Lesioni non palpabili della mammella: strategie diagnostiche e terapeutiche

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.