Mammotome Excision Research Articles

Feasibility and Safety of Ultrasound-Guided Vacuum-Assisted Breast Biopsy System for Intraductal Papilloma

Purpose: We aimed to evaluate the feasibility and safety of ultrasound-guided vacuum-assisted breast biopsy system for the treatment of intraductal papilloma (IDP). A vacuum-assisted breast biopsy system mammotome® was recently introduced for simultaneous biopsy and excision of benign breast masses. Mammotome excision has the advantages of safety and less scar formation compared to open biopsy. Wide excision is a standard treatment for IDP of the breast. Methods: We retrospectively reviewed the clinical data by using the electric medical records of 752 cases of breast masses that were treated via Mammotome excision performed by a single surgeon between January 2007 and December 2012. Among these patients, 26 patients were diagnosed with benign IDP as indicated in the final pathologic reports. Results: The median follow-up period was 56.2 months (range, 29–92 months). Two patients were diagnosed with another IDP during the follow-up period. However, no recurrence was detected at the previous excision site, but new primary lesions were confirmed at another quadrant. Conclusion: We suggest that ultrasound-guided vacuum-assisted breast biopsy system may be feasible and safe for the treatment of IDP. Keywords: Biopsy; Breast; Excision; Intraductal papilloma

High intensity focused ultrasound (HIFU) in the treatment of breast fibroadenomata: a feasibility study

Breast fibroadenomata (FAD) are the most common breast lesions in woman. For palpable lesions, three options are available: reassurance (with or without follow-up), vacuum assisted mammotome (VAM) or surgical excision. High intensity focused ultrasound (HIFU) is a non-invasive ablative technique in which an ultrasound (US) beam propagates through tissue as a high-frequency pressure wave and is focused onto targeted tissue which elevates the temperature of the focused area without causing damage to the adjacent tissues. HIFU is normally applied to the whole lesion. In this trial, we performed circumferential HIFU treatment to isolate the fibroadenoma from its blood supply. Primary end points of this trial included the decrease in treatment time and short-term complication rate.

Low-grade adenosquamous carcinoma of the breast with diverse expression patterns of myoepithelial cell markers on immunohistochemistry: a case study.

This paper reports a case of low-grade adenosquamous carcinoma (LGASC) arising in a 69-year-old woman, who presented with a 1-cm palpable mass on her right breast. Core needle biopsy diagnosed the mass as a fibroadenoma. After six months, the mass increased in size, and the patient received subsequent mammotome excision. On microscopic examination, bland-looking small glands were infiltrating into the fibrotic stroma with lymphocytic infiltrates at the periphery. Hematoxylin and eosin staining revealed relatively easily detectable myoepithelial cells along the outside in each of the glandular structures with variable degrees of squamous metaplasia. Based on histologic features, the patient was diagnosed with LGASC. LGASC is a rare variant of metaplastic carcinoma, which is characterized by a favorable prognosis. Due to the bland cytology and presence of myoepithelial cells, LGASC can be misdiagnosed as benign lesion. Additionally, inconsistent expression of myoepithelial markers could aid the diagnosis of LGASC.

Conservative management of screen-detected radial scars: role of mammotome excision

AimsTraditionally, a core biopsy diagnosis of radial scar will prompt diagnostic surgery because of the risk of associated malignancy. However, in the absence of atypia, the risk of malignancy is...

Minimally invasive excision of gynaecomastia – a novel and effective surgical technique

More aesthetically acceptable treatment options have been sought to minimise the morbidity associated with open surgery for gynaecomastia. This study investigated the use of a vacuum-assisted biopsy device (VABD) and liposuction to provide minimally invasive approach. Patients diagnosed with idiopathic benign gynaecomastia referred to the Breast Care Unit of Castle Hill Hospital between June 2002 and April 2007 and requesting surgical intervention underwent VABD excision and liposuction. All patients underwent thorough investigations to exclude any underlying cause for their gynaecomastia. The procedure was carried out by a single consultant surgeon with special interest in breast surgery. An 8-G mammotome probe was advanced through a 4-mm incision positioned in the corresponding anterior axillary line to excise the glandular disc. Liposuction was performed through the same incision. Incision wounds were closed with Steristrips. A pressure dressing was applied over wound by corset and an inflatable device. Thirty-six male patients with grade I and II gynaecomastia were recruited (22 bilateral, 14 unilateral). Average age was 33.3 years (range, 16-88 years). All underwent mammotome excision and liposuction. There were no conversions to an open procedure. The average procedure time was 50.3 min (range, 30-80 min). One intra-operative complication was recorded. The minimum follow-up time was 2 months. Thirty-four patients reported excellent satisfaction, two patients had residual gynaecomastia and needed a re-do procedure. Three patients developed small haematomas that resolved spontaneously. This novel, minimally invasive, surgical approach for gynaecomastia gives excellent results with minimal morbidity.

Is Further Diagnostic Surgery Necessary for the Benign Papillary Lesions that Are Diagnosed by Large Volume Vacuum Assisted Breast Biopsy?

papillary carcinoma in situ), 침습적유두상암(invasive papPurpose: There is ongoing controversy regarding the management of papillary lesions that are diagnosed by core needle biopsy (CNB). The development of vacuum assisted biopsy now permits non-operative removal of papillary breast lesions. Our aim was to evaluate whether the papillary lesions diagnosed by vacuum assisted breast biopsy (VABB) can be followed up without further diagnostic excision. Methods: From January 2003 to July 2009, a total of 4,655 US-guided mammotome excision were performed in 3,714 patients at Kangnam CHA Hospital. Out of 4,655 lesions, 156 lesions were proved to be papillary lesions. Among these, 82 lesions that had histologic findings that were consistent with benign papillary lesions and that were followed up for more than 2 years without further diagnostic surgical excision were collected and retrospectively analyzed. Ultrasonographic followup was done at 3-6 month intervals to assess for recurrence. The mean follow up period was 49.6 months. Results: The pathologic diagnoses for the 82 lesions obtained via VABB were benign intraductal papilloma and papillomatosis. Half of the lesions were palpable and 50.0% (41 cases) were nonpalpable. Twenty eight lesions (34.1%) were classified as BIRADS category 3, 50 lesions (61.0%) were category 4A, 3 lesions (3.7%) were category 4B and only 1 lesion (1.2%) was category 5 according to the ultrasound exams. No local recurrence developed during the follow up period that needed surgical re-excision or rebiopsy. None of those diagnosed as benign lesions at VABB were upgraded to a more advanced lesions. Conclusion: The benign papillary lesions that are diagnosed and excised by mammotome may not need further diagnostic surgical re-excision if surgeons are sure that the targeted lesions were excised completely.

Histopathological and immunohistochemical evaluations of breast cancer treated with radiofrequency ablation

Although RF ablation is a promising non-surgical ablation technique for the treatment of breast cancer, assessment of the efficacy requires not only imaging of tumor necrosis but also histological confirmation. Two series of patients were treated with RF ablation. In the first series, 17 patients underwent surgical resection immediately and 17 underwent delayed mammotome excision in the second series. The ablated tumor tissue was examined histologically with H&E staining and NADH-diaphorase staining. Furthermore, ssDNA was immunohistochemically stained in the specimen where tumor cells were histologically detected. In the first series, mild response was histologically seen in 14 of 17 patients (82%), whereas complete response was observed in 8 of 16 patients (50%) in the second series. However, NADH-diaphorase staining did not demonstrate any viable tumor tissues in any patient in either the first or the second series. ssDNA staining was positive (non-viable) in 13 of 16 cases in the first series, but it was positive in all 8 cases tested in the second series. Although NADH-diaphorase staining is essential to evaluate tumor cell viability immediately after RF ablation, ssDNA may be useful for the assessment of cell viability after some interval following RF ablation.

1094: Factors Influencing the Recurrence after US Mammotome Excision of Probable Benign Breast Lesions

The propose of this study is to evaluate the clinical outcome after US guided mammotome excision of benign breast lesions and to investigate the clinical, radiological and pathologic features in cases of recurrence.

0104 Is surgical excision necessary for benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum assisted biopsy device (Mammotome)?

Purpose: Phyllodes tumors are characterized by a double-layered epithelial component arranged in cleft-like ducts surrounded by a hypercellular spindle-celled stroma. Currently, phyllodes tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high rate of recurrence is an unsolved management problem. If a malignant phllodes tumor is treated inadequately, it may show a propensity for rapid growth and metastatic spread. However, benign phyllodes tumor are often indistinguishable from fibroadenoma, and can be cured by local surgery. Percutaneous removal of benign breast tumors using the Mammotome system has recently been regarded as a feasible, safe method without serious complications. The Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of the Mammotome biopsy device in the treatment of benign phyllodes tumor, and to identify whether surgical excision is necessary for benign phyllodes tumors diagnosed and excised by Mammotome. Methods: From Jan. 2003 to Feb. 2007, a total of 2,751 USguided mammotome excisions were performed in 2,226 patients at Kangnam Cha hospital. Out of 2,751 lesions, 30 lesions were proved to be benign phyllodes tumors. All lesions were removed using an 8-gauge probe without any residual lesions. Ultrasonographic follow-up was performed at a 3to 6-month interval to assess recurrence. The mean follow-up period was 33.2 months (max, 51 months; min, 2 months). Results: The mean patient age was 31.4 years. The average size of the lesion was 1.5 cm (SD+0.43 cm). The majority of lesions, 73.3% (22 cases), were palpable, and 26.7% (8 cases) were nonpalpable. Twenty-two lesions (73.8%) were classified as BIRADS category 3, eight lesions (26.7%) were classified as category 4A by ultrasound. During the follow-up period, local recurrence developed in only one patient, making the local recurrence rate 3.3%. No distant metastasis was observed. Conclusion: Benign phyllodes tumors found on mammotome excision may not require surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow-up ultrasound does not show any residual lesions, especially in small phyllodes tumors, the greatest dimension of which is less than 3 cm. (J Korean Surg Soc 2007;73:198-203)

The Role of MR Imaging for the Surgical Treatment Planning of Breast Cancer: Comparison with US and the Whole-Excised Breast Histopathologic Correlation

Purpose: We wanted to evaluate the effectiveness of breast magnetic resonance (MR) imaging as a preoperative evaluation modality, as compared with ultrasonography (US) imaging, and we wanted to determine the correlation of MRI and US with using the whole-excised breast histopathology as the standard reference. (Check this and adjust it as needed.) Materials and Methods: From October 2004 to March 2008, among the 245 patients with breast cancer, 82 patients underwent modified radical mastectomy (MRM). Seven patients were excluded due to receiving neoadjuvant chemotherapy before MRI (n=4) or mammotome excision (n=2) or non-visualization of the mass on US and MR imaging (n=1). The remaining 76 breasts in 75 women (one bilateral) were examined preoperatively with MR imaging and US. On US, 42 cases showed unifocal cancer, 16 showed multifocal cancer and 18 showed multicentric breast cancers. On MRI, 39 cases showed unifocal cancer, 11 showed multifocal cancer and 26 showed multicentric breast cancers. We assessed the US findings to identify the patients who were eligible for breast conservative surgery, and then we evaluated the cancers that were treated with conversion to MRM based on the MR imaging. Results: Histopathologic analysis revealed 45 unifocal, 10 multifocal and 22 multicentric breast cancers. Fiftyfive of the 76 breasts were indicated for MRM based on the US findings due to multicentric cancers (n=18), unifocal or multifocal lesions near the nipple (n=31), or unifocal or multifocal lesions showing extension towards the nipple (n=6). The remaining 21 breasts were classified as suitable for BCS on US, but 5 patients who desired MRM were excluded. Sixteen breasts were altered to MRM based on the additional findings that were suspicious for malignancy on the MR imaging. Among them, 14 (88%) breasts were adequately converted on the surgical plan to MRM based on the histopathologic verification. The remaining 2 breasts had been overestimated. Conclusion: Breast MRI has a significant effect for the preoperative surgical planning of breast cancers and it should be performed for the surgical planning.

An audit reviewing the management of fibroadenomas with the advent of Mammotome in the breast unit in Bradford

Fibroadenomas are the commonest benign breast tumours. Prior to vacuum-assisted large-volume biopsy, surgical excision was the only therapeutic option available. Our unit introduced Mammotome (Ethicon Endo-Surgery, Cincinnati, OH, USA) in January 2006, with Mammotome excision offered from September 2006 (for lesions 25 mm or less). We reviewed the change in practice with the advent of Mammotome. Patients with histological diagnosis of fibroadenoma throughout 2006 and 2007 were identified. The radiology and histology were reviewed. A total of 355 fibroadenomas were diagnosed in 333 patients: 252 presented symptomatically, 81 were screen-detected. Thirty-five diagnostic Mammotomes were performed (33 had been nondiagnostic on needle-core biopsy, two had radiology/pathology discordance). Definitive diagnosis was consequently made in 34 cases. One patient with nondiagnostic Mammotome had subsequent surgical biopsy of benign fibroadenoma. Seventy patients underwent excision. Fifteen were ultrasound Mammotome excisions; 13 confirmed fibroadenoma and two were phylloides (having surgical cavity excision subsequently). Fifty-five were surgical excisions; 33 were either unsuitable for Mammotome excision or the patient chose surgery; 11 were B2/B3 lesions and pathology recommended surgical excision; and the remaining 11 were before the introduction of Mammotome excision. Mammotome offers patient choice regarding excision of fibroadenomas, and reduces the number of surgical biopsies.

Large volume “mammotome” biopsy may reduce the need for diagnostic surgery in papillary lesions of the breast

Background:There is currently debate as to whether all papillary lesions diagnosed on breast needle core biopsy (BNCB) require surgical excision. The development of large volume “mammotome” biopsy now permits non-operative...

The Role of Ultrasound-Guided Vacuum-Assisted Removal of Gynecomastia

Purpose: To evaluate the role of performing ultrasound (US)-guided vacuum-assisted breast biopsies for the treatment (mammotome excision) of gynecomastia. Materials and Methods: Between November 2005 and December 2006, nine male patients underwent USguided mammotome excision for eleven cases of true gynecomastia. The patient ages ranged from 14 to 55 years (mean age, 32.3 years). US-guided mammotome excision was performed with an 11-gauge needle in seven cases and an 8-gauge needle in four cases. After the procedure, the cigarette method using gauze packing was performed. The number of samples, procedure time and presence of complications were evaluated. Scheduled follow-up physical and US examinations were performed after three and six months. Results: For 11 cases of US-guided mammotome excision of gynecomastia, the number of samples ranged from 12-126 (mean, 66) and the procedure time ranged from 10-42 minutes (mean time, 25.1 minutes). Clinical significant complications did not occur immediately after the procedure and complications were not seen after a follow-up examination in any of the cases. At the 3- and 6-month follow up examinations, all of the patients showed a normal male physical appearance on a physical examination and there was no evidence of hypoechoic glandular tissues as seen on ultrasonograms. Conclusion: US-guided mammotome excision is effective for the treatment of small, glandular true gynecomastia and is suggested as a new modality to replace the need for surgery or liposuction.

P28 Experience of mammotome excision of benign breast disease in Korea

P28 Experience of mammotome excision of benign breast disease in Korea

Radiofrequency ablation therapy for small breast cancer followed by immediate surgical resection or delayed mammotome excision

There is increasing demand for minimally invasive treatment approaches. Although radiofrequency (RF) ablation therapy is promising for the local treatment of small, well-localized breast cancer, the problem of determining tumor cell death after RF ablation remains. In the first series of this study, 17 patients underwent surgical resection immediately after RF ablation and 7 patients received delayed mammotome excision in the second series. The ablated tumor tissue was examined histologically with hematoxylin-eosin (H&E) staining and nicotinamide adenine dinucleotide (NADH)-diaphorase staining to assess tumor cell viability. Histological examination with H&E staining revealed a spectrum of changes ranging from complete coagulation necrosis to normal-appearing tumor cells, although the degenerative changes were more remarkable in the second than in the first series. However, NADH-diaphorase staining revealed no viable tumor cells in the ablated lesion in either series. NADH-diaphorase staining is essential to assess the effects of RF ablation. However, further studies are needed to determine whether RF ablation may provide equivalent local control and survival compared with conventional BCT for patients with small breast cancer.

Therapeutic mammotome excisions: papillary lesions

Papillary lesions of the breast are fairly common on imaging-guided breast biopsy, and the management remains controversial. Due to the heterogeneity of histological findings, papilloma can be a challenge to the pathologist when interpreting core biopsy specimens, so some may desire the entire lesion to be removed to be confident of the diagnosis of a benign papilloma. In appropriate cases, an attempt at removal with vacuum-assisted biopsy appears a reasonable approach with the hopes of establishing a diagnosis, relieving symptoms of nipple discharge, and avoiding the cost and morbidity of surgical intervention. The management of lesions with atypia on mammotome excision will remain controversial and the prudent approach is to recommend complete surgical excision.

Is the Mammotome excision of indeterminate impalpable lesions found incidentally on mammography best practice?

Mammotome excision of indeterminate (B3) impalpable lesions combined with annual mammographic follow-up can be regarded as routine practice. This quantitative study retrospectively reviewed consecutive Mammotome procedures from January 2003 to July 2005. B3 outcomes were analysed by category combined with follow-up for any evidence of histological upgrade to carcinoma. Out of a total of 120 consecutive Mammotome procedures, 61 (58%) had a B3 outcome. The B3 category subdivided into: 37% (n = 23) atypical ductal hyperplasia, 37% (n = 23) as radial scars, with the remaining 26% (n = 15) in a mixed category containing mucoceles, lobular carcinoma in situ, and papillomata. A total of 42.6% (n = 26) of the B3 category underwent annual mammographic follow-up with no signs of recurrence, 41% (n = 25) proceeded to 3-yearly NHSBSP routine recall follow-up, and 9.8% (n = 6) proceeded to surgical follow-up with two patients being up-graded to carcinoma. Four patients were lost to follow-up. The incidence of carcinoma in the B3 category ranged between 3.6% and 6.3%. Trends demonstrated that Mammotome excision for B3 lesions combined with annual mammographic follow-up can be safe practice providing each case is discussed within a multidisciplinary setting with regard to atypia, past history and concordance of imaging and results.

Sonographically guided mammotome excision of ducts in the diagnosis and management of single duct nipple discharge

Aim To describe our experience in the use of ultrasound guided mammotome in the diagnosis and management of single duct nipple discharge. Methods Patients for whom surgical excision of the single duct had been advised for single duct nipple discharge were offered ultrasound guided mammotome excision of the duct as an alternative to surgical excision. The procedure was performed in the breast clinic by a surgeon or a breast clinician who had interventional ultrasound skills. Results Seventy-seven patients had 81 procedures. Follow-up at a mean time of 16 months revealed resolution of the presenting problematic discharge in 95% of patients. Nipple discharge recurred in four patients. Two patients had microdochectomy and two had a repeat mammotome for recurrence of symptoms. Complications were mild and infrequent. Conclusion Ultrasound guided mammotome excision is a new tool in the work up and management of single duct nipple discharge. It can be performed under local anaesthetic by a surgeon/breast clinician or radiologist with interventional ultrasound skills. It has the potential to replace surgical excision (microdochectomy) as a treatment for nipple discharge.

2108: Papillary lesions diagnosed at sonography-guided biopsy

Objectives: To demonstrate the sonographic features of papillary lesions diagnosed at sonography-guided biopsy (SGB) and to determine the outcome of these lesions and management plan.Methods: The results of 5460 SGB were reviewed to identify cases of papillary lesions. Surgical finding (excisional biopsy, breast-conserving surgery and mastectomy) and follow-up sonographic data were categorized as benign, borderline and malignancy.Results: One hundred ninety-seven (3.6%) of 5460 biopsies exhibited papillary lesions SGB. Among these 197 cases, 100 patients performed surgery (n = 89) or mammotome excision (n = 11), 57 patients had taken the follow-up sonography and remaining 40 patients had no surgery and follow-up study. Malignant lesions were detected in 24%, borderline lesions in 13% and benign lesions in 63% of patients performed surgery. All 57 patients with follow-up sonography had benign papillary lesion. Imaging-histologic discordance was found in nine (14%) of the patients with benign lesion, in one (8%) of the patients with borderline lesion and in four (17%) of patients with malignant lesion.Conclusions: Sonographic findings of papillary lesions diagnosed at SGB are variable from probably benign lesion to suspicious findings. However, SGB results with imaging-histologic concordance may be sufficient to determine the diagnosis and management of papillary lesions with rare exception. Objectives: To demonstrate the sonographic features of papillary lesions diagnosed at sonography-guided biopsy (SGB) and to determine the outcome of these lesions and management plan. Methods: The results of 5460 SGB were reviewed to identify cases of papillary lesions. Surgical finding (excisional biopsy, breast-conserving surgery and mastectomy) and follow-up sonographic data were categorized as benign, borderline and malignancy. Results: One hundred ninety-seven (3.6%) of 5460 biopsies exhibited papillary lesions SGB. Among these 197 cases, 100 patients performed surgery (n = 89) or mammotome excision (n = 11), 57 patients had taken the follow-up sonography and remaining 40 patients had no surgery and follow-up study. Malignant lesions were detected in 24%, borderline lesions in 13% and benign lesions in 63% of patients performed surgery. All 57 patients with follow-up sonography had benign papillary lesion. Imaging-histologic discordance was found in nine (14%) of the patients with benign lesion, in one (8%) of the patients with borderline lesion and in four (17%) of patients with malignant lesion. Conclusions: Sonographic findings of papillary lesions diagnosed at SGB are variable from probably benign lesion to suspicious findings. However, SGB results with imaging-histologic concordance may be sufficient to determine the diagnosis and management of papillary lesions with rare exception.

3115: Ultrasonographic guided mammotome excisional biopsy for abdominal wall masses: A case report

Objectives: To introduce the usefulness of mammotome excisional biopsy for the soft tissue mass other than breast mass.Methods: A 37-year old man who had underwent oriental acupunctures on the abdominal wall 4 years ago, presented three painful palpable masses on previous acupuncture sites since 3 months ago. The largest one measuring as about 1.5 cm in diameter at the suprapubic area was surgically excised but recurrent abscess and seroma were developed at operation site. The two smaller masses measuring about 0.38× 0.25 cm and 0.38× 0.31 cm, respectively, were requested for mammotome excision (Biopsy Medical/Johnson and Johnson, Cincinnati, OH) under ultrasound (ATL(Advanced Technology Laboratories), Bothell, WA, HDI 5000) guidance.Results: Two painful small palpable lesions were successfully excised by mammotome with an 11 gauge probe under ultrasound guidance. Image-evident lesions were not visible after mammotome excision and the patient was satisfied with this procedure rather than surgical excision. On pathology, foreign body reaction with acute and chronic inflammation, eosinophic infiltration and fibrosis was found. Clinical recurrence or post-procedure complication such as hematoma or abscess formation did not occur.Conclusions: Mammotome excisional biopsy may be applicable to the soft tissue mass other than breast mass carefully. Objectives: To introduce the usefulness of mammotome excisional biopsy for the soft tissue mass other than breast mass. Methods: A 37-year old man who had underwent oriental acupunctures on the abdominal wall 4 years ago, presented three painful palpable masses on previous acupuncture sites since 3 months ago. The largest one measuring as about 1.5 cm in diameter at the suprapubic area was surgically excised but recurrent abscess and seroma were developed at operation site. The two smaller masses measuring about 0.38× 0.25 cm and 0.38× 0.31 cm, respectively, were requested for mammotome excision (Biopsy Medical/Johnson and Johnson, Cincinnati, OH) under ultrasound (ATL(Advanced Technology Laboratories), Bothell, WA, HDI 5000) guidance. Results: Two painful small palpable lesions were successfully excised by mammotome with an 11 gauge probe under ultrasound guidance. Image-evident lesions were not visible after mammotome excision and the patient was satisfied with this procedure rather than surgical excision. On pathology, foreign body reaction with acute and chronic inflammation, eosinophic infiltration and fibrosis was found. Clinical recurrence or post-procedure complication such as hematoma or abscess formation did not occur. Conclusions: Mammotome excisional biopsy may be applicable to the soft tissue mass other than breast mass carefully.