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Bracketing Wires for Preoperative Breast Needle Localization

Laura Liberman1, Jennifer Kaplan1, Kimberly J. Van Zee2, Elizabeth A. Morris1, Linda R. LaTrenta1, Andrea F. Abramson1 and D. David Dershaw1

1 Department of Radiology, Breast Imaging Section, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
2 Department of Surgery, Breast Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.



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  		Fig. 1A. —42-year-old asymptomatic woman with abnormal findings on screening mammogram. Left mediolateral mammogram shows pleomorphic and linear calcifications in segmental distribution spanning 4.5 cm.

 


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  		Fig. 1B. —42-year-old asymptomatic woman with abnormal findings on screening mammogram. Left craniocaudal mammogram obtained during needle localization procedure shows breast in compression in fenestrated alphanumeric compression device. Four wires have been placed to delineate lesion boundaries.

 


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  		Fig. 1C. —42-year-old asymptomatic woman with abnormal findings on screening mammogram. Left mediolateral mammogram obtained after needle placement confirms location of needles on orthogonal projection.

 


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  		Fig. 1D. —42-year-old asymptomatic woman with abnormal findings on screening mammogram. Left craniocaudal mammogram obtained after wire deployment shows four localizing wires in position.

 


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  		Fig. 1E. —42-year-old asymptomatic woman with abnormal findings on screening mammogram. Left mediolateral mammogram obtained after wire deployment confirms positioning of four localizing wires. Calcifications extend anterior to most of anterior localizing wire, but localization of most anterior extent of calcium would have required insertion through areola. Surgeon was alerted that calcifications extended anterior to wires, and surgeon planned to extend excision anteriorly into left retroareolar region.

 


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  		Fig. 1F. —42-year-old asymptomatic woman with abnormal findings on screening mammogram. Specimen radiograph shows four localizing wires and extensive calcifications, with calcification extending close to anterior margin (arrow). Surgical histologic analysis yielded ductal carcinoma in situ (DCIS) and focus of microinvasion. Surgical margins were free of tumor.

 


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  		Fig. 1G. —42-year-old asymptomatic woman with abnormal findings on screening mammogram. Magnified (x1.5) left mediolateral oblique mammogram obtained after surgery shows postoperative scarring, with no residual calcifications suggestive of cancer.

 


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  		Fig. 2A. —37-year-old asymptomatic woman with history of right mastectomy for breast cancer. Left mediolateral oblique mammogram shows spiculated mass with pleomorphic and linear calcifications (arrows) spanning approximately 3.5 cm.

 


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  		Fig. 2B. —37-year-old asymptomatic woman with history of right mastectomy for breast cancer. Radiograph obtained during stereotactic 11-gauge directional vacuum-assisted biopsy shows calcification in stereotactic biopsy specimens. Histologic analysis yielded infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS).

 


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  		Fig. 2C. —37-year-old asymptomatic woman with history of right mastectomy for breast cancer. Left mediolateral mammogram obtained after wire deployment shows bracketing wires delineating lesion borders (arrows).

 


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  		Fig. 2D. —37-year-old asymptomatic woman with history of right mastectomy for breast cancer. Left exaggerated craniocaudal mammogram obtained after wire deployment confirms location of bracketing wires on orthogonal projection, delineating boundaries of calcifications (arrows). Surgical histology revealed infiltrating ductal carcinoma measuring up to 0.6 cm and DCIS. Surgical margins were free of tumor.

 


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  		Fig. 3A. —65-year-old asymptomatic woman with history of left lumpectomy for ductat carcinoma in situ (DCIS). Right mediolateral oblique mammogram shows pleomorphic microcalcifications in segmental distribution spanning 4.5 cm (arrows).

 


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  		Fig. 3B. —65-year-old asymptomatic woman with history of left lumpectomy for ductal carcinoma in situ (DCIS). Right mediolateral oblique mammogram shows two bracketing wires delineating lesion borders (arrows). Histologic analysis yielded 0.2-cm infiltrating ductal carcinoma as well as extensive DCIS extending close to inked margins.

 


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  		Fig. 3C. —65-year-old asymptomatic woman with history of left lumpectomy for ductal carcinoma in situ (DCIS). Right mediolateral oblique mammogram obtained 2 weeks after surgery shows hematoma at biopsy site, with small focus of residual pleomorphic calcifications at inferior aspect of hematoma (arrow).

 


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  		Fig. 3D. —65-year-old asymptomatic woman with history of left lumpectomy for ductal carcinoma in situ (DCIS). Right mediolateral oblique mammogram obtained after preoperative needle localization and before reexcision shows wire localizing residual calcifications (arrows).

 


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  		Fig. 3E. —65-year-old asymptomatic woman with history of left lumpectomy for ductal carcinoma in situ (DCIS). Specimen radiograph from reexcision shows localizing wire and calcifications (arrow). Histologic analysis revealed DCIS with clear margins.

 

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