New Type of Percutaneous Needle Biopsy with Introduction of Clips for Localization of Breast Lesions

INTRODUCTION: Breast cancer is the most common malignant neoplasm among women. With the aim of achieving the early diagnosis of breast cancer, annual screening with mammography is recommended starting from 40 years of age in Brazil. Usually these methods detect small changes in the breast, identified according to standardized BI-RADS® classification, in which biopsies are warranted for Category 4 and Category 5 lesions. Many of these lesions are so small that sometimes the biopsy itself removes the entire lesion, requiring some form of marking the location where the lesions were in case surgical resection is needed and return to the previously biopsied site is needed. Another group of patients who require the placement of metallic clips in the tumor bed are those patients with tumors who undergo neoadjuvant chemotherapy in order to preserve the breast since the lesion may disappear and the bed should be surgically resected prior. There are two mechanisms for marking the bed of these lesions on the market: one which involves placing a clip through large-core needle and the other by mammotomy, which has high prices and that are not covered by most health plans or by the Unified Health Care System (SUS). For patients who need biopsy with clip placement and do not have access to these procedures, the option is conventional surgical biopsy, which is usually performed by preoperative marking with radioguided occult lesion localization (ROLL), requiring nuclear medicine service or by the placement of a metal wire by stereotactic marking. The surgery is usually performed under general anesthesia and patients are admitted from one to two days, and are away from their professional activities for a period of 5-7 days. In order to provide the marking of the biopsy bed effectively and cheaper, we have developed methodology for the same metal clip already used in open surgery to be introduced through a large- core needle. METHODOLOGY: A nonrandomized prospective study with patients requiring biopsy with placement of a metallic marker in the surgical bed (non-palpable BI-RADS® Category 4 and Category 5 lesions) or patients who will undergo neoadjuvant chemotherapy with the intention of preservation of the breast. The biopsy should be conducted as in the usual manner and at the end of the procedure, the mandrel should be removed from within the needle, and the needle must be repositioned at the biopsy site with the aid of the method that guided the original procedure (ultrasound or mammography). Complying with the rigors of asepsis, the metal clip with the aid of forceps must be placed inside the needle, and with the aid of a metallic sheath, the clip must be inserted to the end of the needle housing to the biopsy site / within the tumor. Mammography must be performed at the end of the procedure to ensure the correct positioning of the clip. All material used is sterile and controlled by the Central Sterile Supplies Unit. DISCUSSION: This procedure has low cost, is easy to perform with high reproducibility, can avoid many surgeries and hospitalizations, and facilitate the prompt return of patients to work when used for non-palpable lesions, aside from being able to be used more often for patients in neoadjuvant chemotherapy protocol. Both circumstances certainly provide cost savings to SUS and health insurance companies.