Efficacy and Safety of Ultrasound Guided Vacuum-Assisted Excision of Fibroadenomas: A Systematic Review

Tajudeen A Wahab,Botond K Szabó,Dalia Elfadl,Maher Jumah,Kasim Behranwala,Inga Chen

doi:10.4236/ojrad.2017.72011

Abstract

Background: Ultrasound-guided, vacuum-assisted excision [UGVAE] of fibroadenomas is an emerging minimally invasive procedure. UGVAE is being increasingly employed by breast radiologists and surgeons. It has been approved for this use since 2006 by the National Institute for Health and Clinical Excellence in the UK. The aim of this systematic review is to evaluate the efficacy and safety of this procedure based on the up to date available evidence. Methods: A comprehensive literature search of the Cochrane library, Medline, Embase, PubMed, Google scholar, Trip-database, Internet, and the reference lists of relevant articles was performed. We searched for literature with sizeable cases of therapeutic vacuum-assisted excision of fibroadenomas. All prospective studies with more than 20 study participants were screened. The study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach. All were in English. Results: Of the four case series that fulfilled the inclusion criteria there were 516 patients in which 520 procedures were performed. Overall complete excision rate was 89.4%. In two of the studies, this was 100% when the lesions were less than 1.5 cm but reduced to 61% when between 1.5 and 2 cm. Most common significant complication was bleeding with 2 cases of pneumothorax. None of the studies can be regarded as high quality going by GRADE approach. Conclusion: Within the limit of the current published case series, UGVAE appears to be an effective and safe procedure for excision of small fibroadenomas of less than 15 mm in size. A well designed case control study or randomized controlled trials with a sufficient sample size is needed to further assess its safety, effectiveness and more importantly, patients’ satisfaction especially in larger sized fibroadenomas.

Highlights

Breast fibroadenomas (FA) are a common cause of a benign discrete palpable lump in females [1]
UGVAE is being increasingly employed by breast radiologists and surgeons
We searched for literature with sizeable cases of therapeutic vacuum-assisted excision of fibroadenomas

Summary

Introduction

Breast fibroadenomas (FA) are a common cause of a benign discrete palpable lump in females [1]. They are relatively more common in patients aged between 15 and 35 years They often present as a painless mobile breast lump which are discovered incidentally in the majority of cases by the patients themselves. They can be discovered during investigations for other breast conditions or during routine screening imaging or examination. Available MIT includes ultrasound-guided highintensity focused ultrasound (HIFU) [8], interstitial laser ablation [9], cryotherapy [10] and ultrasound-guided vacuum biopsy system [11] The latter was approved by the UK National Institute for Clinical Excellence (NICE) [12] in 2006 based on the available literature .

Literature Search and Synthesis

Inclusion Criteria

Discussion

Findings

Conclusion