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Sanderink WBG, Strobbe LJA, Bult P, Schlooz-Vries MS, Lardenoije S, Venderink DJ, Sechopoulos I, Karssemeijer N, Vreuls W, Mann RM. Minimally invasive breast cancer excision using the breast lesion excision system under ultrasound guidance. Breast Cancer Res Treat 2020; 184:37-43. [PMID: 32737712 PMCID: PMC7568696 DOI: 10.1007/s10549-020-05814-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/15/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE To assess the feasibility of completely excising small breast cancers using the automated, image-guided, single-pass radiofrequency-based breast lesion excision system (BLES) under ultrasound (US) guidance. METHODS From February 2018 to July 2019, 22 patients diagnosed with invasive carcinomas ≤ 15 mm at US and mammography were enrolled in this prospective, multi-center, ethics board-approved study. Patients underwent breast MRI to verify lesion size. BLES-based excision and surgery were performed during the same procedure. Histopathology findings from the BLES procedure and surgery were compared, and total excision findings were assessed. RESULTS Of the 22 patients, ten were excluded due to the lesion being > 15 mm and/or being multifocal at MRI, and one due to scheduling issues. The remaining 11 patients underwent BLES excision. Mean diameter of excised lesions at MRI was 11.8 mm (range 8.0-13.9 mm). BLES revealed ten (90.9%) invasive carcinomas of no special type, and one (9.1%) invasive lobular carcinoma. Histopathological results were identical for the needle biopsy, BLES, and surgical specimens for all lesions. None of the BLES excisions were adequate. Margins were usually compromised on both sides of the specimen, indicating that the excised volume was too small. Margin assessment was good for all BLES specimens. One technical complication occurred (retrieval of an empty BLES basket, specimen retrieved during subsequent surgery). CONCLUSIONS BLES allows accurate diagnosis of small invasive breast carcinomas. However, BLES cannot be considered as a therapeutic device for small invasive breast carcinomas due to not achieving adequate excision.
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Affiliation(s)
- W B G Sanderink
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - P Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M S Schlooz-Vries
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Lardenoije
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - D J Venderink
- Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - I Sechopoulos
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - N Karssemeijer
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - W Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - R M Mann
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
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Özçağlayan TİK, Gürdal SÖ, Öznur M, Özçağlayan Ö, Doğru M, Topçu B. Effectiveness of the diagnostic pathway of BLES: could it be safely used as a therapeutic method in selected benign lesions? Diagn Interv Radiol 2019; 25:428-434. [PMID: 31650964 PMCID: PMC6837293 DOI: 10.5152/dir.2019.18427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/03/2019] [Accepted: 02/18/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE In this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and a practical alternative technique to surgical biopsy and other percutaneous biopsy methods for suspicious lesions. We also wanted to share our initial experience with BLES and compare it with standard percutaneous biopsy methods. METHODS From July 2015 to December 2016, a total of 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in the study. These lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) 3 or 4, which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively. The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed. RESULTS After BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases (2%), and spontaneous remission was observed. Two patients (4%) complained of pain during the procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 (<0.5 mm) damage in 88%, Grade 1 (0.5-1.5 mm) in 10%, Grade 2 (>1.5 mm or thermal damage in diffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015). CONCLUSION BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and atypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.
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Affiliation(s)
- Tuğba İlkem Kurtoğlu Özçağlayan
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Sibel Özkan Gürdal
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Meltem Öznur
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Ömer Özçağlayan
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Mücahit Doğru
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Birol Topçu
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
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Sanderink WBG, Laarhuis BI, Strobbe LJA, Sechopoulos I, Bult P, Karssemeijer N, Mann RM. A systematic review on the use of the breast lesion excision system in breast disease. Insights Imaging 2019; 10:49. [PMID: 31049740 PMCID: PMC6497703 DOI: 10.1186/s13244-019-0737-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/20/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose To outline the current status of and provide insight into possible future research on the breast lesion excision system (BLES) as a diagnostic and therapeutic device. Methods A systematic search of the literature was performed using PubMed, Embase, and the Cochrane databases to identify relevant studies published between January 2002 and April 2018. Studies were considered eligible for inclusion if they evaluated the diagnostic or therapeutic accuracy or safety of BLES. Results Ultimately, 17 articles were included. The reported underestimation rates of atypical ductal hyperplasia and ductal carcinoma in situ (DCIS) ranged from 0 to 14.3% and from 0 to 22.2%, respectively. Complete excision rates for invasive ductal carcinoma and DCIS ranged from 5.3 to 76.3%. Bleeding was the most frequently reported complication (0–11.8%). Device-related complications may arise, with an empty basket being the most common (0.6–3.6%). Thermal damage of the specimen, caused by the use of a radiofrequency cutting wire, was reported in eight of the included studies. Most thermal artifacts were reported as superficial and small (0.1–1.9 mm). Conclusions The BLES, an automated, image-guided, single-pass biopsy system for breast lesions using radiofrequency is designed to excise and retrieve an intact tissue specimen. It is an efficient and safe breast biopsy method with acceptable complication rates, which may be used as an alternative to vacuum-assisted biopsies. The variable rate of complete excision raises questions about the possibility to use BLES as a therapeutic device for the excision of small lesions. Further research should focus on this aspect of BLES.
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Affiliation(s)
- Wendelien B G Sanderink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Babette I Laarhuis
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
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Christou A, Koutoulidis V, Koulocheri D, Panourgias E, Nonni A, Zografos CG, Zografos GC. Role of one-pass breast lesion excision system in complete excision of high-risk breast lesions with atypia expressed as clusters of microcalcifications. Eur Radiol 2019; 29:3149-3158. [PMID: 30617496 DOI: 10.1007/s00330-018-5925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/30/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the role of the breast lesion excision system (BLES) in complete removal of clusters of microcalcifications found on mammogram proved histologically to be high-risk lesions with cell atypia. METHODS AND MATERIALS Three hundred ninety-four consecutive women (mean age 58.5 years, range 39-78 years) with 400 clusters of suspicious microcalcifications underwent stereotactic biopsy using the intact BLES device between January 2014 and January 2016. All cases proved histologically to be high-risk lesions were subsequently assessed for complete removal. The underestimation rate was also assessed. RESULTS Thirty-eight out of 400 (9.5%) lesions were high-risk lesions with atypia with mean size 7.63 mm (st. dev. = 4.03 mm) which was within the size that the BLES needle can excise (20 mm). Four (10.5%) papillomas with atypia, 14 (36.8%) cases with flat epithelial atypia (FEA), 10 (26.3%) cases with lobular intraepithelial neoplasia (LIN-LIN 1, LIN 2), 8 (21.2%) with atypical ductal hyperplasia (ADH) and 2 (5.3%) cases with mucocele-like lesions (MLL) with atypia were found. Twenty-nine out of 38 lesions had subsequent surgery. Complete excision was achieved in 23/29 lesions (79.3%). No underestimation was found. Two-year mammographic stability was found in all lesions. Non-parametric statistical analysis showed no other significant predictive factor for complete excision apart from the distance of the lesions from the specimen margins (p = 0.031 Mann-Whitney test). CONCLUSION One-pass BLES intact biopsy technique is a safe method of complete removal of high-risk atypical lesions with high accuracy rates for certain histologies and could be potentially used as an alternative excision method to diagnostic surgery in selected cases. KEY POINTS • Breast lesion excision system (BLES) is an image-guided biopsy technique that uses radiofrequency to remove an intact piece of tissue including the target breast neoplasm. • Breast lesion excision system (BLES) under stereotactic guidance is able to accurately biopsy high-risk breast lesions expressed mammographically as clusters of suspicious microcalcifications. • BLES under stereotactic guidance is an accurate technique for en bloc excision of selected cases of small clusters of suspicious microcalcifications proved to be high-risk lesions with histopathologically disease-free margins of excision.
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Affiliation(s)
| | - Vassilis Koutoulidis
- 1st Department of Radiology Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Koulocheri
- Department of Radiology, Breast Unit Hippokration Hospital, Athens, Greece
| | - Evangelia Panourgias
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens Areteion Hospital, Athens, Greece
| | - Afrodite Nonni
- 1st Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - George C Zografos
- Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Advances in breast intervention: where are we now and where should we be? Clin Radiol 2017; 73:724-734. [PMID: 29224890 DOI: 10.1016/j.crad.2017.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/31/2017] [Indexed: 11/21/2022]
Abstract
In the past four decades, a variety of methods for minimal or non-invasive diagnosis and treatment of breast cancer have been introduced. Although breast imaging has become more and more specific for diagnosis, specimen biopsy with histopathological confirmation is still necessary. Core-needle biopsy under ultrasound guidance is the appropriate first choice for the diagnosis of most lesions. Fine-needle aspiration is of interest for identification of the presence of metastatic disease in abnormal lymph nodes. For microcalcifications, vacuum-assisted biopsy is recommended, especially with stereotactic guidance. In recent years different therapeutic techniques have been developed for the treatment of solid lesions, including breast cancer. Certainly, with the improvement of technology and medical scientific progress, it is becoming more common to use minimal- or non-invasive therapies. The proposed minimally invasive techniques may offer complete treatment of breast cancer, with better cosmetic results, less psychological stress, and shorter hospital stays. In this article, the strengths and weaknesses of the different diagnostic and therapeutic techniques are presented, and promising techniques for the future are discussed.
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Sklair-Levy M, Rayman S, Yosepovich A, Zbar A, Goitein D, Zippel D. The Intact ® breast lesion excision system as a therapeutic device for selected benign breast lesions. Breast J 2017; 24:304-308. [PMID: 29024205 DOI: 10.1111/tbj.12931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/18/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
The aim of this paper is to evaluate our Unit's initial experience using the Intact breast lesion excision system as a therapeutic excision option for benign or borderline breast lesions, which otherwise would entail open operative excision. The study includes the first 111 patients who underwent therapeutic excision with the intact radiofrequency system between December 2012 and May 2016 performed at the Meirav Center for Breast Health, at the Chaim Sheba Medical Center, Ramat Gan Israel. The indications for the procedure included those patients who have benign, or atypical high risk lesions following a previous core needle biospy (CNB) who would have normally undergone conventional excision biopsy. After reviewing each case separately, we found that the use of the BLES system as a treatment device permitted the avoidance of operations that would have been otherwise indicated, in 98 cases of the total 111 in the cohort (88.3%). Thirteen cases eventually had to undergo surgical excision. In eight cases pathology was upgraded from the initial CNB to invasive or noninvasive carcinoma. Although the INTACT sysytem is most commonly used as an alternative biopsy technique for its diagnostic capabilities, this study assessed its clinical role as a definitive therapeutic excisional modality in selected cases of benign breast disease. It proved valuable in the majority of cases with avoidance of surgery where it was traditionally indicated, (98/111, 88.3%) and as definitive fibroadenoma management in a further 28 patients.
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Affiliation(s)
- Miri Sklair-Levy
- Department of Diagnostic Radiology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Rayman
- Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ady Yosepovich
- Department of Pathology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Andrew Zbar
- Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - David Goitein
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Douglas Zippel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
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Margin-free excision of small solid breast carcinomas using the Intact Breast Lesion Excision System ®: is it feasible? Breast Cancer 2017; 25:134-140. [PMID: 28918560 DOI: 10.1007/s12282-017-0802-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Breast Lesion Excision System® (BLES®) is a stereotactic vacuum-assisted breast biopsy device that utilizes radiofrequency in order to excise non-palpable mammographic lesions for pathologic diagnosis. The purpose of this study was to evaluate the efficacy of BLES® in performing complete, margin-free excisions of small solid carcinomas. METHODS Our retrospective study of prospectively enrolled patients included 50 cases of non-palpable, BIRADS ≥ 4, solid by means of mammography and sonography, lesions. All these patients underwent a BLES® breast biopsy procedure from June 2010 to June 2014 and had a malignant diagnosis. According to each patient's pathologic diagnosis, appropriate surgical treatment was recommended. Postoperatively, surgical specimens were histologically analyzed, aiming to determine whether residual malignant disease was present in the specimen cavity formatted by BLES®. RESULTS Ductal carcinoma in situ (DCIS) was diagnosed in 5 patients and invasive carcinoma (IC) in 45 patients, at primary BLES® pathology report. Tumor-free resection margins (< 0.5 and < 1 mm) were accomplished in only 8/24 subcentimeter cases (33.3%). Absence of residual disease upon surgical excision was confirmed in 23/24 subcentimeter cases (95.8%) and 2/26 of the cases measuring > 1 cm (7.69%). Statistical analysis revealed that mammographic size was the only significant prognostic factor for complete excision (i.e., with no residual disease in the biopsy cavity) of a malignant lesion. CONCLUSIONS Our results indicate that it is possible, when using the BLES® device, to completely excise small (≤ 10 mm) breast carcinomas that appear radiologically as solid lesions. This subset of patients should be investigated regarding the therapeutic potential of this method.
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