Accurate preoperative localization of breast lesions is important to ensure removal of the suspected area without also removing large quantities of tissue. By using a hook retracted into the needle lumen, repositioning prior to the final anchoring of the wire in the tissue is simplified.

Mammograms

The results of 500 preoperative radiographically guided localizations for occult breast lesions over a period of more than 5 years are described. Of the total, 117 (23.4%) were found to be malignant. Biopsy was prompted by abnormal calcifications in 41% (203/500) of the cases and by occult masses, areas of architectural distortion, or asymmetry in 59% (297/500). of 74 patients with carcinoma who underwent axillary lymph node sampling, 78% (58/74) were free of metastatic involvement.

Between March 1980 and April 1981, 1,140 women underwent physical examination, xeromammography, and whole-breast ultrasound (US) using a whole-breast water path system. Results of each study were interpreted independently by separate observers in a blind fashion. Biopsy revealed 125 cancers in 127 breasts. Findings were considered to be suspicious for carcinoma in 199 women based on physical examination, in 201 based on mammograms, and in 255 based on US scans. Physical examinations were able to reveal 91% (115/127) of the cancers, reflecting the referral nature of the population, and failed to detect 12 lesions. Mammograms disclosed 94% (119/127) of the cancers, including 12 clinically occult lesions, but did not show eight palpable cancers. US scans disclosed only 64% (81/127) of the cancers, all of which were palpable. In a 4-year follow-up, no cancers have appeared in the group that had suspicious findings by US only. We conclude that US should not be used routinely to screen women for breast cancer.

Modifications have been made in the spring hookwire system to facilitate accurate three-dimensional placement and to aid surgeons in gauging the location of the hook with respect to a breast lesion. Difficulties in placement of the needle created by rigid compression systems can be overcome by using a combination of a fenestrated compression plate and a spot-compression device.