BREAST BIOPSY WITH NEEDLE LOCALIZATION - ACCURACY OF SPECIMEN X-RAY AND MANAGEMENT OF MISSED LESIONS

Background. One of the more frustrating complications after breast bio psy with needle localization is a missed lesion. To reduce the number of missed lesions, radiographs of the surgical specimen are usually ob tained. In this study we determined the accuracy of specimen x-ray, th e incidence of missed lesions, and the management of patients with thi s complication. Methods. The result of specimen x-ray was compared wit h that of a postoperative mammogram in 192 patients who underwent brea st biopsy with needle localization. The incidence of missed lesions wa s also determined from postoperative mammogram, and the management of patients with this complication was analyzed. Results. The incidence o f false-positive specimen x-ray was 7.8% and that of false-negative 55 %. The sensitivity, specificity, and accuracy of specimen x-ray were 9 6%, 28%, and 89%, respectively. The incidence of missed lesions was 3. 2% and of incompletely excised lesions 6.4%. Eighteen of 24 patients w ith a missed or incompletely excised lesion were treated expectantly b ecause postoperative mammogram showed the lesion to be stable. None of these patients has required a subsequent biopsy. Conclusions. Specime n x-ray can be false positive or false negative. An important implicat ion of this finding is that a postoperative mammography should always be performed after biopsy with needle localization, regardless of the result of the specimen x-ray, to make certain the lesion has not been missed.