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Wire Localization Biopsy of the Breast

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What is the test?

For a surgical biopsy, the surgeon makes an incision in the skin and removes all or part of the abnormal tissue for examination under a microscope. Unlike needle biopsies, a surgical biopsy leaves a visible scar on the breast and sometimes causes a noticeable change in the breast's shape. It's a good idea to discuss the placement and length of the incision with your surgeon beforehand. Also ask your surgeon about scarring and the possibility of changes to your breast shape and size after healing, as well as the choice between local anesthesia and general anesthesia.

Sometimes an abnormal area will be seen on the mammogram that clearly should be tested for cancer or completely removed from the breast, but this area is not easily felt as a lump on examination. The mammography department can help your surgeon to find the area more easily by using a technique called "wire localization."

In this technique, the radiologists (who have had the benefit of seeing the abnormal area on your mammograms) mark the abnormality with a wire that is inserted under your skin into the area of breast that is causing concern. Right afterward, the surgeon can meet you in the operating room and can use the wire to find the abnormal spot in your breast so that he or she can remove it.

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How do I prepare for the test?

You'll undergo a breast exam and possibly a mammogram before the biopsy to determine where the lump is located. If you are having a sedative with local anesthesia, or if you are having general anesthesia, you'll be asked not to eat anything after midnight on the day before the surgery.

Tell your doctor if you're taking insulin, NSAIDs, or any medicine that can affect blood clotting. You might have to stop or adjust the dose of these medicines before your test.

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What happens when the test is performed?

The first part of this procedure occurs in the mammography department. Although you probably just recently had a mammogram, a radiologist will perform another one to find the abnormal area. While watching your x-ray on a screen, the radiologist will then decide where in your breast the abnormality must be. He or she will insert a needle into your breast in this area and will take another mammogram picture that shows the needle in place, to be sure the end of the needle is (hopefully) right in the middle of the area of concern. The needle might require some adjustment so that it is placed just right.

The needle is hollow and the radiologist can slide a small wire right through it. This wire has a tiny fishhook on its end so when the end of the wire reaches the point of the needle in your breast, it can grab onto your breast tissue and hold itself in place. Then the needle can be pulled out, sliding over the outside end of the wire and leaving the wire in your breast.

You will be taken to the operating room for the second part of the biopsy. You will have an IV (intravenous) line placed in your arm so that you can receive medicines through it. Your procedure may be done under either "local" or "general" anesthesia. Local anesthesia is similar to the kind most people get at the dentist — a numbing medicine is injected in a few places under the skin surface so that you won't feel anything in the specific area that will be worked on during the surgery. General anesthesia, on the other hand, causes you to be asleep and unconscious during the procedure and is administered by an anesthesiologist. For general anesthesia, you breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube may be put down your throat to help you breathe.

An incision will be made in your breast right where the wire sticks out of your skin. The surgeon will feel along the wire and separate the breast tissue from the wire until he or she finds where the end of the wire is hooked into your breast. The surgeon knows that it is the area right at the end of the wire that looks abnormal on your mammogram and needs removal. He or she will take out a small sample of breast tissue from the area surrounding the end of the wire — the wire will be removed with the chunk since it will still be holding onto the middle of it.

Any light bleeding is stopped with a wand-like instrument called a "cauterizer" that uses an electric current to seal the ends of bleeding blood vessels. So that you do not feel any electric shock from the cauterizer, your doctor will have attached a plastic pad to your leg, back, or abdomen that works to ground the current.

While you are still in the operating room, your surgeon will give the breast lump he or she has removed (still with the wire attached) to your radiologist. The radiologist will take a special x-ray of your removed lump of breast to see if it looks the same as the spot that had worried him or her on your mammogram. Then he or she can confirm for the surgeon that the correct piece has been removed.

Right afterward, your surgeon might give the same piece of tissue to a pathologist. The pathologist will put dye around the outside of the lump and take a quick look at a few slices of the tissue under a microscope. The pathologist can then tell the surgeon if it looks like cancer or not. If there is cancer inside the lump and if the cancer reaches out all the way to the edges with the colored dye, the pathologist might advise your surgeon to remove some extra tissue from around the edges, increasing the likelihood that the whole cancer will have been removed. If enough tissue has been removed to protect you, your surgeon will then stitch your wound closed.

If you have had general anesthesia, you will have your anesthesia stopped so that you can wake up within a few minutes of your biopsy being finished.

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What risks are there from the test?

Following a surgical breast biopsy, you'll have a short scar in the shape of a line. There may also be some distortion in the shape of the breast depending on its size, and the amount of tissue removed and its location. Expect to feel some soreness and swelling near the surgery site for a few days. There are also some risks associated with anesthesia, although the risk of general anesthesia is lower for breast surgery than for other forms of surgery, because the anesthesia isn't used for very long and the surgery is only slightly more than skin deep.

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Must I do anything special after the test is over?

Medical staff monitor you for a few hours after your surgery to make sure that you're recovering well and not having any adverse reactions to anesthesia. Contact your doctor if you develop a fever, strong pain at the incision site, or bleeding from the incision. You may need a follow-up visit so that your doctor can remove stitches and make sure you are recovering well.

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How long is it before the result of the test is known?

A preliminary report from the pathologist might be available when your surgery is over.A final report typically takes three to four days.

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