Bracketing wires for preoperative breast needle localization

OBJECTIVE. The purpose of this study was to evaluate the outcomes of bracke ting wire placement during preoperative breast needle localization. SUBJECTS AND METHODS. We prospectively examined mammograms of 1057 consecut ive lesions that had preoperative needle localization and surgical excision and classified the lesions according to Breast Imaging Reporting and Data System (BI-RADS) final assessment categories. Bracketing wires, defined as multiple wires placed to delineate the boundaries of a single lesion, were used in 103 (9.7%) of 1057 lesions. Medical records, imaging studies, and h istologic findings in these 103 lesions were reviewed. RESULTS. Of 103 bracketed lesions, median lesion size was 3.5 cm (range, 1. 5-9.5 cm). Ninety-three lesions (90.3%) contained calcifications; 65 lesion s (63.1%) were BI-RADS category 5 (highly suggestive of malignancy); and 33 lesions (32.0%) were percutaneously proven cancers. The median number of w ires placed was two (range, 2-5). Surgical histologic findings were carcino ma in 75 lesions (72.8%), atypical hyperplasia in eight lesions (7.8%), and benign in 20 lesions (19.4%). Of 42 calcitic lesions that were bracketed a nd had postoperative mammograms available for review, complete removal of s uspicious calcifications was accomplished in 34 (81.0%). Of 75 cancers that were bracketed, clear histologic margins of resection were obtained in 33 (44.0%). CONCLUSION. Bracketing wires were used during preoperative needle localizat ion primarily for larger calcitic lesions that were proven cancers or were highly suggestive of malignancy (BI-P,ADS category 5). Bracketing wires may assist the surgeon in achieving complete excision of calcifications, but b racketing wires do not ensure clear histologic margins of resection.