Bracketing comprises of using two or more needles for localization of boundaries of an impalpable breast lesion. The tissue around the wires is excised and sent for histopathology. Objectives: To determine the accuracy & adequacy of pre-operative bracketing for therapeutic excision of non-palpable malignant breast lesions and in achieving tumor free margins.
Retrospective review of mammograms & pathology reports of patients who underwent bracketing for malignant breast lesions at AKUH from January 2004 to April 2016. All cases of clinically non-palpable primary malignant breast lesions requiring therapeutic excision and with complete clinical response to Neoadjuvant therapy targeted for breast conservation were included whereas those with benign pathology were excluded.
76 patients with mean age of 48.09 years (range 25 - 81 years) underwent bracketing for excision of both benign and malignant breast lesions. 62 patients underwent breast conservation surgery for a pre-operative diagnosis of IDC (n = 56), ILC (n = 3), DCIS (n = 2) and metaplastic carcinoma (n = 1) with the help of bracketing. 85.5% (n = 53) received neo-adjuvant chemotherapy to reduce the size of lump. 93.5% (n = 58) underwent stereotactic wire localization, 4.8% (n = 3) underwent sonographic localization whereas 1.6% (n = 1) was localized with the help of both mammogram and ultrasound. Presence of radiopaque marker within the excised specimen and grossly adequate margins around the lesion guided the surgeon to decide about further margin excision. 95.2% (n = 59) had negative margins of the breast lump and 2 out of 62 patients (3.2%) had close margins (DCIS at 0.1cm from closest margin). 1.6% (n = 1) patient had invasive tumor at the margin. None of the re-excised tissue in 2 patients with close margins showed any evidence of tumor in the final histopathology report except the patient with positive margin who underwent second procedure of margin excision followed by mastectomy
Our study showed that bracketing wire localization is a beneficial procedure in terms of achieving clear histologic margins in breast conservation surgery without significant increase in the rate of re-excision
Clinical trial identification
Legal entity responsible for the study
The Aga Khan University and Hospital
The Aga Khan University Hospital
All authors have declared no conflicts of interest.