The wide application of screening mammography
has led to an increase in diagnosis of non
palpable breast lesions (NPBL), representing nowadays
20% of all malignant breast tumors. The finding of a
NPBL represents a clinical problem that involves the
competences of different specialists as radiologist,
pathologist and surgeon. The present study analyses a
series of 167 patients observed during the last twelve
years at the Surgical Clinic of the University of Trieste.
Diagnosis was made in 83.3% of cases in screening
programs and in remaining patients with risk factors.
One-hundred and twenty-one patients (72.46%) underwent
ultrasound. Seventy-seven cases underwent
FNAB. All the patients underwent excisional biopsy after
surgical needle localization under X-ray or ultrasound
guidance. Histological examination was performed
intraoperatively on frozen sections only in the
first years; now we performed always a postoperative
histological examination in microcalcifications and in
lesions <1 cm. Incidence of C1 was significantly higher
in the X-ray guided biopsies vs ecography (58.6% vs
9.7%). Histological examinations identified 72 benign
lesions and 95 cancer (benign/malignant = 0.5). Seventy-
one quadrantectomies and 24 mastectomies were
performed with axillary dissection. Since 2 years we
routinely performed the sentinel node biopsy. The following
conclusions may be drawn: NPBL represents
23.7% of all breast cancers and 47.7% of all T1; mammography
is the first step of a correct diagnostic procedure
with increased specificity when associated to ultrasound.
FNAB attains nowadays a sensibility of nearly
100% and the rate of inadequate specimens is generally
rather low; the final goal is to decrease surgery for benign
lesions. Once again a multidisciplinary approach is
mandatory.
