Reduce Mastectomies with Multiple Wire Localization

In women who would normally undergo mastectomy for a large breast tumor, breast conservation via lumpectomy can be a reality thanks to the use of multiple wires to define the extent of calcifications, according to study results recently published in the Journal of the American College of Surgeons. For the study, Dr. Barbara L. Smith, Massachusetts General Hospital, Boston, and colleagues compared the records of 153 women with large lesions that were managed with multiple wire localization and lumpectomy with 196 women who required single-wire localization and lumpectomy. They found that 77% of the former group and 90% of the latter had successful breast conservation, thanks in part to the likelihood of clear margins in the primary surgery that was afforded with the localizing wires; re-excision was necessary in 28% of those who underwent multiple-wire localization and 36% of 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 team concluded. “The placement of multiple localizing wires can more precisely guide the extent of operation and reduce the need for re-excision.”

Smith advised that mastectomy shouldn’t be assumed as the best option for larger or eccentrically shaped mammographic lesions, as lumpectomy may still be possible following multiple or single wire localization. “This approach is also enhanced by recent 'oncoplastic' surgical approaches,” said Smith. “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.”

Is multiple wire localization an option you would recommend for your patients? As a medical oncologist, would you request it for your breast cancer patients? As a surgical oncologist, why wouldn’t you offer it to a breast cancer patient? E-mail us to tell us what you think!