Percutaneous stereotactic en bloc excision of nonpalpable breast carcinoma: a step in the direction of supraconservative surgery

Abstract

SUMMARYRecently, the advanced breast biopsy instrumentation (ABBI) system has been introduced as an alternative to conventional breast biopsy techniques. This study was prospectively conducted to evaluate the potential of the ABBI method in locoregional management of a consecutive series of patients with nonpalpable mammographically detected breast carcinomas. Sixty-one consecutive patients underwent an ABBI procedure as a first step before possible surgery for nonpalpable breast lesions that would in any case require complete excision. For the 27 patients in whom the ABBI biopsy revealed malignancy further surgery was recommended, including re-excision of the biopsy site and axillary dissection in cases of infiltrating carcinoma. We calculated the probabilities that the ABBI specimen would have tumor-free margins and that a definitely complete excision had been achieved as a function of the mammographic or pathological diameter of the cancer. For cancer with a pathological diameter less than 10 mm measured on the ABBI specimen, the probability (92%) of obtaining complete resection was significantly better than for larger lesions (P = 0.01, Fisher's exact test). Although the therapeutic perspectives for the ABBI method are limited at present, we suggest that this approach is a first step in the direction of a surgical strategy that is better adapted to the pathological characteristics peculiar to these small tumors, whose incidence is increasing.

Predicting complete removal of impalpable breast carcinomas using stereotactic radiologically guided surgery

“…The lesion cannot always be removed successfully1, and the biopsy margins are often affected2. However, with growing experience and improving case selection, these drawbacks have largely been overcome3, 4. The most suitable lesions are either nodules or very well circumscribed clusters of microcalcification less than 15 mm in diameter.…”

“…The question addressed in this report has been examined before4, 5. Lifrange et al 4 found that involvement of breast tissue around a lesion was inversely related to tumour size4.…”

“…The question addressed in this report has been examined before4, 5. Lifrange et al 4 found that involvement of breast tissue around a lesion was inversely related to tumour size4. Watermann et al 5, on the other hand, found that all patients with ductal carcinoma in situ had residual cancer, even those with clear margins of the ABBI specimen5.…”