Ultrasound-guided Vacuum-assisted Biopsy Research Articles

Ultrasound-Guided Vacuum-Assisted Breast Biopsy for Breast Intraductal Lesions: a Meta-Analysis of Underestimation and Pathological Nipple Discharge Cure Rates

Background: Breast intraductal lesions present a diagnostic challenge due to the diverse spectrum of histologic changes. Vacuum-assisted biopsy (VAB) has evolved as a pivotal diagnostic and therapeutic modality. Yet, concerns about the underestimation of malignancy using VAB persist. This review examines the underestimation rates of Ultrasound-guided VAB (US-VAB) for intraductal lesions and evaluates the effectiveness of VAB in addressing pathological nipple discharge (PND). Methods: Following PRISMA guidelines, a comprehensive search was performed across Scopus, PubMed, and Web of Science. Studies detailing the underestimation rates of intraductal breast lesions diagnosed by US-VAB and cure rates for PND post-VAB excision were selected. Statistical analysis comprised a random effects proportion meta-analysis. Results: In this research, 31 studies were deemed eligible: 26 for underestimation and 5 for PND cure rates post-US-VAB. Quantitative synthesis focused on studies reporting data on atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) due to limited availability for other pathologies. The pooled underestimation rate for ADH was 6.14% (95% CI: 1.59%-12.43%). The pooled underestimation rate for DCIS was 13.26% (95% CI: 6.69%-21.08%). PND's pooled cure rate post-US-VAB was 93.32% (95% CI: 82.34%-99.70%). Conclusion: This systematic review and meta-analysis show that US-VAB delivers low ADH underestimation rates, moderate DCIS underestimation rates, and acceptable PND cure rates in breast intraductal lesions.

Unexpected breast cancer mimicking benign lesions on ultrasound-guided vacuum-assisted excision biopsy: A retrospective cross-sectional study over a 20-year period.

This study investigated the occurrence rate of unexpected breast cancer (UEBC) mimicking benign lesions [Breast Imaging Reporting and Data System (BI-RADS) category 3 or 4a] using ultrasound-guided vacuum-assisted excision biopsy (US-VAEB), and explored the factors responsible for late diagnosis of T2 stage UEBC. We collected clinicopathologic data and preoperative US imaging features within 3 months before US-VAEB of patients who were diagnosed with UEBC from January 2002 to September 2022. The UEBC were divided into T1 and T2 stageUEBC. The US imaging features as well as clinical and pathological information of T1 and T2 stage UEBC were compared to explore the factors responsible for late diagnosis of T2 stage UEBC. Breast cancer was diagnosed in 91 of 19306 patients who underwent US-VAEB. We excluded eight patients with breast cancer assigned to BI-RADS 4b category by preoperative US, and two for whom US imaging records were unavailable. Finally, we enrolled 81 patients. The occurrence rate of UEBC after US-VAEB was 0.42%(81/19296). Of the 81 cases of UEBC, 22 were at T2 stage. The ratio of T2 stage UEBC was 27.2%. The differences in risk factor of breast cancer and routine breast US screening between T1 and T2 stage UEBC were significant[96.6% (57/59) vs 81.8% (18/22), 44.1% (26/59) vs 13.6% (3/22), respectively, P<0.05). UEBC was rarely detected by US-VAEB. Most cases of T2 stage UEBC were diagnosed late because of the absence of routine US screening and risk factors for breast cancer. Stricter clinical management regulations for breast lesions and performing regular US screening may be helpful to reduce T2 stage UEBC.

Assessment of Pathological Complete Response Using Vacuum-Assisted Biopsy in Breast Cancer Patients Who Have Clinical and Radiological Complete Response After Neo-Adjuvant Chemotherapy.

Any treatment protocol that leads to complete elimination of surgery may lead to a better patient acceptance of breast cancer treatments. We conducted this study to assess the feasibility of preoperative vacuum-assisted biopsies in identifying pathological complete response (pCR) and its accuracy in correlation to final histopathology report (HPR), in an Indian setting. This was a prospective study conducted between October 1, 2019, and March 31, 2021. Patients with early breast cancer, estrogen and progesterone receptors negative and either Her2 positive or negative, and who were fit to undergo marker placement at the centre of the tumour and to receive third-generation chemotherapy (4 cycles of 3 weekly doxorubicin and cyclophosphamide followed by 4 cycles of 3 weekly docetaxel) were included in the study. Following the enrolment, a tissue marker was placed at the centre of the tumour and appropriate chemotherapy was started. Patients who achieved clinical complete response were subjected to ultrasound-guided vacuum-assisted biopsy (VAB) from the tumour bed before surgery. Pathology results of the VAB and resected specimen were then compared. Descriptive statistics were used in the study. Eighteen patients were enrolled in the study, with a mean age of 43.6 ± 9.8 years. However, only 10 were eligible for VAB procedure, and sensitivity and specificity were calculated based on the results of these 10 patients only. Vacuum-assisted biopsy showed sensitivity of 50% and specificity of 100% in identifying pCR. Combination of mammography, ultrasonography, and VAB showed sensitivity of 77.8% and specificity of 66.7% in identifying pCR. Vacuum-assisted biopsy of tumour bed may not be sensitive enough to eliminate surgery even in patients who have had exceptional response to neo-adjuvant chemotherapy.

Ultrasound-guided vacuum-assisted excision biopsy in breast fibroadenomas: an Egyptian center experience

BackgroundBenign 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.ResultsTwenty-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.ConclusionsThe 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.

Ultrasound-guided vacuum-assisted biopsy is an accurate type of biopsy to detect female breast cancer

Ultrasound-guided vacuum-assisted biopsy is an accurate type of biopsy to detect female breast cancer

A systematic review and meta-analysis: value of ultrasound-guided vacuum-assisted biopsy in the diagnosis and treatment of breast lesions.

In recent years, according to global statistics, breast cancer is the main disease affecting women. Ultrasound-guided vacuum-assisted biopsy (VAB) has become a frequently used method for breast cancer detection because of its accuracy, simplicity, and fewer complications. In PubMed, Medline, EMbase and Cochrane central register of controlled trials, the retrieval time was from the establishment of the database to March 2021, and the keywords included breast tumor, breast cancer-related diseases, breast lesions, vacuum-assisted breast biopsy, sensitivity and specificity. Meta-analysis was performed using RevMan5.3 software provided by the Cochrane Collaboration. A total of 10 articles were included using a random-effects model that pooled the sensitivity, specificity, and other accuracy measures of VAB. The summary receiver operating characteristic (SROC) characteristic curve was used to summarize the overall accuracy. The sensitivity range was 0.94 to 1.00 (mean, 0.981; 95% CI, 0.972-0.987) with a specificity range of 0.87-1.00 (mean, 0.999; 95% CI, 0.997-0.999). The preoperative platelet-lymphocyte ratio (PLR) was 93.84 (95% CI, 41.55-211.95), the neutrophil to lymphocyte ratio (NLR) was 0.05 (95% CI, 0.03-0.09), the sensitivity and specificity of χ2 were 37.10 (P=0.011) and 32.00 (P=0.043), respectively, while those of PLR, NLR, and duration of response (DOR) were 46.98 (P=0.001), 54.92 (P=0.001), and 43.49 (P=0.002), respectively. Differences were considerable. In this meta-analysis, a total of 10 articles were included. VAB is an accurate type of biopsy to detect female breast cancer. The results of the meta-analysis were stable, and VAB had high sensitivity (98%) and specificity (nearly 100%).

Vacuum-Assisted Excision, Scarless Solution for Fibroadenoma Breast-A Single-Center Experience.

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.

Ultrasound-Guided Vacuum-assisted Biopsy Versus Surgical Resection in Patients With Breast Desmoid Tumor

BackgroundRecent studies suggest that desmoid tumors can be managed more conservatively rather than undergoing wide surgical resection (SR). Ultrasound-guided vacuum-assisted biopsy (UGVAB) is a minimally invasive technique. This retrospective study aimed to compare the outcome in patients with breast desmoid tumor (BDT) who received UGVAB alone versus SR. Materials and methodsThe pathology database was searched for patients diagnosed with BDT ≤ 3 cm from 2007 to 2019. All patients underwent breast ultrasound examination and were then performed UGVAB alone or local SR. The Kaplan–Meier method with a log-rank test was used as a univariate analysis to compare the relapse-free survival (RFS) rates between UGVAB and SR groups. Cox regression analysis was used for multivariate analysis. ResultsA total of 39 patients were included. The median follow-up was 41 mo (range, 5-110 mo). The incidence of tumor recurrence was 23.1% (9/39). The 3-y cumulative RFS was 83.1% and 95.8% in the UGVAB and SR group, respectively, which was not significantly different between the two groups (P = 0.131, log-rank test). Multivariate analysis also revealed that treatment strategy (UGVAB versus SR) was not associated with an increased risk of relapse events (P = 0.274). ConclusionsSmall desmoid tumors (≤3 cm) after UGVAB alone did not have a significantly compromised RFS compared with those who underwent SR. UGVAB may be an alternative and relatively conservative method for the diagnosis and local control of BDT with a smaller size. A prospective, randomized study with large sample size is needed to confirm this observation.

Re-excision or "wait and watch"-a prediction model in breast phyllodes tumors after surgery.

BackgroundThe 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.MethodsData 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.ResultsOf 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.ConclusionsThe 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”.

Abstract P1-20-26: Management of breast fibromatosis: Is further surgical resection treatment necessary after ultrasound-guided vacuum-assisted biopsy?

Abstract Purpose: Recently, some studies confirmed that the surgical margin in patients with breast fibromatosis was not associated with recurrence. Wide tumor-free resection surgery, which used to be the first-line treatment, might not be necessary for all fibromatosis patients. Ultrasound-guided vacuum-assisted biopsy (UGVAB) is a minimally invasive technique which has been used for complete excision of benign breast tumors. The purpose of this study is to compare the risk of relapse between patients with breast fibromatosis received UGVAB alone to local surgical resection (SR) in our hospital. Material and methods: The pathology database was searched over the period of 2007 to 2017 for cases in which patients diagnosed as breast fibromatosis/desmoid-typed tumors. All patients were accepted breast ultrasound examination and then treated by UGVAB alone or SR at our breast tumor center. Postoperative follow-up was carried out with ultrasound examination at intervals of 3 to 6 months. X2 test was used to compare clinicopathologic features, Kaplan-Meier method with a log-rank test was used as a univariate analysis to compare the relapse-free survival (RFS) rates, Cox regression analysis was used for multivariate analysis. Results: A total of 40 patients were enrolled in this study. Of these 40 patients, 13 (32.5%) were classified as UGVAB group and 27 (67.5%) as local SR group. The age at the time of initial diagnosis ranged between 21-65 years, with a median age of 35.5 years. Sixteen (16/40, 40.0%) patients had a past history of breast surgery. Tumors were palpable in most patients (33, 82.5%), which was significantly different in two groups [8 (61.5%) in UGVAB group, 25 (92.66%) in SR group, p = 0.027]. Meanwhile, there was a trend towards smaller tumors in UGVAB group (median size 1.1cm) than SR group (median size 1.9cm, p = 0.172). (Table 1) During the follow-up, 25% (10/40) patients developed a tumor recurrence, the median RFS was 36 months (range, 5-110 months). RFS was 69.2% in the UGVAB group and 77.8% in the SR group, the RFS has no difference between these two groups (p = 0.082, log-rank test). Multivariate analysis also identified that treatment strategy (UGVAB vs. SR) was not associated with an increased risk of relapse events (hazard ratio [HR] 0.309, 95% confidence interval [CI] 0.063-1.515; p = 0.148) (Table 2). Conclusion: Patients who were diagnosed with breast fibromatosis and received UGVAB treatment did not have a significantly compromised RFS than those who underwent SR. UGVAB could be an alternative and relatively conservative therapy for local control of breast fibromatosis. TABLE 1 Clinicopathologic features of patients included in the studyTotal N=40UGVAB Group n=13(32.5%)Local SR Group n=27(67.5%)pAge(y)≤3520(50.0)6(46.2)14(51.9)0.736&amp;gt;3520(50.0)7(53.8)13(48.1)Previous breast surgeryYes16(40)3(23.1)13(48.1)0.130No24(60)10(76.9)14(51.9)PalpableYes33(82.5)8(61.5)25(92.6)0.027*No7(17.5)5(38.5)2(7.4)Initial tumor size(cm)≤230(80.0)12(92.3)18(66.7)0.172#&amp;gt;210(20.0)1(7.7)9(33.3)LateralityRight13(32.5)4(30.8)9(33.3)0.586*Left24(60.0)9(69.2)15(55.6)Bilateral3(7.5)0(0)3(11.1)USG BI-RADS category38(20.0)5(38.5)3(11.1)0.126*4A12(30.0)4(30.8)8(29.6)4B-4C/520(50.0)4(30.8)16(59.3)UGVAB ultrasound-guided vacuum-assisted biopsy, SR surgical resection, USG ultrasonography, BI-RADS Breast Imaging-Reporting and Data System* Fisher’s exact test # Continuity correction Table 2. Multivariate analysis of prognostic factors for RFS.UnivariateMultivariateHazard ratio (95% CI)p-valueHazard ratio (95% CI)p-valueAge (≤35 vs. &amp;gt;35)0.640 [0.161-2.551]0.5270.519[0.083-3.245]0.483History of breast surgery (yes vs. no)0.679[0.134-3.448]0.6400.922[0.119-7.113]0.938Treatment (UGVSB vs. SR)0.288[0.064-1.293]0.1040.309[0.063-1.515]0.148Tumor size (≤2cm vs. &amp;gt;2cm)0.259 [0.032-2.079]0.2030.316[0.038-2.648]0.288RFS relapse free survival, UGVAB ultrasound-guided vacuum-assisted biopsy, SR surgical resection Citation Format: Jingsi Mei, Yue Hu, Chang Gong. Management of breast fibromatosis: Is further surgical resection treatment necessary after ultrasound-guided vacuum-assisted biopsy? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-26.

Ultrasound-guided vacuum-assisted excisional biopsy to treat benign phyllodes tumors

PurposeTo evaluate the value of ultrasound (US)-guided vacuum-assisted excisional biopsy (VAB) in treating benign phyllodes tumors (PTs) of the breasts and to investigate the lesion characteristics that could affect the local recurrence rate. Patient and methodsFrom December 2008 to February 2018, 93 patients with PTs diagnosed on histology underwent US-guided, 7-gauge VAB. The recurrence rate of benign PT and complications of VAB were evaluated on follow-up US every three to six months. The lesion characteristics were analyzed to identify the factors affecting the recurrence rate. ResultsOf the 87 patients, local recurrence was found in 15 patients (17%) in a mean follow-up period of 35.8 months, and the rate of complete excision was 82.8% (72/87). PTs with a largest diameter less than 3.3 cm had a significantly lower recurrence rate than PTs with a largest diameter larger than 3.3 cm (P < 0.05). ConclusionsIn conclusion, US-guided VAB is an effective method to treat benign PT, especially in lesions with a diameter less than 3.3 cm.

Ultrasound-Guided Vacuum-Assisted Biopsy in Small Breast: A Cost-Saving Solution

BackgroundThe study aimed to evaluate the feasibility and reliability of ultrasound-guided vacuum-assisted breast biopsy (US-VABB) for sampling of microcalcifications indicative of cancer when stereotactic vacuum-assisted breast biopsy cannot be performed because of reasons such as thin breast tissue, insufficient thickness at compression, and microcalcification situated close to the chest wall or in breast tissue of the axillary tail. Patients and MethodsThe study population was selected from among 187 patients with microcalcifications detected on mammogram. The findings were classified using the American College of Radiology criteria as Breast Imaging Reporting and Data System 3, 4, or 5. 30 Thirty were not eligible for stereotactic guidance because of reasons such as small breast size, compression thickness <2 cm, or microcalcification located in the axillary tails or close to chest wall. In 23 patients microcalcifications were detected at ultrasound, and US-VABB was performed. The other 7 patients underwent surgical biopsy. In the 23 patients who underwent US-VABB, multiple core samples were taken after a specimen mammography to ensure that microcalcifications were included. ResultsBiopsy was successful in all cases of US-VABB. The procedure was well tolerated, and there were no complications. ConclusionUS-VABB should be preferred over diagnostic surgical biopsy when microcalcifications are sonographically visible and stereotactic guidance is contraindicated. The procedure appears to be reliable and accurate, with added advantages such as low cost and absence of radiation exposure.

Microbubble detection and ultrasound-guided vacuum-assisted biopsy of axillary lymph nodes in patients with breast cancer

To assess the feasibility of undertaking microbubble-guided vacuum-assisted biopsy (VAB) of the sentinel lymph node (SLN) and determine its sensitivity in detecting metastases. Patient experience and the impact of VAB on subsequent axillary surgery were also evaluated. Patients with a normal axillary ultrasound or benign core biopsy planned for surgical SLN biopsy were recruited. Part 1 of the study was used to establish the technique of ultrasound microbubble contrast to detect the SLN. In Part 2 microbubble detection of the SLN was followed by 13 G VAB. All patients subsequently had surgical histological correlation. One hundred and thirty-nine patients were recruited: 36 to Part 1 and 103 to Part 2. Of the 100 patients in Part 2 included for analysis, 82 (82%) underwent successful biopsy. Sensitivity for detecting metastases was 58.8% (95% confidence interval: 32.9%, 81.6%). The procedure was generally well tolerated; however, VAB interfered adversely with subsequent surgical SLN biopsy with surgeons reporting moderate or severe interference in 48% of patients and an additional 8.3% with complete failure of SLNB. It is possible to perform VAB of microbubble-detected SLNs. Although the sensitivity for detecting metastases was reasonable, the adverse effect on subsequent surgery was significant.

Minimally Invasive Breast Fibroadenoma Excision Using an Ultrasound-Guided Vacuum-Assisted Biopsy Device.

Introduction We studied the extent to which an ultrasound-guided vacuum-assisted biopsy device ("hand-held Mammotome") could be used not only as a valuable tool for investigation of suspicious breast lesions, but also therapeutically for the complete removal of breast fibroadenomas. Materials and Methods 132 aspiration biopsies showing fibroadenoma on histology were collected retrospectively. We ascertained whether there were residual findings on breast ultrasound at a median follow-up of approx. 9 months following biopsy. A questionnaire was used to determine the complication rate, patient satisfaction and acceptance of the procedure. Results In this study complete fibroadenomectomy was achieved at aspiration biopsy in 76 % of cases (n = 132). Compared to fibroadenomas larger than 2.51 cm3 (59 %), those smaller than 2.5 cm3 were completely removed more often (87.6 %; p < 0.05). The procedure is associated with very little pain during and after biopsy and minimal haematoma development, both factors supporting a high rate of acceptance among patients. Conclusion Ultrasound-guided vacuum-assisted biopsy is safe and associated with very few complications. Its additional therapeutic potential is dependant on the size of the benign lesion as measured at initial ultrasound.

Cumulative Sum Analysis for Learning Curve for Breast Mass Excision Using an Ultrasound-Guided Vacuum-Assisted Biopsy System

Purpose: The aim of the study was to evaluate the existence of a learning curve for procedures using ultrasound-guided vacuum-assisted breast biopsy (VAB) system in terms of the cumulative sum (CUSUM). Methods: Data from a series of 54 consecutive patients who had undergone ultrasound-guided VAB were reviewed in the study. Patients’ characteristics, operative times, and complication rates were analyzed. The total operation time was analyzed by using the CUSUM method. Results: CUSUM analysis revealed three phases of the learning curve: phase 1 (the initial 15 cases), phase 2 (intermediate 23 cases), and phase 3 (subsequent cases). Operative times, including preparation time, procedure time, and total operation time, in phase 1 were significantly longer than those in phases 2 and 3. Surgical complications were the most frequent in the initial phase (26.7%); however, complication rates were not significantly different among the three groups. Conclusion: The current study showed the three different phases of the learning curve for ultrasound-guided VAB using CUSUM analysis. CUSUM analysis can be used to determine appropriate competency of various procedures in patients with breast diseases.

Benign Phyllodes Tumor of the Breast Diagnosed After Ultrasound-Guided Vacuum-Assisted Biopsy: Surgical Excision or Wait-and-Watch?

The role of tumor-free resection in the treatment of benign phyllodes tumors (PTs) is still unknown. Ultrasound-guided vacuum-assisted biopsy (UGVAB) has been used for complete removal of benign breast lesions. This retrospective study aimed to compare the risk of relapse between patients with benign PT who undergo UGVAB and those who receive surgical excision (SE). Benign PT patients with a pathology diagnosis who had received treatment between 2005 and 2013 at the authors' hospital were identified. The patients who received UGVAB did not receive any SE. In the SE group, wide local excision or mastectomy was performed when appropriate. The Kaplan-Meier curve and Cox proportional hazards regression were used to analyze and compare the relapse-free survival (RFS) between the patients in the two groups. The study enrolled 225 female patients with benign PT. The patients in the UGVAB group (n = 108) had significantly smaller tumors, more fibroadenoma, a higher body mass index (BMI), and a lower Breast Imaging-Reporting and Data System classification than the patients in the SE group (n = 117). The 5-year cumulative RFS was 81.6 and 88.7 % (p = 0.11) respectively for the patients receiving UGVAB and SE during a median follow-up period of 35.5 months. After adjustment for age, tumor size, BMI, or presence of fibroadenoma, treatment (UGVAB vs. SE) was not associated with increased risk for relapse events (hazard ratio 0.34; 95 % confidence interval 0.08-1.43; p = 0.14). No distant metastasis or death events occurred. The patients with benign PT who received UGVAB alone did not have a significantly more compromised RFS than those who underwent SE. A prospective, randomized study is needed to confirm this observation.

Handheld ultrasound-guided 20 mm basket Intact breast lesion excision system biopsy for excision of benign breast lesions

In selected patients, our Unit has recently moved from handheld ultrasound-guided vacuum-assisted core biopsy (VACB) piecemeal acquisition of tissue to the handheld Intact Breast Lesion Excision System (Intact). Intact removes a single piece of tissue, potentially allowing radiologists to excise the entire lesion as well as allowing pathologists to visualise lesion architecture more easily and to calculate margins. We evaluated our early experience of excising benign or likely benign breast lesions using the 20 mm Intact.

Sclerosing Adenosis of the Breast: Report of Two Cases and Review of the Literature

SummaryBackgroundSclerosing adenosis is a benign, usually asymptomatic lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast. It is commonly an incidental finding in perimenopausal women undergoing screening mammography.Case ReportWe reported on two patients with sclerosing adenosis assessed with mammography, ultrasound, and contrast-enhanced magnetic resonance imaging. Case 1 was a 21-year-old woman with a palpable lesion in her right breast that was depicted as an irregular mass on contrast-enhanced magnetic resonance imaging. Case 2 was an asymptomatic 42-year-old woman with suspicious ultrasound findings in her left breast; contrast-enhanced magnetic resonance imaging showed regional non-mass-like enhancement associated with increased vascularity. Both patients underwent ultrasound-guided vacuum-assisted biopsy. Sclerosing adenosis does not have distinctive radiological features and can mimic a malignant growth process, thus requiring a diagnostic biopsy.ConclusionsSA is a common, benign, generally asymptomatic proliferative lesion of the breast. It is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be elucidated. It does not exhibit distinctive MG, US or even MRI features. Since it may mimic a carcinoma it requires further investigation with a diagnostic biopsy.

MRI-guided vacuum-assisted breast biopsy: comparison with stereotactically guided and ultrasound-guided techniques

ObjectivesTo analyse the development of MRI-guided vacuum-assisted biopsy (VAB) in Switzerland and to compare the procedure with stereotactically guided and ultrasound-guided VAB.MethodsWe performed a retrospective analysis of VABs between 2009 and 2011. A total of 9,113 VABs were performed. Of these, 557 were MRI guided.ResultsMRI-guided VAB showed the highest growth rate (97 %) of all three procedures. The technical success rates for MRI-guided, stereotactically guided and ultrasound-guided VAB were 98.4 % (548/557), 99.1 % (5,904/5,960) and 99.6 % (2,585/2,596), respectively. There were no significant differences (P = 0.12) between the MRI-guided and the stereotactically guided procedures. The technical success rate for ultrasound-guided VAB was significantly higher than that for MRI-guided VAB (P < 0.001). There were no complications using MRI-guided VAB requiring open surgery. The malignancy diagnosis rate for MRI-guided VAB was similar to that for stereotactically guided VAB (P = 0.35).ConclusionMRI-guided VAB is a safe and accurate procedure that provides insight into clinical breast findings.Key points • Three vacuum-assisted breast biopsy (VAB) procedures were compared. • Technical success rates were high for all three VAB procedures. • Medical complications were relatively low using all three VAB procedures. • The use of MRI-guided vacuum-assisted breast biopsy is growing.

Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 11-gauge vacuum-assisted biopsy

The objective of this study was to compare the underestimation rate of invasive carcinoma cases with ductal carcinoma in situ (DCIS) at percutaneous ultrasound-guided core biopsies of breast lesions between 14-gauge automated core needle biopsy (ACNB) and 11-gauge vacuum-assisted biopsy (VAB), and analyze the diagnostic advantages and insufficiencies in DCIS between this two methods, and to determine the relationship between the lesion type (masses or microcalcifications on radiological findings) and DCIS underestimation rate. We collected 152 breast lesions which were diagnosed as DCIS by retrospectively reviewing data about ultrasound-guided biopsies of breast lesions (from February 2003 to July 2010). There were 98 lesions in 95 patients by 14-gauge ACNB, and 54 lesions in 52 patients by 11-gauge VAB (The system used in this study called Mammatome, MMT). The clinical and radiological findings were reviewed; meanwhile all the selected patients had histological results of the biopsies and follow-up surgeries which also achieved the reliable pathological results to compare with the biopsy results. The differences between two correlated histological results defined as underestimation, and the histological DCIS underestimation rates were compared between the two groups. According to the radiological characteristics, each group was classified into two subgroups (masses or microcalcifications group), and the differences between subgroups were also analyzed. The DCIS underestimation rate was 45.9% (45/98) for 14-gauge ACNB and 16.6% (9/54) for MMT. According to the lesion type on ultrasonography, DCIS underestimation was 31.0% (26/84) in masses (43.1% using ACNB and 12.1% using MMT; P = 0.003) and 42.6% (29/68) in microcalcifications (48.9% using ACNB and 23.8% using MMT; P = 0.036). The underestimation rate of invasive carcinoma in cases with DCIS at ultrasound-guided core biopsies is significantly higher for ACNB than for MMT. Furthermore, this difference does not alter among the two lesion types presented on ultrasonography. So ultrasound-guided VAB (MMT system) could be an effective and useful method for the diagnosis of DCIS lesions no matter what the lesion type is.