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Using multiple wires to define the extent of calcifications allows breast conservation in women who would otherwise undergo mastectomy for larger tumors, according to a report.

Using multiple wires to define the extent of calcifications allows breast conservation in women who would otherwise undergo mastectomy for larger tumors, according to a report in the September Journal of the American College of Surgeons.

"Don't automatically rush to mastectomy for larger or eccentric shaped mammographic lesions," advises senior author Dr. Barbara L. Smith from Massachusetts General Hospital, Boston, Massachusetts. "Lumpectomy may still be possible."

Dr. Smith and her colleagues sought to determine whether using multiple localizing wires to define lesion volume more precisely would allow breast conservation in patients who otherwise would have received a recommendation for mastectomy. For the analysis, they compared records of 153 women with larger lesions that were managed with multiple wire localization and lumpectomy and 196 lumpectomy patients who required only single wire localization.

More than three quarters of women requiring multiple wire localization (77 per cent) had successful breast conservation, the authors report, compared with 90 per cent of women whose lesions required only single wire localization.

The use of multiple localizing wires significantly improved the likelihood of clear margins in the primary surgery, with re-excision necessary in 28 per cent of the women with the larger lesions vs 36 per cent of those in the single-wire group.

"Our data demonstrate that high rates of breast conservation may be achieved through the use of multiple localizing wires in patients with larger mammographic abnormalities," the investigators conclude. "The placement of multiple localizing wires can more precisely guide the extent of operation and reduce the need for re-excision."

"This approach is also enhanced by recent 'oncoplastic' surgical approaches," Dr. Smith told Reuters Health. "This involves the breast cancer surgeon utilizing plastic surgery techniques to shift tissue to close the lumpectomy cavity in a cosmetic way and improve the final appearance."

"This lumpectomy approach also requires the patient to undergo radiation after lumpectomy - the standard for nearly all lumpectomies in current practice."

J Am Coll Surg 2008;207:342-346