Nonpalpable carcinoma of the breast - Diagnosed by vacuum core breast biopsy and surgical management

The wire-localized extirpation is the "gold standard" for the examination o f nonpalpable lesions suspicious of malignancy. Less invasive techniques we re introduced in the last years, offering also a high diagnostic reliabilit y, e.g. stereotactic core needle biopsy, the "advanced breast biopsy" and t he vacuum core biopsy. Based on an analysis of 40 vacuum core breast biopsi es and the following interventions in the case of carcinoma recommendations for the management of the nonpalpable breast carcinoma diagnosed by vacuum core biopsy should be developed. In 12 patients (33%) carcinomas were foun d necessitating further operations. These were 92% pTis or pT1 pN0M0-carcin omas and only in one case an occult pT2pN1M0-carcinoma. We recommend a shor t interval between core biopsy and operation, a preoperative localization o f the clips e.g. the residual microcalcification, and the controlled placem ent of the hooked wire that should also be performed at the Mammotome(R) us ing the same way to the tumor. Furthermore it is necessary to excise the co re biopsy localization channel en bloc together with a wide tumour excision . An intraoperative histological examination of the specimen should be perf ormed to confirm tumour-free excision borders. For this, the position of sp ecimen should be marked by a thread and a specimen radiography should be ma de for the orientation of the pathologist and for documentation. A long-ter m follow-up of these patients under study conditions should be considered. Patients with benign diagnosis, not undergoing general anesthesia and opera tion with the consequences for later radiological evaluation, mostly profit from vacuum core breast biopsy. For patients with carcinoma the costs of t he perioperative management increase. This should have consequences for the quality assurance of this method.