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van de Voort EM, Struik GM, Birnie E, Sinke RH, Verver D, van Streun SP, Macco M, Verhoef C, Klem TM. Implementation of vacuum-assisted excision as a management option for benign and high-risk breast lesions. Br J Radiol 2023:20220776. [PMID: 37171394 DOI: 10.1259/bjr.20220776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Previous studies have shown that vacuum-assisted excision (VAE) is a safe and effective alternative for surgical excision (SE) of benign breast lesions. However, the use of VAE in high-risk lesions is controversial and guidelines are ambiguous. This study describes the impact of the implementation of VAE in terms of management and outcomes compared to a cohort before implementation. METHODS A single centre retrospective study with two cohorts: 'before' and 'after' implementation of VAE was performed. All patients with a benign or high-risk lesion treated by VAE or SE between 2016 and 2019 were included. Excision, complication, and upgrade rates were compared between both cohorts. Cox regression was used for the evaluation of recurrences and re-excisions. RESULTS The overall excision rate of all benign and high-risk lesions was comparable in both cohorts (17% vs 16%, p = 0.700). After implementation, benign lesions were significantly more often managed by VAE (101/151, 67%, p < 0.001). Re-excision, recurrence, and complication rates were low and comparable between cohorts (4.3% vs 3.9%, p > 0.999; 3.0 vs 2.0%, p = 0.683; 3.4 vs 6.6%, p = 0.289, respectively). CONCLUSION SE could safely be replaced by VAE in 58% of patients treated for a benign or high-risk lesion. With this shift in management, the use of operating rooms and general anaesthesia can safely be omitted in this patient group. Further research on high-risk lesions is warranted since our data are exploratory. ADVANCES IN KNOWLEDGE This study provides supportive data for the use of VAE as a management option for both benign (up to 5 cm) and high-risk lesions. Outcomes on re-excision, recurrence should be confirmed in prospective studies especially in high-risk lesions.
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Affiliation(s)
- Elles Mf van de Voort
- Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands
- Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg, Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, Netherlands
| | - Renata Hja Sinke
- Department of Pathology, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands
| | - Daniëlle Verver
- Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands
| | | | - Maura Macco
- Department of Radiology, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands
| | - Taco Mal Klem
- Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands
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Soliman AH. Ultrasound-guided vacuum-assisted excision biopsy in breast fibroadenomas: an Egyptian center experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00874-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Benign breast tumors although classified as benign lesions but excising them remain a troublesome problem. Surgical excision for benign breast lesions frightens most of female population suffering from such a problem, which created an urgency to search for a safe and effective alternative. My aim was to assess the efficacy of vacuum-assisted biopsy (VAB) excision system for the removal of benign breast lesions in terms of complete excision rate and incidence of complications.
Results
Twenty-three female patients with 29 twenty-nine lesions were included in our study. Mean age was 33 years (19–52 years). The incidence of complete excision was 100% in follow-up with 3 drop outs. The largest diameter of the tumors ranged from 1.2 to 3.3 cm. Rate of occurrence of complications in form of intra-procedural pain, 69% of our patients experienced mild intra-procedural pain with visual analog pain scale (VAS) score (1–3).21% experienced moderate pain with VAS score (4–6).8% experienced no pain. Patients who developed post procedural ecchymosis were 17% while hematoma group of patients were 10% of total number of patients.
Conclusions
The study showed that the use of vacuum-assisted biopsy excision system could provide a safe method for complete excision of fibroadenomas, with low rate of complications as incomplete excision, pain, and hematoma formation.
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Guo W, Li F, Jia C, Wang T, Zhang X, Yao G, Shi X, Bai M. The clinical value of conventional ultrasound combined with contrast-enhanced ultrasound in the evaluation of BI-RADS 4 lesions detected by magnetic resonance imaging. Br J Radiol 2022; 95:20220025. [PMID: 35604699 PMCID: PMC10162066 DOI: 10.1259/bjr.20220025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine the value of conventional ultrasound combined with contrast-enhanced ultrasound (CEUS) in Breast Imaging Reporting and Data System (BI-RADS) Category 4 lesions as detected by MRI. METHODS A total of 176 breast lesions from 171 patients were detected by MRI and categorised as BI-RADS 4. All patients also underwent ultrasound and CEUS scans. The combination of ultrasound-BI-RADS and CEUS 5-point scoring system created the Rerated BI-RADS (referred to as CEUS-BI-RADS). The diagnostic performances of ultrasound and CEUS-BI-RADS were then compared. A χ2 test was used to compare the CEUS features of mass-like and non-mass-like enhancement types of MRI-BI-RADS 4 lesions. RESULTS There were 167 (167/176) breast lesions detected by ultrasound, with a detection rate of 94.89%, while all were subsequently detected by "second-look" ultrasound combined with CEUS, with a detection rate of 100%. The areas under the receiver operating characteristic curves for ultrasound and CEUS-BI-RADS were 0.810 and 0.940, respectively. The diagnostic efficiency of CEUS-BI-RADS was significantly higher than that of ultrasound alone (z = 3.264, p = 0.001). For both mass-like and non-mass-like enhancement types of MRI-BI-RADS 4 lesions, CEUS-BI-RADS demonstrated satisfactory sensitivity and accuracy. Moreover, 29 (29/176) category 4 lesions were downgraded to 3 by CEUS-BI-RADS. CONCLUSION Ultrasound combined with CEUS can allow reclassification, reduce biopsy rates, and facilitate pre-surgical localisation for biopsy or surgery for MRI-BI-RADS 4 lesions. ADVANCES IN KNOWLEDGE For MRI-BI-RADS Category 4 lesions with a wide range of malignancies, ultrasound combined with CEUS is a promising diagnostic approach with high clinical utility.
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Affiliation(s)
- Wenjuan Guo
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tong Wang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuemei Zhang
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gehong Yao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiudong Shi
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Bai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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van de Voort EMF, Struik GM, van Streun SP, Verhoef C, Uyl-de Groot CA, Klem TMAL. Hospital costs and cosmetic outcome of benign and high-risk breast lesions managed by vacuum-assisted excision versus surgical excision. Br J Radiol 2022; 95:20220117. [PMID: 35604725 PMCID: PMC10162056 DOI: 10.1259/bjr.20220117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives: Although vacuum-assisted excision (VAE) is a safe and effective alternative to surgical excision (SE), the latter is most commonly used for the management of benign and high-risk breast lesions. To evaluate the healthcare benefit of VAE, hospital costs and cosmetic outcome after VAE were compared to SE. Additionally, the impact of VAE implementation on hospital costs was investigated. Methods: This was a single-centre retrospective cohort study with two cohorts: “VAE” and “SE”. All patients with a benign or high-risk lesion excised by VAE or SE from January 2016 up to December 2019 were included. Cosmetic outcome was measured with the BCTOS-cosmetic subscale, and hospital costs were presented as mean (SD) and median (IQR). Results: During the study period, 258 patients with 295 excised lesions were included. The initial procedure was VAE in 102 patients and SE in 156 patients. Hospital costs after (median € 2324) were significantly lower than before (median € 3,144) implementation of VAE (mean difference € 1,004, p < 0.001), most likely attributable to the lower costs for patients treated with VAE (mean difference € 1,979, p < 0.001). Mean cosmetic outcome was comparable between VAE (median 1.35) and SE (median 1.44, p = 0.802). Conclusions: Implementing VAE as an alternative treatment option for benign and high-risk breast lesions resulted in a large decrease in hospital costs but a cosmetic benefit of VAE could not be demonstrated in this retrospective study. Advances in knowledge: Costs associated with the complete patient pathway were included and not only VAE was compared to SE but also the before cohort was compared to the after cohort to demonstrate the benefit of VAE implementation in clinical practice. Additionally, cosmetic outcome was compared between VAE and SE using patient reported outcome measures.
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Affiliation(s)
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Sophia P van Streun
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Carin A Uyl-de Groot
- Institute for Medical Technoloy Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Taco MAL Klem
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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Björnström M, Niinikoski L, Meretoja TJ, Leidenius MHK, Hukkinen K. Comparison of vacuum-assisted excision (VAE) and breast lesion excision system (BLES) in the treatment of intraductal papillomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:67-72. [PMID: 34728140 DOI: 10.1016/j.ejso.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aims to compare the feasibility of VAE and BLES in the treatment of intraductal papillomas. MATERIAL AND METHODS Patients with a suspected intraductal papilloma who underwent a BLES or a VAE procedure were included in this retrospective study. The BLES procedures were performed between November 2011 and June 2016 and the VAE procedures between May 2018 and September 2020 at the Department of Radiology of Helsinki University Hospital (HUH). The procedures were performed with an intent of complete removal of the lesions. RESULTS In total, 72 patients underwent 78 BLES procedures and 95 patients underwent 99 VAE procedures. Altogether 52 (60%) papillomas with or without atypia were completely removed with VAE, whereas 24 (46%) were completely removed with BLES, p = 0.115. The median radiological size of the high-risk lesions completely removed with BLES was 6 mm (4-12 mm), whereas with VAE it was 8 mm (3-22 mm), p = 0.016. Surgery was omitted in 90 (94.7%) non-malignant breast lesions treated with VAE and in 66 (90.4%) treated with BLES, p = 0.368. CONCLUSION Both VAE and BLES were feasible in the treatment of intraductal papillomas. In most non-malignant lesions surgery was avoided, but VAE was feasible in larger lesions than BLES. However, follow-up ultrasound was needed more often after VAE. The histopathologic assessment is more reliable after BLES, as the lesion is removed as a single sample.
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Affiliation(s)
- Michaela Björnström
- Radiology, HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 140, 00029, HUS, Finland.
| | - Laura Niinikoski
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 281, 00029, HUS, Finland.
| | - Tuomo J Meretoja
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 281, 00029, HUS, Finland.
| | - Marjut H K Leidenius
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 281, 00029, HUS, Finland.
| | - Katja Hukkinen
- Radiology, HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 140, 00029, HUS, Finland.
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Brzuszkiewicz K, Hodorowicz-Zaniewska D, Miękisz J, Matyja A. Comparison of two minimally invasive biopsy techniques - Breast Lesion Excision System and vacuum-assisted biopsy - for diagnosing and treating breast lesions. Arch Med Sci 2022; 18:1453-1459. [PMID: 36457991 PMCID: PMC9710256 DOI: 10.5114/aoms.2019.85656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The vacuum-assisted biopsy (VAB) and the Breast Lesion Excision System (BLES) are minimally invasive biopsy techniques, both used as diagnostic and therapeutic tools. The aim of the study is to compare these two methods and assess them in the context of discomfort, early and late complications and their diagnostic and therapeutic potential. MATERIAL AND METHODS The study involved 173 patients who underwent a VAB or a BLES breast biopsy in the period between 2009 and 2016. Approximately 3 months after the biopsy, the patients completed a questionnaire in which they assessed the procedure for discomfort associated with the procedure and the final cosmetic outcome. The cosmetic effect of the biopsy was also assessed by a surgeon. RESULTS The BLES and the VAB breast biopsies did not differ in terms of pain, duration, and discomfort of the procedure, breast bruising, breast tenderness about 24 h after the procedure or pain lasting over 3 months after the biopsy. Subsequently, the biopsies were evaluated in terms of the cosmetic effect assessed by the patient and by a surgeon and no differences were observed. There were no significant differences between the VAB and the BLES breast biopsies in the course of the procedure, early and late complications and cosmetic effect. CONCLUSIONS Since the BLES breast biopsy makes it possible to evaluate the margins, it is a good alternative to the open breast biopsy.
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Affiliation(s)
- Karolina Brzuszkiewicz
- First Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Diana Hodorowicz-Zaniewska
- First Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Andrzej Matyja
- Second Chair of Endoscopic, Metabolic and Soft Tissue Cancer Surgery, Jagiellonian University Medical College, Krakow, Poland
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Panzironi G, Moffa G, Galati F, Pediconi F. Ultrasound-guided 8-Gauge vacuum-assisted excision for selected B3 breast lesions: a preliminary experience. Radiol Med 2021; 127:57-64. [PMID: 34800217 DOI: 10.1007/s11547-021-01429-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Nowadays, surgical excision is no longer justified for all B3 lesions and a minimally-invasive therapeutic treatment has been encouraged. The aim of this study was to evaluate the feasibility and the therapeutic efficacy of ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of selected breast lesions of uncertain malignant potential (B3). MATERIAL AND METHODS From July 2018 to December 2019, 11/48 breast lesions classified as B3 after ultrasound-guided core needle biopsy were treated with US-VAE in our Institution. Inclusion criteria were: B3 nodules ultrasonographically detectable for which VAE is recommended by international guidelines2, size ranging between 5 and 25 mm, circumscribed margins, and lesion position at least 5 mm from the skin and the nipple. A radiological follow-up to evaluate the completeness of excision, the presence of post-procedural hematoma or of residual disease/recurrence was performed after 10 and 30 days and 6 and 12 months. 12-month ultrasound was considered the gold standard. All patients were asked to complete a satisfaction survey and a full assessment of the costs of US-VAE was performed. RESULTS Complete excision was achieved in 81.8% of US-VAE. No lesions were upgraded to carcinoma and no patients had to undergo surgery. No complications occurred during or after US-VAE. All patients were satisfied with the procedure and the cosmetic result (100%). US-VAE cost approximately 422 Euros per procedure. CONCLUSION US-VAE has proven to be an optimal tool for the therapeutic excision of selected B3 lesions, with high success rate, good patient compliance and considerable money savings compared to surgery. This technique has the potential to reduce unnecessary surgery and healthcare costs.
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Affiliation(s)
- Giovanna Panzironi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza - University of Rome, Rome, Italy
| | - Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences, Sapienza - University of Rome, Rome, Italy.
| | - Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza - University of Rome, Rome, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza - University of Rome, Rome, Italy
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Vacuum-Assisted Excision, Scarless Solution for Fibroadenoma Breast—A Single-Center Experience. Indian J Radiol Imaging 2021; 31:844-849. [PMID: 35136495 PMCID: PMC8817826 DOI: 10.1055/s-0041-1735651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Fibroadenoma is one of the most common benign breast lesions that is frequently surgically excised in breast practice.
Aim
The aim of this study was to determine the efficacy and safety of ultrasound-guided (USG) vacuum-assisted excision biopsy (VAEB) of fibroadenoma.
Settings and Design
A retrospective observational study.
Methods and Materials
A total of 113 patients with 163 fibroadenomas who underwent USG-guided VAEB under local anesthesia with 7G and 10G probes using an Encor Enspire equipment were included in the study. The patients were followed up after 1, 6, and 12 months. The fibroadenomas up to 4 cm were excised as per the U.S. Food and Drug Administration-approved guidelines of the American Society of Surgeons for percutaneous removal of benign breast lesions.
Results
The percentage of complete excision rate was 98.8% and the most frequent complication encountered was hematoma including immediate and delayed accounting for 3.06%. There were no recurrent lesions in our study.
Conclusion
USG-guided VAEB of benign breast lumps can be a safe and effective alternative to surgical excision and had better patient satisfaction in terms of efficacy and cosmesis.
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Kong Y, Lyu N, Wang J, Wang Y, Sun Y, Xie Z, Liu P. Does Mammotome biopsy affect surgery option and margin status of breast conserving surgery in breast cancer? Gland Surg 2021; 10:2428-2437. [PMID: 34527554 DOI: 10.21037/gs-20-701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/02/2021] [Indexed: 12/20/2022]
Abstract
Background The Mammotome, an image-guided, usually ultrasound-guided vacuum-assisted breast biopsy (US-VABB) system, has been widely used in the early diagnosis of breast disease and the complete excision of benign lesions. However, in some malignant lesions underestimated by U.S., whether Mammotome biopsy would affect the surgery option, especially the margin status in breast-conserving surgery (BCS), has never been studied. Methods Between 2015 and 2019, 198 patients with 200 lesions who have been diagnosed with breast cancer by Mammotome elsewhere received surgery by pathological confirmation in our center. The clinicopathological characteristics, surgery options, therapies, and the details of the specimen, such as margin status of BCS, tumor residual after VABB, and hematoma were reviewed. Results Among 200 lesions, 90% were evaluated below US-BIRADS 4b before Mammotome biopsy and 94.5% with a tumor size ≤3 cm. 131 patients received mastectomy (66.2%) and 67 received BCS (33.8%). Hematoma and tumor residual were observed in 37.5% and 71.5% of all lesions, respectively. There is a higher incidence of hematoma in the mastectomy group than in the BCS group (44.4% vs. 23.9%, P=0.005). In BCS group, the positive margin was found in 7 patients at first examination including four focals with re-excision, two extensive with mastectomy and one focal but refusing further surgery. The ultimate success rate of BCS was 95.5%. Margin positivity correlated with tumor residual (P=0.044) but not with hematoma. Conclusions Mammotome biopsy might lead to hematoma and tumor residual; however, it is not the determinant factor for a surgery option, and BCS is feasible through a complete excision of tumor residual to acquire negative margin.
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Affiliation(s)
- Yanan Kong
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ning Lyu
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianwei Wang
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan Wang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ya Sun
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zeming Xie
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Peng Liu
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Byun IH, Koo HK, Kim SJ, Kim HJ, Lee SW. Simultaneous Augmentation Mammoplasty and Vacuum-Assisted Breast Biopsy for Enhanced Cosmesis and Efficacy. Aesthetic Plast Surg 2020; 44:2041-2047. [PMID: 32671448 DOI: 10.1007/s00266-020-01858-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In this era of expanding life expectancy and popularity of aesthetic breast surgeries, more women are likely to live more years with their augmented breasts. Thus, consistent attention to general breast health is crucial, and preoperative ultrasound is helpful to locate suspicious lesions. In this study, we present a combinative procedure of augmentation mammoplasty and vacuum-assisted breast biopsy (VABB). METHODS From January of 2018 to December of 2019, a total of 102 patients received simultaneous augmentation mammoplasty and VABB in our institute. Only patients of primary augmentation mammoplasty who received VABB on unilateral breasts were included. We sought to investigate the results of each breast and safety of adding VABB before performing augmentation within the same incision. RESULTS Among 204 breasts and implants, 28.43% were done via endoscopic transaxillary approach and 71.57% via inframammary approach. The mean implant volume was 329.34 ± 44.79 ml, and the mean follow-up period was 14.23 ± 4.64 months. All of the complication rates exhibited no statistically significant differences between the two groups. CONCLUSION Simultaneous augmentation mammoplasty and VABB prevented unnecessary scars and pain, and the complication rates did not statistically differ from those of augmentation only group. This co-operation is a safe and simple method potentially beneficial to many women interested in breast surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Il Hwan Byun
- Department of Plastic and Reconstructive Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Hyun Kook Koo
- Department of Plastic and Reconstructive Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Soo Jung Kim
- Department of Plastic and Reconstructive Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Hye-Jin Kim
- Department of General Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Sang Woo Lee
- Department of Plastic and Reconstructive Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea.
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Chao X, Jin X, Tan C, Sun P, Cui J, Hu H, Ouyang Q, Chen K, Wu W, He Z, Nie Y, Yao H. Re-excision or "wait and watch"-a prediction model in breast phyllodes tumors after surgery. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:371. [PMID: 32355815 PMCID: PMC7186749 DOI: 10.21037/atm.2020.02.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background The prognosis of breast phyllodes tumors (PTs) largely depending on the pathological grading, which lacks objectivity. This study aimed to develop a nomogram based on clinicopathological features to evaluate the recurrence probability of PTs following surgery. Methods Data from 334 patients with breast PTs, who underwent surgical treatment at Sun Yat-sen Memorial Hospital from January 2005 to December 2014, were used to develop a prediction model. Additionally, data of 36 patients from Peking University Shenzhen Hospital (cohort 1) and data of 140 patients from Sun Yat-sen University Cancer Center (cohort 2) during the same period were used to validate the model. The medical records and tumor slides were retrospectively reviewed. The log-rank and Cox regression tests were used to develop a clinical prediction model of breast PTs. All statistical analyses were performed using R and STATA. Results Of all 334 patients included in the primary cohort, 224 had benign, 91 had borderline, and 19 had malignant tumors. The 1-, 3-, and 5-year recurrence-free survival was 98.5%, 97.9%, and 96.8%, respectively. Ultrasound-guided vacuum-assisted biopsy (UGVAB) is a non-inferior treatment application in benign PTs compared with open surgery [hazard ratio (HR), 2.38; 95% confidence interval (CI), 0.59–9.58]. Width of surgical margin, mitoses, and tumor border were identified as independent risk factors for breast PTs. A nomogram was developed based on these three variables. The C-index of internal and external validation was 0.71, 0.67 (cohort 1) and 0.73 (cohort 2), respectively. Conclusions The study model presented more concise and objective variables to evaluate the recurrence-free survival of patients after surgery, which can help deciding whether to do a re-excision or “wait and watch”.
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Affiliation(s)
- Xue Chao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Pathology Department, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou 510000, China
| | - Xiaoyan Jin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,General Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Cui Tan
- Pathology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Peng Sun
- Pathology Department, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou 510000, China
| | - Junwei Cui
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Hui Hu
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Qian Ouyang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Wei Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhanghai He
- Pathology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yan Nie
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Herui Yao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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12
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Bennett IC, Saboo A. The Evolving Role of Vacuum Assisted Biopsy of the Breast: A Progression from Fine-Needle Aspiration Biopsy. World J Surg 2019; 43:1054-1061. [PMID: 30617562 DOI: 10.1007/s00268-018-04892-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The management of breast disease has been greatly facilitated by the technology of needle biopsy interventions, and over the past 30 years, this has evolved from the use of fine-needle aspiration biopsy (FNAB) to the current methodology of vacuum assisted biopsy (VAB). METHODS This article provides an historical review of the application of needle interventions of the breast in the diagnosis and management of breast conditions, and discusses current indications for the use of vacuum assisted biopsies and vacuum assisted excisions. RESULTS Whilst FNAB continues to have a limited role in breast disease diagnosis, the necessity of achieving an histological diagnosis has preferentially seen the development and wider application of automated core needle biopsies (CNB) and VAB in the assessment and management of breast lesions. The advantages of CNB and VAB include the ability to distinguish in situ and invasive disease pre-operatively, and the ability to achieve prior knowledge of immunohistochemical tumour markers particularly in the setting of neoadjuvant drug treatments. CONCLUSION Due to its ability to obtain larger tissue samples, VAB does have diagnostic advantages over CNB and indications for the utilization of VAB are discussed. VAB additionally has an expanding role as a tool for breast lesion excision.
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Affiliation(s)
- Ian C Bennett
- Breast and Endocrine Surgical Unit, Princess Alexandra Hospital, University of Queensland, Woolloongabba, Brisbane, QLD, Australia.
| | - Apoorva Saboo
- Breast and Endocrine Surgical Unit, Princess Alexandra Hospital, University of Queensland, Woolloongabba, Brisbane, QLD, Australia
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13
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Ultrasound-Guided Vacuum-Assisted Biopsy in Small Breast: A Cost-Saving Solution. Clin Breast Cancer 2019; 19:e352-e357. [DOI: 10.1016/j.clbc.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/01/2018] [Accepted: 12/01/2018] [Indexed: 11/21/2022]
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14
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Serial image changes in ultrasonography after the excision of benign breast lesions by mammotome® biopsy system. Saudi J Biol Sci 2019; 26:178-182. [PMID: 30622424 PMCID: PMC6319199 DOI: 10.1016/j.sjbs.2018.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022] Open
Abstract
Mammotome-an ultrasound guided vacuum-assisted breast biopsy (VABB) device, has proved beneficial to the treatment of benign breast lesions. The aim of this study is to analyze the characteristics of ultrasound images of residual cavity and the changes in ultrasound images at follow-up at different intervals after the excision of benign breast lesions by Mammotome® biopsy system. A series of 247 consecutive 8-gauge Mammotome® procedures were performed under ultrasound guidance and multivariate analysis was conducted. We found fibroadenoma and adenomatosis are appeared to be the most common pathological manifestations. Follow-up by ultrasonography at an interval of one month after excision of benign breast lesions by 8-gauge vacuum-assisted Mammotome® biopsy system, is not reliable due to the residual cavity formation. A follow-up schedule starting from at least 3 months after resection is highly recommended.
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15
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Salazar JP, Miranda I, de Torres J, Rus MN, Espinosa-Bravo M, Esgueva A, Salvador R, Rubio IT. Percutaneous ultrasound-guided vacuum-assisted excision of benign breast lesions: A learning curve to assess outcomes. Br J Radiol 2018; 92:20180626. [PMID: 30359092 DOI: 10.1259/bjr.20180626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE: To evaluate the efficacy and learning curve of ultrasoundguided vacuum-assisted excision (US-VAE) of benign breast lesions, and to assess characteristics associated with residual lesion. METHODS: This was a retrospective study with institutional review board-approval. Sonographic and clinical follow-up were performed 6 months after intervention. Effectiveness and safety of the technique were analyzed. The cumulative summation (CUSUM) graphs were used to evaluate learning curves concerning complete excision and hematoma. RESULTS: 152 ultrasound-VAEs in 143 patients were included. Initial complete resection was achieved in 90.8 % (138 of 152). 6-month follow-up was completed for 143 (94%) of cases and complete resection was observed in 72 % (100 of 143). Mean maximum size without residual tumor was 16.9 mm, while with residual lesion it was 21.9 mm (p = < 0.001), with a volume of 1.53 and 3.39 cm3, respectively (p = < 0.001). Increase in lesion size and volume was associated with less effectiveness (p = 0.05), clinical control (p = 0.05), and higher risk of clinically significant hematoma (p = 0.05). Receiver operating characteristic analysis demonstrate a volume threshold of 2.6 cm3 (r = 0.71, specificity 84.5%) for leaving no residual lesion. Cumulative summation graphs demonstrate that, on average, 11 excisions were required to acquire skills to perform complete excision in more than 80% at the end of the ultrasound-VAE and 18 excisions at 6 months. CONCLUSION: Ultrasound-VAE is an effective treatment for benign breast lesions. Breast lesion volume should be considered when assessing for percutaneous treatment. ADVANCES IN KNOWLEDGE: A follow-up of the learning process of ultrasound-VAE will be a valuable tool to assess the efectiveness and safety of the technique i.
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Affiliation(s)
- Juan Pablo Salazar
- 1 Department of Radiology, Breast Imaging.Hospital Universitario Vall d'Hebron , Barcelona , Spain.,2 Institut de Diagnòstic per la Imatge (IDI) , Barcelona , Spain
| | - Ignacio Miranda
- 1 Department of Radiology, Breast Imaging.Hospital Universitario Vall d'Hebron , Barcelona , Spain
| | - Juan de Torres
- 1 Department of Radiology, Breast Imaging.Hospital Universitario Vall d'Hebron , Barcelona , Spain.,2 Institut de Diagnòstic per la Imatge (IDI) , Barcelona , Spain
| | - María N Rus
- 1 Department of Radiology, Breast Imaging.Hospital Universitario Vall d'Hebron , Barcelona , Spain.,2 Institut de Diagnòstic per la Imatge (IDI) , Barcelona , Spain
| | - Martin Espinosa-Bravo
- 3 Breast Surgical Oncology. Department of Gynecology. Hospital UniversitarioVall d'Hebron , Barcelona , Spain
| | - Antonio Esgueva
- 4 Breast Surgical Oncology Unit. Clinica Universidad de Navarra , Madrid , Spain
| | | | - Isabel T Rubio
- 4 Breast Surgical Oncology Unit. Clinica Universidad de Navarra , Madrid , Spain
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16
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Percutaneous Removal of Benign Breast Lesions with an Ultrasound-guided Vacuum-assisted System: Influence Factors in the Hematoma Formation. ACTA ACUST UNITED AC 2018; 31:31-36. [PMID: 28031085 DOI: 10.1016/s1001-9294(16)30019-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses received excisional biopsy with ultrasound- guided vacuum-assisted system. The pathology of patients, Results of hematoma development and outcome, influence factors for hematoma occurrence (nodule size, nodule location, number of nodule, breast shape, menstrual period, efficacy time of bandage, and application of hemostatic agents during the procedure) were recorded.Results Pathologic examination revealed fibroadenomas in 138 lesions, fibroadenosis in 127 lesions, intraductal papillomas in 39 lesions, inflammatory change in 4 lesions, retention cyst of the breast in 3 lesions, and benign phyllodes tumor in 1 lesion. Thirty hematomas were observed in patients (9.6%). Finally, 97.0% hematomas were absorbed completely within 6 months follow-up. The incidence rates of hematoma were increased by 24.7%, 10.0%, 63.2%, 13.9% in the nodule diameter larger or equal to 25 mm group, removal of larger or equal to two nodules once time from one patient group, menstrual period group, and larger and loose breast group, respectively (all P<0.05). However, the incidences were decreased by 60.6% in the bandage performed for 12-24 hours or beyond 24 hours group (P<0.05). The multiple logistic regression models revealed that nodule size (χ2=15.227, P<0.001), number of nodule (χ2=7.767, P=0.005), menstrual period (χ2=24.530, P<0.001), and breast shape (χ2=9.559, P=0.002) were independent risk factors associated with hematoma occurrence, but efficacy time of bandage was a protective factor associated with hematoma occurrence.Conclusion The occurrence of hematoma after the minimally invasive operation was associated with nodule size, number of nodule, menstrual period, breast shape, and efficacy time of bandage.
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17
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Bozzini A, Cassano E, Raciti D, Disalvatore D, Pala O, Vingiani A, Renne G. Analysis of Efficacy and Accuracy of 2 Vacuum-Assisted Breast Biopsy Devices: Mammotome and Elite. Clin Breast Cancer 2018; 18:e1277-e1282. [PMID: 30072194 DOI: 10.1016/j.clbc.2018.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/25/2018] [Accepted: 06/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ultrasound-guided vacuum-assisted breast biopsy (US-VABB) has recently replaced surgical biopsy as a result of its high diagnostic accuracy and low patient discomfort, and at present it relies mainly on 2 devices, Mammotome and, more recently, Mammotome Elite (Elite). Our purpose was to compare the efficacy of these 2 bioptical devices. PATIENTS AND METHODS We performed US-VABB on 195 patients with Mammotome 8G or 11G in 130 patients and Elite 13G in 65 patients. Of these 195 patients, 95 were submitted to surgery for lumpectomy or mastectomy in case of malignant lesions or of lesions of uncertain malignant potential (B5 and B3), while the remaining 100 were strictly monitored clinically and radiologically for 12 to 24 months. RESULTS Both the devices showed high absolute sensitivity (96.2% for Mammotome and 83.3% for Elite), complete sensitivity (98.1% for Mammotome and 90.0% for Elite), specificity (92.3% for Mammotome and 94.3% for Elite), and diagnostic accuracy (99.1% for Mammotome and 95% for Elite), thus fulfilling criteria suggested by the European guidelines. Total underestimation rate seemed to be higher in the Elite cohort (14.2%) than in the Mammotome cohort (3.4%) (P = .02). However, none of the patients with a benign diagnosis (B2) presented any event during the follow-up period. CONCLUSION US-VABB is an accurate method for sampling breast lesions. Our study did not show large, statistically significant differences in diagnostic accuracy between the Elite and Mammotome systems, except for a slight increase in diagnostic underestimation of benign pathologies when using the Elite.
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Affiliation(s)
- Anna Bozzini
- Breast Imaging Unit, European Institute of Oncology, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Unit, European Institute of Oncology, Milan, Italy
| | - Dario Raciti
- Breast Imaging Unit, European Institute of Oncology, Milan, Italy
| | - Davide Disalvatore
- IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy
| | - Oriana Pala
- Division of Pathology, European Institute of Oncology, Milan, Italy
| | - Andrea Vingiani
- Division of Pathology, European Institute of Oncology, Milan, Italy.
| | - Giuseppe Renne
- Division of Uropathology and Intraoperative Consultation, European Institute of Oncology, Milan, Italy
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18
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Liu S, Zou JL, Zhou FL, Fang YM. [Efficacy of ultrasound-guided vacuum-assisted Mammotome excision for management of benign breast diseases: analysis of 1267 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1121-1125. [PMID: 28801296 PMCID: PMC6765730 DOI: 10.3969/j.issn.1673-4254.2017.08.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the clinical value of ultrasound-guided vacuum-assisted Mammotome (MMT) system for surgical resection of benign breast disease. METHODS This retrospective study was conducted among 1267 patients who underwent minimally invasive surgery with ultrasound-guided MMT system for benign breast disease at our center between January, 2009 and January, 2014. The resection rate, incidence of complication, recurrence rate, patients' satisfaction, clinical follow-up results and risk factors were analyzed. The patients were followed up at 1 month, 6 months and every 6 months thereafter for up to 2 years with a median follow-up of 22 months. RESULTS Of the total of 1267 patients, 1259 (99.36%) had complete resection of the breast lesions, and residual lesions were found in 8 cases 1 month after the operation. The resection rate was significantly associated with lesion size (P=0.003) but not with the patients'age, pathology, BI-RADS classification, or the number or location of the lesions (P>0.05). Eighty-nine (7.02%) patients showed postoperative complications, and hematoma occurred in 70 (5.52%) patients after the operation. The complication rate was significantly associated with the number and location of lesions (P=0.000) but not with age, pathology, BI-RADS classification or the lesion size (P>0.05). A total of 193 (15.23%) patients had recurrence after the operation, including 65 (5.13%) with in situ recurrence and 128 (10.1%) with new lesions. The recurrence rate was significantly associated with the number and size of lesions (P=0.000) but not with age, pathology, BI-RADS classification or location of lesions(P>0.05). Six patients were not satisfied with the appearance of the incision, and the overall satisfaction rate of the patients was 99.52%. CONCLUSION s Ultrasound-guided vacuum-assisted MMT excision is a safe and effective procedure for benign breast disease with a low surgical complication rate, a high resection rate and a low recurrence rate. This technique results in good postoperative appearance for treatment of benign and high-risk breast lesions, especially multiple benign breast lesions.
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Affiliation(s)
- Shu Liu
- Department of Breast Surgery, Guiyang Maternal and Child Healthcare Hospital/Guiyang Minimally Invasive Breast Center, Guiyang 550003, China. E-mail:
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19
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Bennett IC. The Changing Role of Vacuum-assisted Biopsy of the Breast: A New Prototype of Minimally Invasive Breast Surgery. Clin Breast Cancer 2017; 17:323-325. [PMID: 28359730 DOI: 10.1016/j.clbc.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/18/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Ian C Bennett
- University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.
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20
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Park HL, Hong J. Vacuum-assisted breast biopsy for breast cancer. Gland Surg 2014; 3:120-7. [PMID: 25083505 DOI: 10.3978/j.issn.2227-684x.2014.02.03] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/15/2014] [Indexed: 01/11/2023]
Abstract
Sonographic examination of the breast with state-of-the-art equipment has become an essential part of the clinical work-up of breast lesions and a valuable adjunct to mammographic screening and physical examination. Fine-needle aspiration (FNA) and core-needle biopsy (CNB) are well-established, valuable techniques that are still used in most cases, whereas vacuum-assisted breast biopsy (VABB) is a more recent technique. VABB has proven clinical value and can be used under sonographic, mammographic, and magnetic resonance imaging guidance. The main indication for the use of VABB is for biopsies of clustered microcalcifications, which are usually performed under stereotactic guidance. This method has been proven reliable and should replace surgical biopsies. The ultrasound-guided procedure is still more a matter of discussion, but it should also replace surgical biopsies for nodular lesions, and it should even replace surgery for the complete removal of benign lesions. This viewpoint is gradually gaining acceptance. Different authors have shown increased diagnostic accuracy of VABB compared to FNA and CNB. VABB particularly leads to less histological underestimation. The other indications for VABB are palpable or nonpalpable nodular lesions or American College of Radiology Breast Imaging Reporting and Data System 3 and 4A lesions. For masses that are likely benign or indeterminate, we attempt to completely remove the lesion to eliminate uncertainty on later follow-up images. VABB offers the best possible histological sampling and aids avoidance of unnecessary operations. VABB complications include bleeding or pain during the procedure, as well as postoperative pain, hemorrhaging, and hematomas. But, these hemorrhaging could be controlled by the post-procedural compression and bed resting. Overall, VABB is a reliable sampling technique with few complications, is relatively easy to use, and is well-tolerated by patients. The larger amount of extracted tissue reduces sampling error.
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Affiliation(s)
- Hai-Lin Park
- Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
| | - Jisun Hong
- Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
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21
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Yi W, Xu F, Zou Q, Tang Z. Completely removing solitary intraductal papillomas using the Mammotome system guided by ultrasonography is feasible and safe. World J Surg 2014; 37:2613-7. [PMID: 23942535 DOI: 10.1007/s00268-013-2178-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Because of the potential for an intraductal papilloma to progress to malignancy and the likelihood of detecting unexpected coexisting malignant disease, complete removal of the intraductal papilloma is safer than merely sampling it. The purpose of this study was to estimate the feasibility and safety of excising a solitary intraductal papilloma using the Mammotome system guided by ultrasonography (US). METHODS We retrospectively reviewed the clinical information of 136 patients who underwent excision of solitary intraductal papillomas using the 8-gauge probe with the US-guided Mammotome system between December 2005 and December 2011 at our institution. Their lesions had been suspected preoperatively or were occasionally diagnosed postoperatively. RESULTS There were no local recurrences during the follow-up period. Of the patients who showed atypia and underwent re-excision, only 2 (6.1 %) had local ductal atypia. The patients with atypia were significantly older than the patients without atypia (p < 0.05). CONCLUSIONS Using the US-guided 8-gauge probe Mammotome system to completely remove a solitary intraductal papilloma is feasible and safe. Close follow-up may be considered for those whose lesions exhibit atypia.
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Affiliation(s)
- Wenjun Yi
- Department of Breast and Thyroid Surgery, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China,
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Mátrai Z, Gulyás G, Kunos C, Sávolt A, Farkas E, Szollár A, Kásler M. [Minimally invasive breast surgery]. Orv Hetil 2014; 155:162-9. [PMID: 24463161 DOI: 10.1556/oh.2014.29783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices - similar to other surgical subspecialties -, will gradually become popular and it may form part of routine breast surgery even. Vacuum-assisted core biopsy with a therapeutic indication is suitable for the removal of benign fibroadenomas leaving behind an almost invisible scar, while endoscopically assisted skin-sparing and nipple-sparing mastectomy, axillary staging and reconstruction with latissimus dorsi muscle flap are all feasible through the same short axillary incision. Endoscopic techniques are also suitable for the diagnostics and treatment of intracapsular complications of implant-based breast reconstructions (intracapsular fluid, implant rupture, capsular contracture) and for the biopsy of intracapsular lesions with uncertain pathology. Perception of the role of radiofrequency ablation of breast tumors requires further hands-on experience, but it is likely that it can serve as a replacement of surgical removal in a portion of primary tumors in the future due to the development in functional imaging and anticancer drugs. With the reduction of the price of ductoscopes routine examination of the ductal branch system, guided microdochectomy and targeted surgical removal of terminal ducto-lobular units or a "sick lobe" as an anatomical unit may become feasible. The paper presents the experience of the authors and provides a literature review, for the first time in Hungarian language on the subject. Orv. Hetil., 2014, 155(5), 162-169.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Gusztáv Gulyás
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Csaba Kunos
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Akos Sávolt
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Emil Farkas
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - András Szollár
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Miklós Kásler
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
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Pan S, Liu W, Jin K, Liu Y, Zhou Y. Ultrasound-guided vacuum-assisted breast biopsy using Mammotome biopsy system for detection of breast cancer: results from two high volume hospitals. Int J Clin Exp Med 2014; 7:239-246. [PMID: 24482711 PMCID: PMC3902263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/11/2013] [Indexed: 06/03/2023]
Abstract
Ultrasound-guided vacuum-assisted breast biopsy (VABB) has been recently regarded as a feasible, effective, minimally invasive and safe method for removal of benign breast lesions without serious complications. The frequency of detection of noninvasive malignant breast lesions by ultrasound-guided VABB is increasing. The aim of this study was to evaluate the role of the ultrasound-guided VABB using Mammotome biopsy system in the early detection of breast cancer. Retrospective review between January 2008 to March 2013 the First Affiliated Hospital, Zhejiang University School of Medicine and Taizhou Hospital, Wenzhou Medical College. From January 2008 to March 2013, a total of 5232 ultrasound-guided VABB procedures were performed in 3985 patients whose mean ages were 36.3 years (range: 16-73). The histological results of 5232 ultrasound-guided VABB were retrospectively reviewed. Ultrasonography follow-up was performed at 3 to 6 month intervals in order to assess recurrence. Two hundred twenty three high risk lesions (comprising 59 papilloma, 57 papillomatosis, and 107 atypical hyperplasia) and 61 malignant lesions (comprising 23 ductal carcinoma in situ, 21 lobular carcinoma in situ, 12 infiltrating ductal carcinoma, and 5 infiltrating mucinous carcinoma) were identified. Sensitivity (100%) and diagnostic accuracy (100%) regarding the detection of malignancy were excellent for ultrasound-guided VABB using Mammotome biopsy system. Our results indicate that ultrasound-guided VABB using Mammotome biopsy system is an accurate technique for the sampling, diagnosis, and early detection of breast cancer. It is recommended that the Mammotome biopsy system could be as the method of choice for detecting nonpalpable early breast cancer.
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Affiliation(s)
- Shaobo Pan
- Operating Room, The First Affiliated Hospital, Zhejiang University School of Medicine, HangzhouZhejiang 310003, China
| | - Wenguang Liu
- Department of Emergency Surgery, Linyi People’s HospitalLinyi, Shandong 276000, China
| | - Ketao Jin
- Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical CollegeLinhai, Zhejiang 317000, China
| | - Yu Liu
- Department of Breast Surgery, The First Affiliated Hospital, Zhejiang University School of MedicineHangzhou, Zhejiang 310003, China
| | - Yunxiao Zhou
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of MedicineHangzhou, Zhejiang 310003, China
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Jiang Y, Lan H, Ye Q, Jin K, Zhu M, Hu X, Teng L, Cao F, Lin X. Mammotome ® biopsy system for the resection of breast lesions: Clinical experience in two high-volume teaching hospitals. Exp Ther Med 2013; 6:759-764. [PMID: 24137261 PMCID: PMC3786805 DOI: 10.3892/etm.2013.1191] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/21/2013] [Indexed: 11/06/2022] Open
Abstract
Ultrasound-guided vacuum-assisted breast biopsy (VABB) is regarded as a feasible, effective, minimally invasive and safe method for the removal of benign breast lesions, without the occurrence of serious complications. The aim of this study was to evaluate the feasibility, efficacy and safety of ultrasound-guided VABB using the Mammotome® biopsy system in the treatment of breast lesions. The clinical outcomes of 3,681 patients with breast lesions were evaluated following excisions by ultrasound-guided VABB in two high-volume teaching hospitals. From January 2008 to December 2012, a total of 4,867 ultrasound-guided VABB procedures were performed in the 3,681 patients, who had a mean age of 37.8 years (range, 16-73 years). The parameters examined in this analysis included lesion size, lesion location in the inner breast, Breast Imaging Reporting and Data System (BI-RADS) ultrasound category and histopathological diagnosis. Ultrasonography follow-up was performed at 3-6 month intervals in order to assess recurrence. The size of the investigated lesions ranged between 6 and 62 mm and a histopathological diagnosis was made in 100% of cases. The results indicated that the majority of specimens (98.89%) were benign. On average, the ultrasound-guided VABB was performed in 10.3 min (range, 7.5-43 min) and the mean number of cores removed in the procedure was 8.1 (range, 3-32). A complete excision was achieved in the majority of cases (99.7%). The presence of a hematoma was the most common complication following the biopsy, and was observed in 27.5% of patients. The mean follow-up period was 25.5 months (range, 1-60 months), during which the rate of recurrence was 4.4%. The results indicated that ultrasound-guided VABB using the Mammotome biopsy system is an effective and safe procedure that is able to rapidly remove the majority of benign breast lesions using a small incision and without the occurrence of scarring or complications.
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Affiliation(s)
- Yangping Jiang
- Department of Surgical Oncology, Dongyang Hospital, Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
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Mammotome biopsy under ultrasound control in the diagnostics and treatment of nodular breast lesions - own experience. POLISH JOURNAL OF SURGERY 2012; 84:242-6. [PMID: 22763299 DOI: 10.2478/v10035-012-0040-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mammotome biopsy is an effective, minimally invasive, novel technique used in the verification of breast lesions.The aim of the study was to assess the value of ultrasound-guided vacuum-assisted core needle biopsy (mammotome biopsy) in the diagnostics and treatment of nodular breast lesions, considering own data.Material and methods. Analysis comprised 1183 mammotome biopsies under ultrasound control performed in 1177 female patients during the period between 2000 and 2010, at the Regional Clinic for Early Diagnostics and Treatment of Breast Lesions, I Chair and Department of General Surgery, Jagiellonian University, Collegium Medicum.Results. The average patient age amounted to 41.7 years. The size of the investigated lesions ranged between 4 and 65 mm (mean - 12 mm). The histopathological examination result was as follows: fibrocystic lesions (n=285), adenofibroma (n=477), adenosis sclerosans (n=188), hyperplasia without atypy (n=58), phyllode tumor (n=2), papilloma (n=14), hamartoma (n=1), atypical hyperplasia (n=25), in situ ductal carcinoma (n=4), in situ lobular carcinoma (n=5), infiltrating ductal carcinoma (n=114), infiltrating lobular carcinoma (n=4), non-diagnostic result (n=6). The histopathological diagnosis was obtained in 99.5% of cases. Patients diagnosed with atypical hyperplasia or cancer were qualified for surgery, according to accepted standards. The presence of a hematoma was the most common complication after the biopsy, observed in 16.5% of patients.Conclusions. The obtained results confirmed the high value of ultrasound-guided biopsies in the diagnostics of nodular breast lesions. The method is safe, minimally invasive, with few complications, providing a good cosmetic effect. In case of benign lesions with a diameter of less than 15 mm the mammotome biopsy enables to completely excise the lesions, being an alternative to open surgical biopsies. The mammotome biopsy should become the method of choice considering the diagnostics of nodular breast lesions.
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Ultrasound-guided vacuum-assisted core biopsy in the diagnosis and treatment of focal lesions of the breast - own experience. Wideochir Inne Tech Maloinwazyjne 2012; 8:63-8. [PMID: 23630556 PMCID: PMC3627158 DOI: 10.5114/wiitm.2011.31630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/19/2012] [Accepted: 10/09/2012] [Indexed: 12/26/2022] Open
Abstract
Introduction Vacuum-assisted core biopsy (VACB) guided by ultrasound is a minimally invasive method used in diagnosis and treatment of breast focal lesions. Vacuum-assisted core biopsy is an interesting minimally invasive alternative to open surgical biopsy. Aim To assess the value of ultrasound-guided vacuum-assisted core biopsy in the diagnosis and treatment of breast focal lesions. Material and methods In the period 2009-2010, 397 ultrasound-guided vacuum-assisted core biopsies were performed. Mean age of the patients was 41.7 years (18-92 years), and size of the lesions ranged from 3 mm to 65 mm, mean size being 12 mm. All women with diagnosed atypical ductal hyperplasia or cancer were qualified for surgery. The patients with histopathologically benign lesions were under follow-up. Results Samples sufficient for histopathological examination were obtained from 394 cases (99.2%). Of all 397 lesions, 293 (73.7%) were diagnosed as benign, there were 6 (1.6%) cases of atypical ductal hyperplasia and 98 (24.7%) malignant lesions. Three hundred and sixty-nine lesions were below 15 mm in diameter, of which 339 (91.9%) were totally removed during the VACB. Conclusions The results obtained confirm high efficiency of ultrasound-guided VACB in the differential diagnosis of breast focal lesions, including impalpable ones. It is a safe method with a low complication rate. In the case of benign lesions with a diameter not exceeding 15 mm, it allows one to excise the whole lesion and is a very good alternative to an open surgical biopsy. Vacuum-assisted core biopsy should be a standard and the method of choice in diagnosing breast lesions.
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Venkataraman S, Dialani V, Gilmore HL, Mehta TS. Stereotactic core biopsy: Comparison of 11 gauge with 8 gauge vacuum assisted breast biopsy. Eur J Radiol 2012; 81:2613-9. [DOI: 10.1016/j.ejrad.2011.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 10/21/2011] [Accepted: 10/27/2011] [Indexed: 10/14/2022]
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Xiaofeng L, Lianfang L, Fei C, Yuming L, Hui C, Qing L, Lu C, Shude C. An Intraoperative Localization Technique for a Postexcision Specimen of Nonpalpable Breast Calcifications: A Pilot Study. Am Surg 2011. [DOI: 10.1177/000313481107701135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The specimens obtained through excisional biopsy (EB) are commonly large in size and it is difficult to remove the tissues containing nonpalpable calcifications accurately from them for pathologic examination. Therefore, the aim of the study is to develop a novel method of subarea localization technique (SLT) for sampling from the postexcisional specimens. A retrospective clinical study of 48 consecutive patients with breast microcalcifications were divided into a study group (n = 24 patients, 25 breasts) and a control group (n = 24 patients, 24 breasts) in time sequence. The specimens of study group were localized by SLT performed by cutting lines and/or metallic markers. The main study end points were the duration of intraoperative pathologic diagnosis (DIPD) and duration of conclusive pathology diagnosis (DCPD). The number of frozen blocks, number of paraffin blocks, number of sections, and other parameters correlated with pathologic diagnosis were compared between the two groups. SLT was succeeded in 48 of 48 (100%) patients, which shortened DIPD (29.3 vs 45.5 minutes, P < 0.01) significantly with less frozen blocks (6.2 vs 12.6, P < 0.01) and less frozen sections (8.5 vs 13.7, P = 0.01) than that of the control group. Moreover, SLT shortened DCPD (4.1 vs 5.1 days, P = 0.02) with less paraffin blocks (12.2 vs 21.7, P < 0.01) and less paraffin sections (20.0 vs 39.9, P < 0.01) than that of the control group. SLT decreased workload of the specimens sampling procedure and SLT may be recommended as a reliable specimens sampling method to guide pathology test for EB specimens containing calcifications.
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Affiliation(s)
- Liu Xiaofeng
- Department of Breast, Nanjing Maternity and Child Health Hospital of Nanjing, Medical University, Nanjing, China
| | - Li Lianfang
- Department of Breast, Henan Province Tumor Hospital, Zhengzhou, China
| | - Chen Fei
- Department of Breast, Nanjing Maternity and Child Health Hospital of Nanjing, Medical University, Nanjing, China
| | - Li Yuming
- Departments of Radiography, Nanjing Maternity and Child Health Hospital of Nanjing, Medical University, Nanjing, China
| | - Chen Hui
- Departments of Radiography, Nanjing Maternity and Child Health Hospital of Nanjing, Medical University, Nanjing, China
| | - Li Qing
- Departments of Pathology, Nanjing Maternity and Child Health Hospital of Nanjing, Medical University, Nanjing, China
| | - Cheng Lu
- Department of Breast, Nanjing Maternity and Child Health Hospital of Nanjing, Medical University, Nanjing, China
| | - Cui Shude
- Department of Breast, Henan Province Tumor Hospital, Zhengzhou, China
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Povoski SP, Jimenez RE, Wang WP. Ultrasound-guided diagnostic breast biopsy methodology: retrospective comparison of the 8-gauge vacuum-assisted biopsy approach versus the spring-loaded 14-gauge core biopsy approach. World J Surg Oncol 2011; 9:87. [PMID: 21835024 PMCID: PMC3171710 DOI: 10.1186/1477-7819-9-87] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 08/11/2011] [Indexed: 11/12/2022] Open
Abstract
Background Ultrasound-guided diagnostic breast biopsy technology represents the current standard of care for the evaluation of indeterminate and suspicious lesions seen on diagnostic breast ultrasound. Yet, there remains much debate as to which particular method of ultrasound-guided diagnostic breast biopsy provides the most accurate and optimal diagnostic information. The aim of the current study was to compare and contrast the 8-gauge vacuum-assisted biopsy approach and the spring-loaded 14-gauge core biopsy approach. Methods A retrospective analysis was done of all ultrasound-guided diagnostic breast biopsy procedures performed by either the 8-gauge vacuum-assisted biopsy approach or the spring-loaded 14-gauge core biopsy approach by a single surgeon from July 2001 through June 2009. Results Among 1443 ultrasound-guided diagnostic breast biopsy procedures performed, 724 (50.2%) were by the 8-gauge vacuum-assisted biopsy technique and 719 (49.8%) were by the spring-loaded 14-gauge core biopsy technique. The total number of false negative cases (i.e., benign findings instead of invasive breast carcinoma) was significantly greater (P = 0.008) in the spring-loaded 14-gauge core biopsy group (8/681, 1.2%) as compared to in the 8-gauge vacuum-assisted biopsy group (0/652, 0%), with an overall false negative rate of 2.1% (8/386) for the spring-loaded 14-gauge core biopsy group as compared to 0% (0/148) for the 8-gauge vacuum-assisted biopsy group. Significantly more (P < 0.001) patients in the spring-loaded 14-gauge core biopsy group (81/719, 11.3%) than in the 8-gauge vacuum-assisted biopsy group (18/724, 2.5%) were recommended for further diagnostic surgical removal of additional tissue from the same anatomical site of the affected breast in an immediate fashion for indeterminate/inconclusive findings seen on the original ultrasound-guided diagnostic breast biopsy procedure. Significantly more (P < 0.001) patients in the spring-loaded 14-gauge core biopsy group (54/719, 7.5%) than in the 8-gauge vacuum-assisted biopsy group (9/724, 1.2%) personally requested further diagnostic surgical removal of additional tissue from the same anatomical site of the affected breast in an immediate fashion for a benign finding seen on the original ultrasound-guided diagnostic breast biopsy procedure. Conclusions In appropriately selected cases, the 8-gauge vacuum-assisted biopsy approach appears to be advantageous to the spring-loaded 14-gauge core biopsy approach for providing the most accurate and optimal diagnostic information.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA.
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Luo HJ, Chen X, Tu G, Wang J, Wu CY, Yang GL. Therapeutic Application of Ultrasound-Guided 8-Gauge Mammotome System in Presumed Benign Breast Lesions. Breast J 2011; 17:490-7. [DOI: 10.1111/j.1524-4741.2011.01125.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wang ZL, Liu G, Huang Y, Wan WB, Li JL. Percutaneous excisional biopsy of clinically benign breast lesions with vacuum-assisted system: comparison of three devices. Eur J Radiol 2011; 81:725-30. [PMID: 21300503 DOI: 10.1016/j.ejrad.2011.01.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 01/03/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to compare three devices in percutaneous excisional biopsy of clinically benign breast lesions in terms of complete excision rate, duration of procedure and complications. MATERIALS AND METHODS In a retrospective study from March 2005 to May 2009, 983 lesions underwent ultrasound-guided excisional biopsy with three vacuum-assisted systems, respectively. The lesions were category 3 lesions as determined by ultrasound imaging according to Breast Imaging Reporting and Data System (BI-RADS) (n=951) or had been confirmed as benign by a previous core needle biopsy (n=32). The completely excision rate, duration of procedure and complications (hematoma, pain and ecchymosis) were recorded. RESULTS 99.7% (980/983) lesions were demonstrated to be benign by pathology after percutaneous excisional biopsy. The overall complete excision rate was 94.8% (932/983). In lesions whose largest diameter equal to or larger than 1.5cm, the complete excision rates of EnCor(®) group (97.8%, 348/356) and Mammotome(®) group (97.2%, 139/143) were significantly higher than that of Vacora(®) group (91.9%, 445/484) (P<0.05). The EnCor(®) group (6.6±6.5min) had a significant less duration than Mammotome(®) (10.6±9.3min) and Vacora(®) group (25.6±23.3min) (P<0.05). Hematoma occurred more in EnCor(®) group and Mammotome(®) group than in Vacora(®) group (P<0.05). CONCLUSIONS All these three vacuum-assisted systems are highly successful for excisional biopsy of benign breast lesions.
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Affiliation(s)
- Zhi Li Wang
- Department of Ultrasound, Clinical Division of Iatrotechnique, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China.
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Wang ZL, Liu G, Li JL, Ding Q, Su L, Tang J, Ma L. Sonographically guided percutaneous excision of clinically benign breast masses. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:1-5. [PMID: 20957735 DOI: 10.1002/jcu.20752] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To report our experience with a vacuum-assisted biopsy device system in percutaneous excision of clinically benign breast masses under sonographic guidance. METHODS Percutaneous removal of 79 masses in 58 patients was performed with a vacuum-assisted biopsy device under sonographic guidance from April 2008 to September 2008. The lesions were category 3 lesions on sonogram, according to Breast Imaging Reporting and Data System (n = 74), or had been confirmed as benign by a previous core needle biopsy (n = 5). RESULTS All procedures were technically successful. Confirmed as benign were 98.7% (78/79) lesions on pathology after resection, and 93.7% (74/79) lesions were excised completely as demonstrated by follow-up sonographic examination. The duration of the procedure ranged from 2 to 19 minutes (mean ± SD, 9.6 ± 9.3). CONCLUSIONS Percutaneous excision using a vacuum-assisted biopsy device is an alternative to surgical excision of benign breast masses.
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Affiliation(s)
- Zhi Li Wang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
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Wei H, Jiayi F, Qinping Z, Junyi S, Yuan S, Li L, Dongwei S, Liying Q. Ultrasound-guided vacuum-assisted breast biopsy system for diagnosis and minimally invasive excision of intraductal papilloma without nipple discharge. World J Surg 2010; 33:2579-81. [PMID: 19777298 DOI: 10.1007/s00268-009-0171-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As intraductal papilloma (IP) includes both benign and malignant lesions, it is difficult to decide whether the patient should merely be followed up. The purpose of this study is to validate the ultrasound (US)-guided vacuum-assisted breast biopsy system (Mammotome) for diagnosis and minimally invasive excision of IP. METHODS Six women with breast cystic-solid lesions without nipple discharge underwent B-US-guided 8-gauge Mammotome biopsy. Interval US surveillance was performed at a median time of 7 months (range 5-12 months). RESULTS All lesions were removed accurately and thoroughly with satisfactory cosmetic outcomes. All of them were histologically diagnosed as IP. No clinically significant hematoma developed. CONCLUSIONS The US-guided 8-gauge Mammotome biopsy provides an accurate pathologic diagnosis and successful complete excision of cystic-solid breast lesions. This technique appears to be an alternative to surgical biopsy in IP patients without nipple discharge.
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Affiliation(s)
- Hu Wei
- Department of General Surgery, Changhai Hospital, Second Military Medical University, 200433 Shanghai, China.
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Dowlatshahi K, Wadhwani S, Alvarado R, Valadez C, Dieschbourg J. Interstitial Laser Therapy of Breast Fibroadenomas With 6 and 8 Year Follow-Up. Breast J 2010; 16:73-6. [DOI: 10.1111/j.1524-4741.2009.00830.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Certain nonmalignant lesions encountered on percutaneous breast biopsies pose dilemmas with regard to the most appropriate clinical management subsequent to needle biopsy (ie, surgical excision vs. follow-up). These lesions include columnar cell lesions, atypical ductal hyperplasia, lobular neoplasia, papillary lesions, radial scars, fibroepithelial lesions, and mucocele-like lesions. As minimally invasive diagnostic procedures are now standard it is more important than ever to be aware of the limitations of percutaneous biopsy, particularly with regard to apparently benign lesions because of the risk that the radiologically detected lesion may harbor malignant disease not represented in the biopsy specimen. This underscores the importance of radiologic-pathologic correlation. Increasingly, radiologists are adopting vacuum-assisted devices using larger gauge needles. The changing practices among radiologists are reflected in recent studies which have enriched the literature. In addition, magnetic resonance imaging is being used more frequently in breast imaging, resulting in pathologists more often encountering benign biopsies with uncertain imaging correlation. These changes prompted evaluation of the recent literature and its possible effect on management concerns. This review focuses on management issues following the diagnosis of nonmalignant lesions diagnosed on percutaneous breast biopsy and highlights imaging terms commonly used in breast radiology reports to facilitate accurate radiologic-pathologic correlation.
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An evaluation of a 10-gauge vacuum-assisted system for ultrasound-guided excision of clinically benign breast lesions. Breast 2009; 18:192-6. [PMID: 19446453 DOI: 10.1016/j.breast.2009.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/06/2009] [Accepted: 04/07/2009] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to evaluate a 10-gauge vacuum-assisted system for the excision of clinically benign breast lesions. The minimal excision of 245 lesions in 162 patients was performed with VACORA vacuum-assisted system under the guidance of ultrasound between July 2007 and April 2008. The lesions were category 3 lesions as determined by ultrasound imaging according to Breast Imaging Reporting and Data System (BI-RADS) (n=208) or had been confirmed as benign by a previous core-needle biopsy (n=37). As many as 244 lesions were demonstrated to be benign and one case was demonstrated to be malignant by pathology after resection. In the 244 benign lesions, 220 lesions were excised completely as demonstrated by the follow-up ultrasound examination. The malignant lesion was managed with surgical excision. The 10-gauge vacuum-assisted system is highly successful for the excision of benign breast lesions; it is an alternative tool for minimal treatment of benign breast lesions.
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Mammotome versus ATEC: a comparison of two breast vacuum biopsy techniques under sonographic guidance. Arch Gynecol Obstet 2009; 281:287-92. [PMID: 19404655 DOI: 10.1007/s00404-009-1101-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The study evaluates the differences between the Mammotome (MT) and ATEC (A) vacuum biopsy (VB) of the breast in terms of diagnostic reliability, biopsy duration and complications. METHODS In a prospective randomized study, 62 ultrasound-guided VBs of the breast were performed. MT and A were compared using Mann-Whitney U test. RESULTS The mean lesion size and the BI-RADS distribution were equal in both groups. Representative tissue was extracted in all 62 biopsies; thus no repeat biopsies were necessary. A sonographically guided complete excision was possible in 46 cases. More imaging-guided complete excisions were achieved with the MT than with A (87 vs. 63%). Technical complications occurred twice with A and once with MT. No medical complications occurred in either group. CONCLUSIONS Both systems are suitable for the diagnostic clarification of unclear breast lesions as well as complete excision of benign lesions under sonographic imaging. Sonographically guided complete resection was achieved more often with the MT.
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Cortes-Mateos MJ, Martin D, Sandoval S, Ruidiaz ME, Messmer D, Wang-Rodriguez J, Trogler W, Kummel AC, Blair SL. Automated microscopy to evaluate surgical specimens via touch prep in breast cancer. Ann Surg Oncol 2009; 16:709-20. [PMID: 19137376 PMCID: PMC3154836 DOI: 10.1245/s10434-008-0274-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 10/29/2008] [Accepted: 10/29/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast conservation therapy is the standard treatment for breast cancer; however, 20-50% of operations have a positive margin leading to secondary procedures. The standard of care to evaluate surgical margins is based on permanent section. Imprint cytology (touch prep) has been used to evaluate surgical samples, but conventional techniques require an experienced cytopathologist for correct interpretation. An automated image screening process has been developed to discern cancer cells from normal epithelial cells. This technique is based on cellularity of the imprint specimen and does not require expertise in cytopathology. METHODS A rapid immunofluorescent staining technique coupled with automated microscopy was used to classify specimens as cancer vs. noncancer based on the density of epithelial cells captured on touch prep of tumor cross-sections. The results of the automated analysis vs. a manual screen of ten 20x fields were compared to the pathology interpretation on permanent section. RESULTS A total of 34 consecutive cases were analyzed: 10 normal cases, and 24 cancer cases. The cross-section specimens for invasive cancer were correctly classified in at least 65% of the cases by using manual microscopy and at least 83% by using automated microscopy. The manual and automated microscopy correlated well for measurements of epithelial cell density (R(2)=0.64); however, the automated microscopy was more accurate. CONCLUSIONS This preliminary study using an automated system for intraoperative interpretation does not require a cytopathologist and shows that rapid, low-resolution imaging can correctly identify cancer cells for invasive carcinoma in surgical specimens. Therefore, automated determination of cellularity in touch prep is a promising technique for future margin interpretation of breast conservation therapy.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnosis
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/surgery
- Combined Modality Therapy
- Cytological Techniques
- Female
- Fluorescent Antibody Technique
- Humans
- Lymph Nodes/pathology
- Lymph Nodes/surgery
- Lymphatic Metastasis
- Mastectomy
- Microscopy/methods
- Middle Aged
- Neoplasm Staging
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/surgery
- Pattern Recognition, Automated/methods
- Prognosis
- Survival Rate
- Treatment Outcome
- Young Adult
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Percutaneous excisional biopsy of impalpable breast lesions under ultrasound visualization. Breast 2008; 17:666-70. [PMID: 18835778 DOI: 10.1016/j.breast.2008.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 05/20/2008] [Accepted: 08/02/2008] [Indexed: 11/20/2022] Open
Abstract
Within the last ten years, the development of innovative minimally invasive breast biopsy technologies has made a significant impact on the diagnostic evaluation of impalpable breast lesions. The Mammotome minimally invasive biopsy system is a diagnostic tool used under stereotactic or ultrasound guidance. The minimally invasive biopsies for 143 impalpable breast lesions in 86 patients were performed using the B-ultrasound-guided 8-gauge vacuum-assisted Mammotome system at Jinan Military General Hospital. One hundred and forty-three breast lesions in 86 patients were excised completely using this method. The average biopsy procedure time was 17 min (range, 3-45 min). Clinically, suspicious lesions were satisfactorily confirmed by this system. One hundred and twenty-one lesions were diagnosed as fibroadenoma, nineteen lesions as breast adenosis, one lesion as invasive breast cancer, and two lesions as ductal carcinoma in situ. Skin ecchymosis was found in two patients. One hundred and thirty-two impalpable lesions were completely excised, as demonstrated by the follow-up ultrasound examination. The results suggest that the B-ultrasound-guided Mammotome system may be an efficient tool for the diagnosis and treatment of impalpable breast lesions.
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Hahn M, Okamgba S, Scheler P, Freidel K, Hoffmann G, Kraemer B, Wallwiener D, Krainick-Strobel U. Vacuum-assisted breast biopsy: a comparison of 11-gauge and 8-gauge needles in benign breast disease. World J Surg Oncol 2008; 6:51. [PMID: 18489771 PMCID: PMC2405782 DOI: 10.1186/1477-7819-6-51] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 05/19/2008] [Indexed: 11/23/2022] Open
Abstract
Background Minimal invasive breast biopsy is standard care for the diagnosis of suspicious breast lesions. There are different vacuum biopsy (VB) systems in use. The aim of the study was to determine the differences between the 8-gauge and the 11-gauge needle with respect to a) diagnostic reliability, b) complication rate and c) subjective perception of pain when used for vacuum-assisted breast biopsy. Methods Between 01/2000 and 09/2004, 923 patients at St. Josefs-Hospital Wiesbaden underwent VB using the Mammotome® (Ethicon Endosurgery, Hamburg). Depending on preoperative detection, the procedure was performed under sonographic or mammographic guidance under local anaesthesia. All patients included in the study were followed up both clinically and using imaging techniques one week after the VB and a second time after a median of 41 months. Excisional biopsy on the ipsilateral breast was an exclusion criteria. Subjective pain scores were recorded on a scale of 0 – 10 (0 = no pain, 10 = unbearable pain). The mean age of the patients was 53 years (30 – 88). Results 123 patients were included in the study in total. 48 patients were biopsied with the 8-gauge needle and 75 with the 11-gauge needle. The use of the 8-gauge needle did not show any significant differences to the 11-gauge needle with regard to diagnostic reliability, complication rate and subjective perception of pain. Conclusion Our data show that there are no relevant differences between the 8-gauge and 11-gauge needle when used for VB. Under sonographic guidance, the use of the 8-gauge needle is recommended for firm breast tissue due to its sharp scalpel point and especially for complete removal of benign lesions. We did not find any advantages in the use of the larger 8-gauge needle compared to the 11-gauge needle in the mammography setting. The utilisation costs of the 8-gauge needle are somewhat higher.
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Affiliation(s)
- Markus Hahn
- Clinic for Obstetrics and Gynaecology, University of Tuebingen, Germany.
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Povoski SP. The utilization of an ultrasound-guided 8-gauge vacuum-assisted breast biopsy system as an innovative approach to accomplishing complete eradication of multiple bilateral breast fibroadenomas. World J Surg Oncol 2007; 5:124. [PMID: 17967193 PMCID: PMC2147012 DOI: 10.1186/1477-7819-5-124] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 10/29/2007] [Indexed: 11/10/2022] Open
Abstract
Background Ultrasound-guided vacuum-assisted breast biopsy technology is extremely useful for diagnostic biopsy of suspicious breast lesions and for attempted complete excision of appropriately selected presumed benign breast lesions. Case presentation A female patient presented with 16 breast lesions (eight within each breast), documented on ultrasound and all presumed to be fibroadenomas. Over a ten and one-half month period of time, 14 of these 16 breast lesions were removed under ultrasound guidance during a total of 11 separate 8-gauge Mammotome® excision procedures performed during seven separate sessions. Additionally, two of these 16 breast lesions were removed by open surgical excision. A histopathologic diagnosis of fibroadenoma and/or fibroadenomatous changes was confirmed at all lesion excision sites. Interval follow-up ultrasound imaging revealed no evidence of a residual lesion at the site of any of the 16 original breast lesions. Conclusion This report describes an innovative approach of utilizing ultrasound-guided 8-gauge vacuum-assisted breast biopsy technology for assisting in achieving complete eradication of multiple bilateral fibroadenomas in a patient who presented with 16 documented breast lesions. As such, this innovative approach is highly recommended in similar appropriately selected patients.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA.
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