The ABBI-system as an option for work-up of non-palpable lesions

For non-palpable lesions detected radiographically alone, lumpectomy after needle-localization is currently performed. Specimen radiography provides a n indirect proof of complete excision of the mammographic abnormality. Up t o now, intraoperative mammography of the operated breast has not been possi ble. Digital intraoperative mammography is now possible with the ABBI-syste m, which will be introduced in this article. In a pilot study, we have inve stigated, whether it is possible to excise small carcinomas with the ABBI s tereotactic biopsy device (maximum diameter 20 mm) without compromising bre ast conserving therapy. In a prospective study, 69 patients were diagnosed or treated using the ABBI-system. In all 60 patients with a primary lesion, a cylindrical excision was performed. Of these, 11 invasive and 5 intraduc tal carcinomas were diagnosed. 7 of the invasive and 2 of the intraductal c ancers were treated with breast conserving surgery. In 9 cases, an in-breas t recurrence was suspected. In 7 of these a cylindrical excision was perfor med. One invasive and 3 intraductal carcinomas were found and mastectomy wa s performed in these four patients. In two patients with the suspicion of a n in-breast recurrence, the ABBI-system was used to perform a core-needle b iopsy. In one patient, the biopsy finding was positive and mastectomy was p erformed. Patients with lesions close to the chest wall are not suited for the ABBI-system. The postoperative course was uneventful in all cases, the cosmetic result after breast-conserving therapy was very good. The advantag es of this new method consist in the reliable stereotactic localization of suspicious lesions and in the fast intraoperative imaging.