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.

Management of Patients with Breast Biopsy under Anti-Coagulation or Anti-Platelet Therapy: Results of a Survey of German Experts

Introduction: Pre-therapeutic histologic diagnosis through image-guided core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) for suspicious breast findings is a standard procedure. Despite the moderate risk of bleeding, a significant proportion of patients are on temporary or permanent anti-coagulation therapy (ACT) or anti-platelet therapy (APT). Currently, there are no established guidelines for managing biopsies in such patients, leading to varying approaches in clinical practice. Methods: An online survey was conducted among all members of the breast ultrasound working group at the German Society for Ultrasound in Medicine (DEGUM) and the working group for breast diagnostics at the German Radiology Society (DRG). It included n = 51 questions about individual risk perception of biopsy-related bleeding complications and the specific management of biopsies on ACT/APT. Results: A total of 332 experts participated, with 51.8% reporting the absence of a standardized management plan for breast biopsies on ACT/APT. Concerning specific ACT/APT medications, the survey revealed discrepancies in risk perception and management: The majority preferred discontinuing medication with directly acting oral anti-coagulants (DOACs; CNB: 66.9%; VAB: 91.1%), phenprocoumon (CNB: 74.9%; VAB: 96.7%), or therapeutic heparin (CNB: 46.1%; VAB: 72.7%). However, there was a lower inclination to discontinue acetylsalicylic acid (ASA; CNB: 15.2%; VAB: 50.3%) or prophylactic heparin (CNB: 11.9%, VAB: 36.3%). Conclusion: Breast biopsies for patients on ASA or prophylactic heparin are deemed safe and part of standard clinical practice. However, despite available feasibility studies, conducting breast biopsies on ACT medications such as DOACs or phenprocoumon appears feasible only for a minority of experts.

Omission of Breast Surgery in Predicted Pathologic Complete Response after Neoadjuvant Systemic Therapy: A Multicenter, Single-Arm, Non-inferiority Trial.

Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). Vacuum-assisted biopsy (VAB) has been suggested to accurately evaluate pCR. This study aims to confirm the non-inferiority of the 5-year disease-free survival of patients who omitted breast surgery when predicted to have a pCR based on breast magnetic resonance imaging (MRI) and VAB after NST, compared with patients with a pCR who had undergone breast surgery in previous studies. The Omission of breast surgery for PredicTed pCR patients wIth MRI and vacuum-assisted bIopsy in breaST cancer after neoadjuvant systemic therapy (OPTIMIST) trial is a prospective, multicenter, single-arm, non-inferiority study enrolling in 17 tertiary care hospitals in the Republic of Korea. Eligible patients must have a clip marker placed in the tumor and meet the MRI criteria suggesting complete clinical response (post-NST MRI size ≤ 1 cm and lesion-to-background signal enhancement ratio ≤ 1.6) after NST. Patients will undergo VAB, and breast surgery will be omitted for those with no residual tumor. Axillary surgery can also be omitted if the patient was clinically node-negative before and after NST and met the stringent criteria of MRI size ≤ 0.5 cm. Survival and efficacy outcomes are evaluated over five years. This study seeks to establish evidence for the safe omission of breast surgery in exceptional responders to NST while minimizing patient burden. The trial will address concerns about potential undertreatment due to false-negative results and recurrence as well as improved patient-reported quality of life issues from the omission of surgery. Successful completion of this trial may reshape clinical practice for certain breast cancer subtypes and lead to a safe and less invasive approach for selected patients. ClinicalTrials.gov Identifier: NCT05505357. Registered on August 17, 2022. Clinical Research Information Service Identifier: KCT0007638. Registered on July 25, 2022.

Practical Challenges of DBT-Guided VABB: Harms and Benefits, from Literature to Clinical Experience.

Vacuum-assisted breast biopsy (VABB) guided by digital breast tomosynthesis (DBT) represents one of the best instruments to obtain a histological diagnosis of suspicious lesions with no ultrasound correlation or those which are visible only on DBT. After a review of the literature, we retrospectively analyzed the DBT-guided VABBs performed from 2019 to 2022 at our department. Descriptive statistics, Pearson's correlation and χ2 test were used to compare distributions of age, breast density (BD) and early performance measures including histopathology. We used kappa statistics to evaluate the agreement between histological assessment and diagnosis. Finally, we compared our experience to the literature to provide indications for clinical practice. We included 85 women aged 41-84 years old. We identified 37 breast cancers (BC), 26 stage 0 and 11 stage IA. 67.5% of BC was diagnosed in women with high BD. The agreement between VABB and surgery was 0.92 (k value, 95% CI: 0.76-1.08). We found a statistically significant inverse correlation between age and BD. The post-procedural clip was correctly positioned in 88.2%. The post-procedural hematoma rate was 14.1%. No infection or hemorrhage were recorded. When executed correctly, DBT-guided VABB represents a safe and minimally invasive technique with high histopathological concordance, for detecting nonpalpable lesions without ultrasound correlation.

PP136 De-escalation of breast cancer surgery in patients with pathologic complete response (pCR) after neoadjuvant therapy confirmed by vacuum-assisted biopsy (VAB)

PP136 De-escalation of breast cancer surgery in patients with pathologic complete response (pCR) after neoadjuvant therapy confirmed by vacuum-assisted biopsy (VAB)

CLINICAL VALUE OF MAGNETIC RESONANCE IMAGING-GUIDED CORE NEEDLE AND VACUUM-ASSISTED BREAST BIOPSIES

Breast cancer is the most common oncological disease in women. When changes in the breasts are not visible on an ultrasound or mammogram, they can be detected by a magnetic resonance imaging (MRI) scan. A biopsy of the breast tissue is performed to examine the changes and predict the most suitable further treatment method. Most often, a core needle biopsy is performed under ultrasound or mammography guidance, but if lesions are only visible on MRI images, the biopsy should be performed under MRI control. MRI-guided biopsy is a relatively new diagnostic method. The aim of our study was to assess the clinical value of MRI-guided core nee­dle and vacuum-assisted core needle breast biopsies. We conducted a systematic literature analysis. Articles were retrieved from PubMed and ClinicalKey electronic data­bases. Eligible articles were selected based on inclusion and exclusion criteria. 12 articles were included from 512 publications. We conclude that MRI -guided core needle and vacuum-assissted core needle biopsies are a safe and effective method of taking a breast tissue biopsy, allowing you to assess abnormalities that are not visible on mammography or ultrasound. MRI-guided biopsy is appropriate for all patients with suspicious lesions seen only on MRI, irrespective of breast cancer risk, as ma­lignant lesions are likely to be found in ~21% of patients. MRI-guided core needle biopsies have a low compli­cation rate. The diagnostic performance of MRI-guided core needle biopsy (sensitivity ~ 93%) is comparable to the diagnostic performance of other image-guided breast biopsy techniques.

Study of the effectiveness of vacuum-aspiration breast biopsy in patients with complete clinical response after neoadjuvant polychemotherapy in complex treatment of breast cancer

Purpose of the study. Evaluation of the diagnostic value of vacuum-assisted biopsy (VAB) based on pathomorphological studies in patients with breast cancer (BC) who have achieved a complete clinical response (cCR) after neoadjuvant polychemotherapy (NACT).Patients and methods. In the study, conducted from 2021 to 2023 at the P. A. Hertsen Moscow Oncology Research Institute – a branch of the National Medical Research Radiology Center of the Ministry of Health of Russia, 35 patients with BC cT1–3N0–3M0 of various molecular-biological types who were diagnosed with cCR after NACT were included. All patients underwent VAB (needle size 7–10 G) of the breast followed by histological examination, after which surgical treatment was performed. Subsequently, histological conclusions of VAB and surgical materials were compared with each other for the presence and degree of pathomorphological response.Results. According to the pathomorphological conclusion when conducting VAB, the following results were obtained: 1 – true positive, 29 – true negative, 3 – false negative, and 0 – false positive. No statistically significant results of the association between complete pathomorphological response and the molecular-biological type of breast cancer were obtained (p > 0.05), however, there is a tendency towards the greatest number of complete pathomorphological responses in Her2-neu-positive (luminal – 100 %, non-luminal – 90.9 %) and triple-negative (87.50 %) types of breast cancer. The overall sensitivity of the method was 25.0 % (CI 6.8–60.2 %); specificity – 100 % (CI 88.1–100 %); false-negative result (presence of tumor cells in the surgical material and a negative result of VAB) – 9.1 % (CI 3.4–20.2 %); false-positive result (absence of tumor cells in the surgical material and a positive result of VAB) – 0 % (CI 0–10.6 %). The overall diagnostic accuracy of the method was 90.9 % (CI 79.8–96.6 %).Conclusion. The results of the conducted research allow for the consideration of excluding surgical treatment when a complete pathomorphological response is obtained by VAB. However, further research is required with the inclusion of a larger number of patients.

European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO

IntroductionBreast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence. MethodsThese guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool. ResultsRecommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion. ConclusionsThese guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice.

Preoperative breast MRI positively impacts surgical outcomes of needle biopsy–diagnosed pure DCIS: a patient-matched analysis from the MIPA study

ObjectivesTo investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS).MethodsThe MIPA observational study database (7245 patients) was searched for patients aged 18–80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs).ResultsOf 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111).ConclusionsCompared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation.Clinical relevance statementWhen confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies.Key Points• Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS.• When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI.• The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.

Minimally Invasive Breast Biopsy After Neoadjuvant Systemic Treatment to Identify Breast Cancer Patients with Residual Disease for Extended Neoadjuvant Treatment: A New Concept

BackgroundBreast cancer patients with residual disease after neoadjuvant systemic treatment (NAST) have a worse prognosis compared with those achieving a pathologic complete response (pCR). Earlier identification of these patients might allow timely, extended neoadjuvant treatment strategies. We explored the feasibility of a vacuum-assisted biopsy (VAB) after NAST to identify patients with residual disease (ypT+ or ypN+) prior to surgery.MethodsWe used data from a multicenter trial, collected at 21 study sites (NCT02948764). The trial included women with cT1-3, cN0/+ breast cancer undergoing routine post-neoadjuvant imaging (ultrasound, MRI, mammography) and VAB prior to surgery. We compared the findings of VAB and routine imaging with the histopathologic evaluation of the surgical specimen.ResultsOf 398 patients, 34 patients with missing ypN status and 127 patients with luminal tumors were excluded. Among the remaining 237 patients, tumor cells in the VAB indicated a surgical non-pCR in all patients (73/73, positive predictive value [PPV] 100%), whereas PPV of routine imaging after NAST was 56.0% (75/134). Sensitivity of the VAB was 72.3% (73/101), and 74.3% for sensitivity of imaging (75/101).ConclusionResidual cancer found in a VAB specimen after NAST always corresponds to non-pCR. Residual cancer assumed on routine imaging after NAST corresponds to actual residual cancer in about half of patients. Response assessment by VAB is not safe for the exclusion of residual cancer. Response assessment by biopsies after NAST may allow studying the new concept of extended neoadjuvant treatment for patients with residual disease in future trials.

Introduction of Stereotactic Vacuum-Assisted Breast Biopsy in Bulgaria

Summary Breast cancer is the most common cancer in women worldwide. The gold standard for biopsy is core needle biopsy. However, in certain cases, core needle biopsy cannot be applied, and the method of choice is vacuum-assisted biopsy. It is a minimally traumatic and precise method for diagnosing microcalcifications and small breast lesions. We aimed to present the initial experience with stereotactic vacuum-assisted biopsy in breast diseases at the Department of Surgical Oncology. We show indications and contraindications for this kind of biopsy and present our initial experience. From February 2020 to December 2022, 29 stereotactic vacuum-assisted biopsies were performed. Benign histology was found in 9 cases, malignant – in 15, and 5 cases were precancerous. Therefore, being an innovative, minimally invasive, and highly accurate method for diagnosing breast lesions with a good cosmetic effect, it allows early diagnosis of breast cancer, and, last but not least, the procedure can be curative for benign lesions.

Atypical ductal hyperplasia on vacuum-assisted breast biopsy: a scoring system to predict the risk of upgrade to malignancy.

Our multicentric study analysed clinical, radiologic and pathologic features in patients with atypical ductal hyperplasia (ADH) diagnosed with vacuum-assisted biopsy (VAB), to identify factors associated with the risk of upgrade, to develop a scoring system to support decision making. Patients with ADH on VAB under stereotactic/tomosynthesis guidance (2012-2022) were eligible. Inclusion criteria were availability of surgical histopathological examination of the entire lesion or radiologic follow-up (FUP) ≥ 24months. VAB results were compared with surgical pathological results or with imaging FUP evolution to assess upgrade. A backward stepwise linear regression was used to identify predictors of upgrade. The discriminatory power of the model was calculated through the area under the receiver operating curve (ROC-AUC); the Hosmer-Lemeshow test was used to assess model calibration. The points system was developed based on the selected risk factors, and the probability of upgrade associated with each point total was determined. 112 ADH lesions were included: 91 (91/112, 81.3%) underwent surgical excision with 20 diagnosis of malignancy, while 21 (21/112, 18.7%) underwent imaging FUP with one interval change (mean FUP time 48months). Overall upgrade rate was 18.7% (21/112). Age, menopausal status, concurrent breast cancer, BIRADS classification and number of foci of ADH were identified as risk factors for upgrade. Our model showed an AUC = 0.85 (95% CI 0.76-0.94). The points system showed that the risk of upgrade is < 2% when the total score is ≤ 1. Our scoring system seemed a promising easy-to-use decision support tool for management of ADH, decreasing unnecessary surgeries, reducing patients' overtreatment and healthcare costs.

Evaluating the use of vacuum-assisted excisions in the management of B3 breast lesions.

To evaluate the use of vacuum-assisted excisions (VAEs) in the management of B3 lesions within a single UK breast care centre. Assessment was made by determining the upgrade rates of the different B3 lesions at VAE. The study population comprised all patients who had a B3 result and subsequently underwent a VAE between November 2016 and October 2021. Patients with ipsilateral cancers were excluded. Retrospective biopsy and VAE results were reviewed. Upgrade rates and confidence intervals were calculated, and statistical significance was tested to determine any differences between upgrade rates of the B3 groups. 480 VAEs for B3 lesions were performed, with 10 excluded. Overall upgrade rate was 5%. 87.5% of upgrades were to non-invasive disease. Atypical intraductal epithelial proliferation (AIDEP) had a 15% upgrade rate, significantly different to lobular neoplasia (2%), papilloma without atypia (0%), and radial scar without atypia (0%). 10% of B3 lesions with atypia were upgraded, significantly different to 0% of B3 lesions without atypia. B3 lesions diagnosed by vacuum-assisted biopsy (VAB) had a significantly higher upgrade rate of 8% compared with 2% for lesions diagnosed by core biopsy (CBX), although this result was impacted by high numbers of AIDEP diagnosed by VAB. The results suggest using VAE for the management of AIDEP is appropriate. However, they also indicate that by performing VAEs of papillomas and radial scars without atypia, overtreatment may be occurring. This study adds to the ongoing discussion on the best treatment of B3 breast lesions.

Potential role of vacuum-assisted procedures in resecting breast cancers and highlighting selection criteria to support future trials.

The purpose of this study was to evaluate the role of vacuum-assisted biopsy (VAB) in resecting breast cancers. Retrospective database analysis of 116 cancers [both invasive breast cancers (IC) and ductal carcinoma in situ (DCIS)] diagnosed by VAB submitted to standard surgical treatment with complete histological data from VAB and surgery. Excision following VAB was defined as complete resection (CR) if there was no residual tumor in the surgical specimen, minimal residual disease (MRD) if residual tumor ≤ 3mm, gross residual disease (GRD) if residual tumor > 3mm, and upgrade from DCIS on VAB to IC. CR and MRD were combined as potentially resected percutaneously (PRP). GRD and those with upgrade to IC were determined not eligible for percutaneous resection (NPR). Factors predictive of PRP were evaluated. Mean age was 55.6 years (20-91; SD: 12,27). CR was seen in 29 of 116 cases (25%), MRD in 18 of 116 cases (15.5%), GRD in 64 of 116 cases (55.2%), and five of 116 cases (4.3%) were upgraded from DCIS to IC, and those groups combined represented 47 cases of PRP (40.5%) and 69 (59,5%) of NPR. For 77 tumors ≤ 10mm, 45 (58.5%) were PRP. Multivariate analysis reveals significance for enlarged VAB (EVAB) (p = 0.008, OR: 4.4, 95% CI), low/intermediate nuclear grade (p < 0.001, OR: 12.5, 95% CI) and final tumor size (T) ≤ 10mm (p = 0.001, OR: 50.1, 95% CI) for PRP. This study showed that lesions completely excised with VAB that were cancer could have been treated with VAB rather than surgery but tumor selection in terms of subtype and size is important.

Long-Term Follow-Up of High-Risk Breast Lesions at Vacuum-Assisted Biopsy without Subsequent Surgical Resection

Introduction: B3-lesions of the breast are a heterogeneous group of neoplasms, associated with a higher risk of breast cancer. Recent studies show a low upgrade rate into malignancy after subsequent open surgical excision (OE) of most B3-lesions when proven by vacuum-assisted biopsy (VAB). However, there is a lack of long-term follow-up data after VAB of high-risk lesions. The primary aim of this study was to demonstrate whether follow-up of B3 lesions is a beneficial and reliable alternative to OE in terms of long-term outcome. The secondary aim was to identify patient and lesion characteristics of B3 lesions for which OE is still necessary. Methods: This retrospective multicenter study was conducted at 8 Swiss breast centers between 2010 and 2019. A total of 278 women (mean age: 53.5 ± 10.7 years) with 286 B3-lesions who had observation only and who had at least 24 months of follow-up were included. Any event during follow-up (ductal carcinoma in situ [DCIS], invasive cancer, new B3-lesion) was systematically recorded. Data from women who had an event during follow-up were compared with those who did not. The results for the different B3 lesions were analyzed using the t test and Fisher’s exact test. A p value of <0.05 was considered statistically significant. Results: The median follow-up interval was 59 months (range: 24–143 months) with 52% (148/286) having a follow-up of more than 5 years. During follow-up, in 42 women, 44 suspicious lesions occurred, with 36.4% (16/44) being invasive cancer and 6.8% (3/44) being DCIS. Thus, 6.6% (19/286) of all women developed malignancy during follow-up after a median follow-up interval of 6.5 years (range: 31–119 months). The initial histology of the B3 lesion influenced the subsequent occurrence of a malignant lesion during follow-up (p < 0.038). The highest malignancy-developing rate was observed in atypical ductal hyperplasia (ADH) (24%, 19/79), while all other B3-lesions had malignant findings ipsi- and contralateral between 0% and 6%. The results were not influenced by the VAB method (Mx-, US-, magnetic resonance imaging-guided), the radiological characteristics of the lesion, or the age or menopausal status of the patient (p > 0.12). Conclusion: With a low risk of <6% of developing malignancy, VAB followed by long-term follow-up is a safe alternative to OE for most B3-lesions. A higher malignancy rate only occurred in ADH (24%). Based on our results, radiological follow-up should be bilateral, preferable using the technique of initial diagnosis. As we observed a late peak (6–7 years) of breast malignancies after B3-lesions, follow-up should be continued for a longer period (>10 years). Knowledge of these long-term outcome results will be helpful in making treatment decisions and determining the optimal radiological follow-up interval.

Preoperative factors associated with underestimation of invasive breast cancer in stereotactic vacuum-assisted biopsy-diagnosed DCIS patients

Objective: To determine preoperative factors associated with underestimation of invasive breast cancer, where stereotactic vacuum-assisted biopsy (VAB) diagnosed as ductal carcinoma in situ (DCIS). Materials and Methods: Data from 95 patients diagnosed with DCIS by stereotactic VAB, including their clinical, radiological, and pathological findings between November 2010 and May 2021, were analyzed retrospectively. The clinical, radiological, and pathological features were analyzed. Results: The underestimation rate was 30.5 %. Three preoperative features were significantly associated with the underestimation of invasive breast cancer in multivariable analysis, including palpability (OR, 11.51; 95% CI: 1.817-72.897; P = 0.009), BI-RADS category (OR, 3.705; 95% CI: 1.214-11.303; P = 0.021), and visibility of a mammographically detected lesion at ultrasonography (OR, 7.115; 95% CI: 1.977-25.611; P = 0.003). The calcification morphology was statistically significant in an univariable analysis but not in a multivariable analysis. Conclusion: Preoperative variables significantly associated with underdiagnosis of invasive breast cancer, including palpability, BI-RADS category, and visibility of mammographically detected lesions at ultrasonography, could aid in assessing the risk of developing invasive breast cancer and conducting treatment selection.

Vacuum-assisted biopsy system for breast lesions: a potential therapeutic approach.

The primary objective is to optimize the population eligible for Mammotome Minimally Invasive Surgery (MIS) by refining selection criteria. This involves maximizing procedure benefits, minimizing malignancy risk, and reducing the rate of malignant outcomes. A total of 1158 female patients who came to our hospital from November 2016 to August 2021 for the Mammotome MIS were analyzed retrospectively. Following χ2 tests to screen for risk variables, binary logistic regression analysis was used to determine the independent predictors of malignant lesions. In addition, the correlation between age and lesion diameter was investigated for BI-RADS ultrasound (US) category 4a lesions in order to better understand the relationship between these variables. The malignancy rates of BI-RADS US category 3, category 4a and category 4b patients who underwent the Mammotome MIS were 0.6% (9/1562), 6.4% (37/578) and 8.3% (2/24) respectively. Malignant lesions were more common in patients over the age of 40, have visible blood supply, and BI-RADS category 4 of mammography. In BI-RADS US category 4a lesions, the diameter of malignant tumor was highly correlated with age, and this correlation was strengthened in patients over the age of 40 and with BI-RADS category 4 of mammography. The results of this study demonstrate that the clinical data and imaging results, particularly age, blood supply, and mammography classification, offer valuable insights to optimize patients' surgical options and decrease the incidence of malignant outcomes.

Pathological characteristics of breast nodules after large-volume fat grafting for breast augmentation.

The complications of large-volume fat grafting (LVFG) for breast augmentation remain unpredictable and include palpable breast nodules, oil cysts, and calcifications. This study was aimed to provide an optimal treatment option for breast nodules after LVFG and evaluate their pathological characteristics. We effectively performed complete resection of breast nodules in 29 patients after LVFG using a minimal skin incision with the vacuum-assisted breast biopsy (VABB) system under ultrasound guidance. And we further carried on histologic examination of excised nodules and evaluated their pathological characteristics. The breast nodules were excised thoroughly with cosmetic effect satisfactorily. Interestingly, subsequent histologic examination showed that type I and VI collagens were strongly expressed in the fibrotic area and type IV collagen were positively expressed around the blood vessel. Furthermore, we found that the type VI collagen+ area appeared around mac2+ macrophages and α-SMA+ myofibroblasts. The VABB system may be the optimal treatment option for breast nodules after LVFG. And type VI collagens may serve as a biomarker of grafted adipose tissue fibrosis. The relationship between macrophages, fibroblasts, and collagen formation may be therapeutic targets for regulating fibrosis.

Upgrade risk of image-targeted radial scar and complex sclerosing lesions diagnosed at needle-guided biopsy: a retrospective study.

To determine the upgrade rate of radial scar (RS) and complex sclerosing lesions (CSL) diagnosed with percutaneous biopsy. The secondary objectives were to determine the new atypia rate after surgery and to assess the diagnosis of subsequent malignancy on follow-up. This single-institution retrospective study had IRB approval. All image-targeted RS and CSL diagnosed with percutaneous biopsy between 2007 and 2020 were reviewed. Patient demographics, imaging presentation, biopsy characteristics, histological report, and follow-up data were collected. During the study period, 120 RS/CSL were diagnosed in 106 women (median age, 43.5years; range, 23-74), and 101 lesions were analyzed. At biopsy, 91 (90.1%) lesions were not associated with another atypia or malignancy and 10 (9.9%) were associated with another atypia. Out of the 91 lesions that were not associated with malignancy or atypia, 75 (82.4%) underwent surgical excision, and one upgrade to low-grade CDIS was detected (1.3%). Among the 10 lesions initially associated with another atypia, 9 were surgically excised and no malignancy was detected. After a median follow-up of 47months (range: 12-143months), two (1.98%) developed malignancy in a different quadrant; in both cases, another atypia was present at biopsy. We found a low upgrade rate on image-detected RS/CSL, with or without another atypia associated. Associated atypia was underdiagnosed at biopsy in almost one-third of cases. Subsequent cancer risk could not be established because the only two cases were associated with another high-risk lesion (HRL), which might have increased the patient's risk of developing malignancy. Our upgrade rates of RS/CSL with or without atypia diagnosed with core needle biopsy are almost as low as the ones reported with larger sampling methods. This result has particular importance in places with limited accessibility to US-guided vacuum-assisted biopsy. •New evidence is showing lower upgrade rates of RS and CSL after surgery, leading to a more conservative management with extensive sampling using VAB or VAE. •Our study showed only one upgrade to a low-grade DCIS after surgery, yielding an upgrade rate of 1.33%. •During follow-up, no new malignancy was detected in the same quadrant where RS/CSL was diagnosed, including patients without surgery.

Preoperative diagnosis of ductal carcinoma in situ of the breast over a 24-year period.

The method of diagnosis of ductal carcinoma in situ (DCIS) has changed since the 1980s. The aim of this audit was to assess changes in the preoperative diagnosis of DCIS since the introduction of needle core biopsy, particularly the proportion with a preoperative biopsy diagnosis of DCIS. The preoperative diagnoses of patients with a final diagnosis of DCIS in the surgical specimen were reviewed (i) in 809 patients who presented through breast screening from 1997 to 2021, and (ii) in all patients in 5 individual years at 5-year intervals from 2000 to 2020 (254 in total). For screening-detected DCIS the proportion with a preoperative diagnosis of DCIS increased from 75% to 98% over the study period. In a detailed analysis of all cases of DCIS in 5 separate years the proportion with a preoperative diagnosis of DCIS increased from 68% in 2000 to 96% in 2020. For high-grade DCIS the proportion increased from 87% to 97%, and for low- or intermediate-grade DCIS from 48% to 93%. The proportion of women who had vacuum-assisted biopsy increased from 7% in 2000 to 58% in 2015. There was a small increase in the number of biopsies that had basal cytokeratin and oestrogen receptor immunohistochemistry to aid diagnosis. There has been an increase in the preoperative diagnosis of DCIS, particularly of low- or intermediate-grade, over the last two decades. The increasing use of vacuum-assisted biopsy is likely to be a major contributory factor to this increase.