[Non-palpable lesions of the breast. Preoperative location techniques with vegetable charcoal].

PURPOSE

Mammography and US increase the rate of early breast cancer diagnoses. The difficult intraoperative location of nonpalpable lesions has led to the development of various techniques suitable to this purpose. We investigated the effectiveness of free-hand vegetable charcoal lesion marking during both mammography and US and compared this technique with other more commonly used methods.

MATERIAL AND METHODS

Our series consisted of 485 consecutive charcoal markings of nonpalpable breast lesions submitted to histologic examination. Marking was carried out free-hand under mammographic guidance in 392 cases and under US guidance in 93 cases. The technique, presented in the paper with schematic drawings, was successful because the surgeon correctly identified the charcoal tracing in all 485 cases. There were no complications, neither during charcoal introduction nor during surgery.

RESULTS

The comparison with other marking techniques showed the following advantages of our method: 1) it is rapid and easy to perform; 2) patient discomfort is minimal and no local anesthesia is needed; 3) it is accurate and there are no risks of charcoal displacement or spread; 4) the tracing charcoal is easy to find; 5) the most appropriate surgical route can be followed, with consequently better cosmetic results in the patients not undergoing quadrantectomy; 6) surgery can be performed on an outpatient basis under local anesthesia; 7) a minimal amount of glandular tissue is removed; 8) there are absolutely no side-effects; 9) cost is low; 10) surgery can be planned over time; 11) there is no risk of cutting the wire with an electrotome; 12) no particular equipment or instruments are needed; 13) there are no problems in very superficial lesions.

CONCLUSIONS

To conclude, on account of our results and of so many advantages, we believe that free-hand vegetable charcoal marking during mammography and US is now the best possible solution to the problem of surgical identification of nonpalpable breast lesions.