Vacuum-assisted Core Biopsy Research Articles

Abstract PD18-06: Image-guided optimization of neoadjuvant chemotherapy duration in stage II and III HER2-positive breast cancer: radiologic and pathologic complete response (pCR) rates in the multicenter phase 2 TRAIN-3 study (BOOG 2018-01)

Abstract Background pCR rates in stage II – III HER2-positive breast cancer have greatly improved since the addition of HER2 targeted agents to neoadjuvant chemotherapy and are associated with excellent long-term survival. While longer treatment regimens increase pCR rate, early complete responses are also common. We evaluated an image-guided approach to tailor chemotherapy duration based on the identification of early complete responders. Methods 45 hospitals across the Netherlands participated in the phase 2 TRAIN-3 trial. Patients received neoadjuvant systemic treatment consisting of paclitaxel, trastuzumab, carboplatin and pertuzumab (PTC-Ptz). Response to treatment was monitored every three cycles and patients were referred for surgery in case of a radiologic complete response (rCR) or after a maximum of 9 cycles. RCR was defined as the absence of pathological enhancement on MRI breast plus negative vacuum assisted core biopsies in case of hormone-receptor positive (HR+) tumors. In addition, negative fine needle aspiration or lymph node biopsy was required in patients with nodal involvement at baseline. The primary endpoint was 3-year event-free survival (EFS). Here, we report locally assessed rCR and pCR rates after 3, 6 and 9 cycles, the negative predictive value of rCR assessment and the incidence of adverse events (AEs). Analyses are stratified by HR-status. Results We included 467 patients between April 2019 and May 2021. Median age was 51 years, 69% had stage II disease and 232 had HR+ tumors. 33.6% of HR- patients and 15.5% of HR+ patients achieved pCR after 3 cycles of PTC-Ptz (see table). The NPV was higher in HR- patients and independent of the number of cycles. AE evaluation is currently ongoing. Conclusion Three cycles of PTC-Ptz induce an early pCR in one in three HR- and one in six HR+ tumors in patients with stage II-III HER2+ breast cancer. Dynamic contrast enhanced MRI-based response evaluation identifies these patients with ±87% certainty in HR- disease and ±58% in HR+ disease. Continuation of PTC-Ptz after 6 cycles further improves pCR rates and can be considered to reduce the need for adjuvant T-DM1. Efficacy and safety of this image-guided approach to tailor treatment duration need to be confirmed with follow-up in EFS and OS analyses. Table 1: Cumulative rCR & pCR according to HR-status *Including patients who underwent surgery for other reasons than rCR Citation Format: Anna van der Voort, Mette S. van Ramshorst, Rob Kessels, Ingrid A. Mandjes, Inge Kemper, Mariëtte J. Agterof, Wim A. van der Steeg, Joan B. Heijns, Marlies L. van Bekkum, Ester J. Siemerink, Philomeen M. Kuijer, Astrid Scholten, Jelle Wesseling, Marie-Jeanne T.F.D. Vrancken Peeters, Ritse M. Mann, Gabe S. Sonke. Image-guided optimization of neoadjuvant chemotherapy duration in stage II and III HER2-positive breast cancer: radiologic and pathologic complete response (pCR) rates in the multicenter phase 2 TRAIN-3 study (BOOG 2018-01) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD18-06.

Digital Mammography Stereotactic Biopsy versus Digital Breast Tomosynthesis-guided Biopsy: Differences in Biopsy Targets, Pathologic Results, and Discordance Rates.

Background Digital breast tomosynthesis (DBT)-guided biopsy is increasingly used in practice. It is important to know expected changes in biopsy targets, pathologic results, and discordance rates. Purpose To compare biopsy target types, pathologic results, and discordance rates for 2 years preceding and 2 years following implementation of DBT-guided biopsy. Materials and Methods All 9-gauge vacuum-assisted core biopsies from a single tertiary breast center that used digital mammography (DM) stereotactic guidance from 2013 to 2015 and DBT-guided biopsy from 2015 to 2017 were retrospectively reviewed. All mammographic examinations were performed with DBT. Patient demographics, biopsy target type, pathologic reports, surgical excision specimens when available, breast density, and imaging follow-up results were recorded. Biopsy targets and discordance rates between radiologic and pathologic examinations were compared between the two biopsy groups. Generalized mixed modeling was used to examine results before and after DBT-guided biopsy. Results A total of 1313 women underwent 1405 breast biopsies: 643 by using DM (August 2013 to July 2015) (median age, 56 years; interquartile range, 49-66 years) and 762 by using DBT (August 2015 to July 2017) (median age, 58 years; interquartile range, 50-67 years), (P = .58). Calcifications were the most common biopsy target for both groups, constituting 89.9% (578 of 643) of DM-guided biopsies and 71.1% (542 of 762) of DBT-guided biopsies (P = .03). The rate of architectural distortion biopsies was 2.0% (13 of 643) with DM-guided biopsy and 17.7% (135 of 762) with DBT-guided biopsy (P = .01). Although overall malignancy rate was similar for DM-guided biopsy (27.8% [179 of 643]) and DBT-guided biopsy (24.8% [191 of 762], P = .54), DBT-guided biopsy helped identify a similar percentage of invasive malignancies (37.4% [72 of 191] vs 29.0% [52 of 179] at DM P = .35), but more radial sclerosing lesions (8.3% [95% confidence interval {CI}: 6.0, 10.0] vs 1.7% [95% CI: 1.0, 3.1]) (P = .01). The discordance rate was 1.4% (95% CI: 1.0, 2.7) with DM-guided biopsy and 4.5% (95% CI: 3.2, 6.3) with DBT-guided biopsy (P = .01). Of the 34 discordant DBT-guided biopsies, 30 were architectural distortions. Conclusion With the transition to digital breast tomosynthesis-guided biopsy, more architectural distortions were biopsied, more radial sclerosing lesions were identified, and more discordance existed in radiologic and pathologic examinations, with a similar percentage of carcinomas diagnosed. © RSNA, 2020 Online supplemental material is available for this article.

Ultrasound-guided 7-gauge vacuum-assisted core biopsy: Could it be sufficient for the diagnosis and treatment of intraductal papilloma?

The aim of this study was to evaluate whether ultrasound-guided 7-gauge vacuum-assisted core biopsy is sufficient for the diagnosis and treatment of intraductal papilloma and to evaluate the lesion characteristics and histologic features affecting the excision rate of papilloma with vacuum-assisted core biopsy. Between March 2008 and October 2016, 2816 patients underwent US-guided, 7-gauge vacuum-assisted core biopsy (VACB). In them, 101 (3.6%) were demonstrated to have intraductal papilloma by pathology. The accurate diagnostic rate and excision rate of intraductal papilloma after vacuum-assisted core biopsy were evaluated by open surgical biopsy or follow-up US. The lesion characteristics and histologic features were analyzed to identify factors affecting the excision rate of papilloma after VACB. Of the 101 intraductal papillomas, 83 (82.2%) cases were benign papilloma. Two cases were intraductal papilloma accompanied by invasive carcinoma. Sixteen (15.8%) cases were with signs of atypical hyperplasia. In them, one intraductal papilloma accompanied by severe atypical hyperplasia underwent further surgery, and it was demonstrated to have intraductal papilloma accompanied by invasive carcinoma. The accurate diagnostic rate of intraductal papillomas by 7-gauge VACB was 99.0% (100/101). There was no recurrence or malignant transformation in 85.1% (86/101) intraductal papillomas after 7-gauge vacuum-assisted core biopsy. Intraductal papilloma with largest diameter <1cm, with clear margin, without branch involvement or calcification had a significantly higher excision rate. Seven-gauge VACB is an effective method for the diagnosis of intraductal papilloma of the breast. If histopathological examination confirms a benign character of the lesion, surgery may be avoided but regular follow-up is recommended. If histopathological examination confirms a papilloma with moderate to severe atypical hyperplasia, it was strongly recommended for surgical excision. Lesion characteristics and histologic features could affect the excision rate of intraductal papillomas with VACB.

Immediate Migration of Biopsy Clip Markers After Upright Digital Breast Tomosynthesis-Guided Vacuum-Assisted Core Biopsy

The goal of this retrospective study was to evaluate the rate of immediate post-biopsy clip migration on an upright digital tomosynthesis-guided vacuum-assisted core biopsy unit and determine if any factors were associated with immediate clip migration. We performed a retrospective review of patients who had undergone a biopsy performed at one facility from November 1, 2014 to September 30, 2016. Post-biopsy mammograms were reviewed to assess immediate clip position relative to the targeted lesion. The effects of age, lesion type, breast density, biopsy approach, number of samples, size of the biopsy chamber, and clip type on clip migration were examined using logistic regression analysis. One hundred ninety-seven biopsies were performed on 188 patients for calcifications (n = 159), architectural distortions (n = 29), masses (n = 5), and asymmetries (n = 4). The clip migration rate was 38% as defined as greater than 0.5 cm from the site of the biopsied lesion. The only independently predictive variable of clip migration was breast density in a numeric covariate in the logistic regression model, as migration was more likely with decreased breast density. The estimated odds ratio for a single level increase in BI-RADS breast density was 0.60 (95% confidence interval: 0.40, 0.91) with p = 0.018. Immediate clip migration following biopsy was more likely with decreased breast density. Radiologists should be aware of immediate clip migration as correct clip location guides preoperative localization and allows the biopsy site to be monitored for changes on future mammograms.

P124. Avoiding surgery in breast cancer patients with exceptional Response to neo-adjuvant chemotherapy - ASTARTE Trial

Background: Neoadjuvant chemotherapy (NACT) is increasingly used in phenotype-appropriate, early-stage breast cancer. Modern chemotherapy regimens and the use of targeted therapies can eliminate gross disease in an increasing number of women. Particularly in triple negative (TN) and HER2-positive subtypes, pathologic complete response (pCR) rates exceeding 60% have been reported. In these cases, the role of surgery is limited to histopathological confirmation of pCR. Recent data suggest that in selected women with exceptional clinical and imaging response, post-NACT, pre-surgery large volume, vacuum-assisted core biopsy (VACB) of the imaging residuum can reliably identify those who achieve pCR and therefore may not benefit from surgery. ASTARTE is a pilot study aiming to evaluate the safety of omission of surgery in a selected group of women with exceptional response to NACT.

Biopsy Feasibility Trial for Breast Cancer Pathologic Complete Response Detection after Neoadjuvant Chemotherapy: Imaging Assessment and Correlation Endpoints.

This study was designed to present the secondary imaging endpoints of the trial for evaluating mammogram (MMG), ultrasound (US) and image guided biopsy (IGBx) assessment of pathologic complete response (pCR) in breast cancer (BC) patients undergoing neoadjuvant chemotherapy (NAC). Patients with T1-3, N0-3, M0 triple-negative or HER2-positive BC who received NAC were enrolled in an Institutional ReviewBoard-approved prospective, clinical trial. Patients underwent US and MMG at baseline and after NAC. Images were evaluated for residual abnormality and to determine modality for IGBx [US-guided (USG) or stereotactic guided (SG)]. Fine-needle aspiration and 9-G, vacuum-assisted core biopsy (VACBx) of tumor bed was performed after NAC and was compared with histopathology at surgery. Forty patients were enrolled. Median age was 50.5 (range 26-76) years; median baseline tumor size was 2.4cm (range 0.8-6.3) and 1cm (range 0-5.5) after NAC. Nineteen patients had pCR: 6 (32%) had residual Ca2+ presurgery, 5 (26%) residual mass, 1 (5%) mass with calcifications, and 7 (37%) no residual imaging abnormality. Sensitivity, specificity, and accuracy of US, MMG, and IGBx for pCR were 47/95/73%, 53/90/73%, and 100/95/98%, respectively. Twenty-five (63%) patients had SGBx and 15 (37%) had US-guided biopsy (USGBx). Median number of cores was higher with SGBx (12, range 6-14) than with USGBx (8, range 4-12), p < 0.002. Positive predictive value for pCR was significantly higher for SG VACBx than for USG VACBx (100 vs. 60%, p < 0.05). SG VACBx is the preferred IGBx modality for identifying patients with pCR for trials testing the safety of eliminating surgery.

Post–Vacuum-Assisted Stereotactic Core Biopsy Clip Displacement: A Comparison Between Commercially Available Clips and Surgical Clip

PurposeThe placement of localization clips following percutaneous biopsy is a standard practice for a variety of situations. Subsequent clip displacement creates challenges for imaging surveillance and surgical planning, and may cause confusion amongst radiologists and between surgeons and radiologists. Many causes have been attributed for this phenomenon including the commonly accepted “accordion effect.” Herein, we investigate the performance of a low cost surgical clip system against 4 commercially available clips. MethodsWe retrospectively reviewed 2112 patients who underwent stereotactic vacuum-assisted core biopsy followed by clip placement between January 2013 and June 2016. The primary performance parameter compared was displacement >10 mm following vacuum-assisted stereotactic core biopsy. Within the group of clips that had displaced, the magnitude of displacement was compared. ResultsThere was a significant difference in displacement among the clip types (P < .0001) with significant pairwise comparisons between pediatric surgical clips and SecureMark (38% vs 28%; P = .001) and SenoMark (38% vs 27%; P = .0001) in the proportion displaced. The surgical clips showed a significant magnitude of displacement of approximately 25% greater average distance displaced. ConclusionsAs a whole, the commercial clips performed better than the surgical clip after stereotactic vacuum-assisted core biopsy suggesting the surrounding outer component acts to anchor the central clip and minimizes clip displacement. The same should apply to tomosynthesis-guided biopsy.

Clinicopathological Factors Associated with Remnant or Regrowth of Benign Breast Tumor after Previous Vacuum-Assisted Core Biopsy

Clinicopathological Factors Associated with Remnant or Regrowth of Benign Breast Tumor after Previous Vacuum-Assisted Core Biopsy

Abstract P5-16-30: Feasibility trial for identification of patients for eliminating breast cancer surgery following neoadjuvant systemic therapy

Abstract P5-16-30: Feasibility trial for identification of patients for eliminating breast cancer surgery following neoadjuvant systemic therapy

Minimally invasive breast surgery: vacuum-assisted core biopsy

Fibrocystic breast disease is diagnosed in 20 % of women. Morphological verification of breast lumps is an important part of monitoring of these patients. Study objective. To study the role of vacuum-assisted core biopsy (VAB) in differential diagnosis of fibrocystic breast disease. Materials and methods. In 2014 in Innomed plus clinic the VAB method for tumor diagnostics was introduced for the first time in the Primorsky Region. We studied application of VAB in 22 patients with a diagnosis of nonpalpable breast lesion. Results. Relapse rate for VAB is 4.5 %, complication rate in the form of postoperative hematomas is 22.7 %, but these complications do not increase duration of rehabilitation and are not clinically relevant. Conclusion. VAB is a minimally invasive surgical approach which allows to collect the same volume of tumor tissue as sectoral resection. The benefits of the method are better cosmetic results and shorter rehabilitation period with comparable complication rate. This allows to use VAB not only for diagnostic purposes but as a treatment for benign breast tumors.

Preoperative clinicopathologic factors and breast magnetic resonance imaging features can predict ductal carcinoma in situ with invasive components

PurposeDuctal carcinoma in situ (DCIS) is a non-invasive cancerous breast lesion; however, from 10% to 50% of patients with DCIS diagnosed by core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) are shown to have invasive carcinoma after surgical excision. In this study, we evaluated whether preoperative clinicopathologic factors and breast magnetic resonance image (MRI) features are predictive of DCIS with invasive components before surgery. Materials and methodsPatients comprised 128 adult women with a diagnosis of DCIS as determined by pathological analysis of CNB or VACB specimens and positive MRI findings who underwent breast surgery during the period January 2011 to December 2013 at the Changhua Christian Hospital. Clinicopathologic and breast MRI factors were compared between patients with postoperative pathology indicative of true DCIS and those with postoperative pathology showing DCIS with invasive components. ResultsOf the 128 patients with a preoperative diagnosis of DCIS, 73 (57.0%) had postoperative histopathologic evidence of true DCIS and 55 (43.0%) showed evidence of DCIS with invasive components. Results of statistical analyses revealed that MRI evidence of a mass-like lesion (P=0.025), nipple-areolar complex (NAC) invasion (P=0.029), larger tumor volume (P=0.010), larger maximum measurable apparent diffusion coefficient (ADC) area (P=0.039), heterogenous or rim enhancement pattern (P=0.010), as well as immunohistochemical evidence of human epidermal growth factor receptor 2 (HER-2) overexpression (P=0.010) were predictive of DCIS with an invasive component in postoperative surgical specimens. ConclusionInvasive component should be considered in biopsy proven DCIS patients with preoperative MRI evidence of a mass-like lesion, nipple-areolar complex invasion, large tumor volume, a larger maximum measurable ADC area, or a rim or heterogenous enhancement pattern, as well as in patients with immunohistochemical evidence of HER-2 overexpression.

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.

P056. Value of vacuum-assisted core biopsy of indeterminate (B3) lesions of the breast

P056. Value of vacuum-assisted core biopsy of indeterminate (B3) lesions of the breast

PB.8. Ultrasound-guided excision of fibroadenomas: 9 years' experience in a British breast unit

Fibroadenomas are benign breast tumours made up of glandular and fibrous tissue. Despite their benign pathology, factors such as size, discomfort, altered breast shape and patient choice sometimes lead to excision. Traditionally, open excision biopsy has been the method of choice for fibroadenoma removal but, since 2005, our breast unit has offered patients minimally invasive ultrasound-guided complete fibroadenoma excision using vacuum-assisted core biopsy (VACB). We present an audit of our practice and patient outcomes regarding VACB excision of fibroadenomas.

PB.10. Stereotactic 20 mm basket Intact Breast Lesion Excision System biopsy for indeterminate breast microcalcification: pilot study within a UK breast unit

For several years our breast unit has evaluated indeterminate breast microcalcification using stereo-guided vacuum-assisted core biopsy (VACB) - piecemeal acquisition of unorientated tissue. The Intact Breast Lesion Excision System (Intact) removes a single larger piece of tissue, potentially allowing pathologists to calculate margins and visualise lesion architecture more easily. This study evaluates the role of the 20 mm Intact in assessment of subcentimetre clusters of indeterminate breast microcalcification.

PB.9. Randomised controlled trial of stereotactic 11G vacuum-assisted core biopsy for diagnosis and management of malignant microcalcification

Vacuum-assisted biopsy (VAB) may improve accuracy of diagnosis of malignant microcalcification (MM) compared with 14G core biopsy (SCNB), thus reducing requirements for further surgical procedures.

Stereotactic vacuum-assisted core biopsy results for non-palpable breast lesions.

The increase in breast cancer awareness and widespread use of mammographic screening has led to an increased detection of (non-palpable) breast cancers that cannot be discovered through physical examination. One of the methods used in the diagnosis of these cancers is vacuum-assisted core biopsy, which prevents a considerable number of patients from undergoing surgical procedures. The aim of this study was to present the results of stereotactic vacuum-assisted core biopsy for suspicious breast lesions. Files were retrospectively scanned and data on demographic, radiological and pathological findings were recorded for patients who underwent stereotactic vacuum-assisted core biopsy due to suspicious mammographic findings at the Interventional Radiology Centre of the Florence Nightingale Hospital between January 2010, and April 2013. Statistical analysis was carried out using Pearson's Chi-square, continuity correction, and Fisher's exact tests. The mean age of the patients was 47 years (range: 36-70). Biopsies were performed due to BIRADS 3 lesions in 8 patients, BIRADS 4 lesions in 77 patients, and BIRADS 5 lesions in 3 patients. Mammography elucidated clusters of microcalcifications in 73 patients (83%) and focal lesions (asymmetrical density, distortion) in 15 patients (17%). In terms of complications, 1 patient had a hematoma, and 2 patients had ecchymoses (3/88; 3.3%). The histopathologic results revealed benign lesions in 63 patients (71.6%) and malignant lesions in 25 patients (28.4%). The mean duration of the procedure was 37 minutes (range: 18-55). Although all of the BIRADS 3 lesions were benign, 22 (28.6%) of the BIRADS 4 lesions and all of the BIRADS 5 lesions were malignant. Among the malignant cases, 80% were in situ, and 20% were invasive carcinomas. These patients underwent surgery. In cases where non-palpable breast lesions are considered to be suspicious in mammography scans, the vacuum-assisted core biopsy method provides an accurate histopathologic diagnosis thus preventing a significant number of patients undergoing unnecessary surgical procedures.

Surgical management of non-palpable breast tumors

Due to the improvement of the diagnostic and screening methods for detecting breast cancer (e.g. mammography, breast ultrasonography, MR imaging, FNAC, core biopsy or vacuum-assisted core biopsy), non-palpable breast masses are more and more commonly discovered. Resection guided by a radiologically placed hookwire has gained outstanding importance in the surgical management of these non-palpable cases of breast malformations. In this retrospective study we analyzed the data of 830 patients operated in the past 5 years because of breast malformations. Of those, 36.9% of the breast surgeries were performed because of a non-palpable breast mass. In such cases we performed preoperative histological sampling to support setting up the surgical plan. We managed to get a precise histological diagnosis preoperatively in 78% of our cases. After the introduction of vacuum-assisted core biopsy, operations for histologically indeterminate breast tumors became less common. The surgical resections of breast masses which later prove to be benign are expected to decrease further. Intraoperative radiological analysis of the resection margins helps performing a definitive surgical resection. Specimen mammography and ultrasonography is part of our daily routine. When evaluating the histological samples, the question of resection margins is substantial. In absence of clear resection margins, re-resection is needed. Due to incomplete resection margins 5.5% of the cases re-resection was needed. To avoid unnecessary axillary lymph node dissection in case of early-stage breast cancers, sentinel lymph node biopsy is always carried out.

Minimally invasive breast surgery

Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices - similar to other surgical subspecialties -, will gradually become popular and it may form part of routine breast surgery even. Vacuum-assisted core biopsy with a therapeutic indication is suitable for the removal of benign fibroadenomas leaving behind an almost invisible scar, while endoscopically assisted skin-sparing and nipple-sparing mastectomy, axillary staging and reconstruction with latissimus dorsi muscle flap are all feasible through the same short axillary incision. Endoscopic techniques are also suitable for the diagnostics and treatment of intracapsular complications of implant-based breast reconstructions (intracapsular fluid, implant rupture, capsular contracture) and for the biopsy of intracapsular lesions with uncertain pathology. Perception of the role of radiofrequency ablation of breast tumors requires further hands-on experience, but it is likely that it can serve as a replacement of surgical removal in a portion of primary tumors in the future due to the development in functional imaging and anticancer drugs. With the reduction of the price of ductoscopes routine examination of the ductal branch system, guided microdochectomy and targeted surgical removal of terminal ducto-lobular units or a "sick lobe" as an anatomical unit may become feasible. The paper presents the experience of the authors and provides a literature review, for the first time in Hungarian language on the subject. Orv. Hetil., 2014, 155(5), 162-169.

Management of patients diagnosed with atypical ductal hyperplasia by vacuum-assisted core biopsy: a prospective assessment of the guidelines used at our institution

BackgroundBecause of underestimation, surgical excision is recommended for atypical ductal hyperplasia diagnosed on directional vacuum-assisted biopsies. The following guidelines have been established according to our retrospective study published in 2008: excision for lesions ≥21 mm, follow-up for lesions <6 mm with complete removal of microcalcifications, and follow-up or excision for 6 to 21-mm lesions with respectively less or >2 atypical ductal hyperplasia foci. Methods and ResultsThese guidelines were assessed in a prospective series of 124 patients with a median follow-up of 30 months. Conformity rate was 92%. Upgrading was 28% (15 of 53 patients) for conformed surgery and absent for surgery performed beyond the scope of guidelines. For the patients with benign result at surgery (n = 38) or just followed (n = 61), 3 cancers occurred in either breast at 1 to 3 years. ConclusionsThese convenient guidelines can safely spare surgery for a subset of patients. However, annual mammographic follow-up is recommended since the risk of subsequent cancer remains high for both breasts.