is also important after superficial excision in WGB due to
the considerable risk of residual disease. Touch preparation cytology
cannot be recommended for the assessment of margins in lumpectomy
specimens of early breast cancer. Cosmetic outcome after WGB of
benign breast lesions is satisfactory in 75 % of cases.
Deep excisions and complications endanger the cosmetic outcome.
Preoperative biopsy and tumor localization methods have proven
their utility; nevertheless, free margins are still difficult to
obtain and to evaluate accurately. The surgeon may often be forced
to choose between free margins and an acceptable cosmetic outcome.
| Identifer | oai:union.ndltd.org:oulo.fi/oai:oulu.fi:isbn951-42-5360-4 |
| Date | 02 September 1999 |
| Creators | Saarela, A. (Arto) |
| Publisher | University of Oulu |
| Source Sets | University of Oulu |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/doctoralThesis, info:eu-repo/semantics/publishedVersion |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess, © University of Oulu, 1999 |
| Relation | info:eu-repo/semantics/altIdentifier/pissn/0355-3221, info:eu-repo/semantics/altIdentifier/eissn/1796-2234 |
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