Vacuum-assisted Excision Research Articles

Efficacy of second-time vacuum-assisted breast excision in the management of screen-detected high-risk breast lesions

Surgical excision of breast lesions is usually required for high-risk (B3) lesions or radiological pathological discordance. The risk of underestimation of malignancy is 45 to 50% for 14G core biopsy and 20 to 25% for vacuum-assisted biopsies (VAB).

Does isolated flat epithelial atypia on vacuum-assisted breast core biopsy require surgical excision?

To determine whether flat epithelial atypia (FEA) found in isolation on large core vacuum-assisted biopsy (CNB) requires surgical excision. After Institutional Review Board approval, pathology reports of all patients who underwent CNB from January 1, 2005 to December 31, 2010 were reviewed. All patients with reports of isolated FEA without other atypia or in situ or invasive carcinoma were identified. Patient age, history, target on imaging, biopsy modality, and residual target post CNB noted. Histology of CNB's (blinded to surgical outcome) and subsequent surgical excisions were reviewed by a dedicated breast pathologist. Only cases with confirmed isolated FEA on review were used for data analysis. Of 2,556 CNB's performed over 6years, 37 (1.4%) had isolated FEA confirmed on review, comprising our study population. Thirty (81%) had biopsy for calcifications on mammography and 7 (19%) for mass or non-mass like enhancement on magnetic resonance imaging. There were no US guided CNBs that met our inclusion criteria. 29 (78.4%) underwent surgical excision, 6 (16.2%) had imaging follow-up, and 2 (5.4%) were lost to follow-up. Of the 29 with surgery, 2 (6.9%) had "upgrade" to low-grade in situ carcinoma (1 ductal and 1 pleomorphic lobular), 5 (17.2%) had "change in diagnosis" to other atypia (ADH/ALH), 15 (51.7%) had additional FEA and 7 (24.2%) had benign tissue without atypia. Both "upgraded" cases had residual microcalcifications on imaging following CNB. There were no upgrades to invasive cancers. In our study, none of 29 with isolated FEA on CNB had invasive cancer on surgical excision. If there are residual microcalcifications or residual lesion after a CNB that shows isolated FEA, excision is warranted, due to the possibility of other atypia (ADH/ALH [17.2%] or DCIS [5.4%]). If there are no residual microcalcifications following CNB, imaging follow-up as an alternative to surgery may be a reasonable option.

A Novel Vacuum-assisted Excision for Giant Breast Fibroadenomas

A Novel Vacuum-assisted Excision for Giant Breast Fibroadenomas

Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up.

Purpose:To evaluate the accuracy of benign core biopsy of probably benign breast lesions (category 3) 2 cm or larger on the basis of excisional biopsy and long-term follow-up. Methods:We retrospectively reviewed 146 category 3 lesions in 146 patients 2 cm or larger which were diagnosed as benign by ultrasound (US)-guided core biopsy. Patients were initially diagnosed as benign at core needle biopsy and then followed up with excisional biopsy (surgical excision, n=91; US-guided vacuum assisted excision, n=35) or breast ultrasonography (n=20). Results:Of the 126 patients who underwent surgical excision or US-guided vacuum-assisted excision, 114 patients were diagnosed with benign lesions, 10 patients with borderline lesions (benign phyllodes tumor), and two patients with malignant phyllodes tumors. The probabilities of lesions being benign, borderline and malignant were 91.8% (134/146), 6.8% (10/146), and 1.4% (2/146), respectively. Of 13 patients who had growing masses on follow-up ultrasonography, three (23.1%) were non-benign (two benign phyllodes tumors and one malignant phyllodes tumor). Conclusion:US-guided core needle biopsy of probably benign breast mass 2 cm or larger was accurate (98.6%) enough to rule out malignancy. But, it was difficult to rule out borderline lesions even when they were diagnosed as benign.

Usefulness of Fine-Needle Aspiration Biopsy before Performing Ultrasound-Guided Vacuum-Assisted Excision

Usefulness of Fine-Needle Aspiration Biopsy before Performing Ultrasound-Guided Vacuum-Assisted Excision Ku Sang Kim, Ra Mi Kim, Hyun Ee Yim, Doo Kyoung Kang, Tae Hee Kim, Hyun-Joo Shin, Ji Young Kim, Yongsik Jung Departments of Surgery and Biomedical Informatics, Ajou University School of Medicine, Suwon; Department of Surgery, Dongtan Jeil Hospital, Hwasung; Departments of Pathology and Radiology, Ajou University School of Medicine, Suwon, Korea

PB.29: Ultrasound-guided vacuum-assisted percutaneous excision of breast papillomas: results of long-term follow-up

The purpose was to determine the frequency of recurrent/residual papillomas in women who had previously undergone vacuum-assisted excision biopsy (VAB) of benign papillomas without atypia and to identify factors that may be associated with recurrence.

PB.35: Comparison of large-bore vacuum-assisted biopsy and surgical diagnostic excision biopsy in B3 breast lesions

B3 lesion management is unclear. Despite varying malignancy risk, diagnostic excision was conventional, revealing malignancy in some and benign features in others. Large-bore vacuum-assisted biopsy (VAB, 7 to 8G) can enhance pathological certainty, providing reassurance of benignity, or identify co-existing malignancy, with many groups moving towards VAB to replace surgical excision biopsy. However, little research has addressed the accuracy of VAB compared with surgical biopsy in this situation.

Vacuum-assisted excision for benign breast lesions

Vacuum-assisted excision for benign breast lesions

Comparison of Sonographically Guided Core Needle Biopsy and Excision in Breast Papillomas

The aim of this study was to evaluate the clinical factors and sonographic features of benign papillomas of the breast proven by sonographically guided 14-gauge core needle biopsy and their upgrade or malignancy rate after sonographically guided vacuum-assisted excision or surgical excision. We reviewed the medical records of patients who underwent core needle biopsy from July 2005 to December 2011. We evaluated 39 benign papillomas without atypia in 34 patients. The papillomas were diagnosed by core needle biopsy and underwent surgical or vacuum-assisted excision. After core needle biopsy, imaging-histologic correlation was performed to determine concordance. The upgrade and malignancy rates were assessed after surgical or vacuum-assisted excision, and associated clinical and radiologic factors, including patient age, lesion size, distance from the nipple, sonographic features, and American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) category were evaluated. Three lesions (7.7 %) among 39 papillomas were upgraded to papilloma with atypia after surgical excision. There was no malignancy after excision. The upgrade rates for BI-RADS categories 3, 4a, 4b, and 4c were 0%, 6.9%, 0%, and 20%, respectively. There were no significant differences in the upgrade to papilloma with atypia in terms of the presence of symptoms, lesion size, distance from the nipple, BI-RADS category, or imaging-histologic correlation. Prediction of papilloma with atypia, not malignancy, was challenging because there were no associated clinical or radiologic factors to predict papilloma with atypia before excision. However, there was no malignancy after excision. Therefore, intensive surveillance is preferable to immediate surgical excision for benign papillomas diagnosed on core needle biopsy.

Sonographically Guided Vacuum-Assisted Breast Biopsy for Complete Excision of Presumed Benign Breast Lesions

Benign breast disease has a high prevalence and a substantial impact on women's quality of life. Excisional biopsy is still frequently used for the diagnosis of breast masses in China. We report our experience with percutaneous removal of presumed benign lesions under sonographic guidance with a multidirectional handheld vacuum-assisted biopsy device and evaluate this procedure as an alternative approach in the diagnosis and treatment of clinically benign breast lesions. A total of 1766 sonographically guided vacuum-assisted excision procedures were performed on 738 patients with clinically benign breast lesions between February 2008 and October 2011. The mean patient age ± SD was 35.86 ± 11.2 years. The mean diameter of the lesions was 1.25 ± 0.70 cm. The mean number of cores needed to achieve removal was 11.6 ± 4.8. Fifty-nine percent of cases (436 of 738) had multiple breast lesions. There were no serious adverse events. There were only 37 cases with substantial bleeding. No cases had wound infection. Hematoma occurred in 62 cases (8%), but none needed surgical intervention. Skin damage occurred in only 5 cases (0.7%) and 14 cases (1.9%) had a vasovagal response. Most of the specimens (1755 of 1766 [99.4%]) were benign. Postoperative pain was minimal, and better cosmetic results were obtained than with conventional open biopsy. Percutaneous excisional biopsy with a sonographically guided vacuum-assisted core device is a safe and effective approach for accurate diagnosis and complete removal of presumed benign breast masses.

Management of recurrent intra corneal epithelial cyst with ethanol irrigation and vacuum-assisted cyst wall excision

The clinical and pathological features and management of a patient with recurrent intracorneal epithelial cyst are reported. A child presented with a large intracorneal cyst and underwent drainage with 96% ethanol irrigation. Histopathology confirmed the epithelial nature of the cyst. The cyst recurred, however, and subsequently a repeat ethanol irrigation with removal of the cyst wall was done. The cyst wall was vacuumed to ensure complete removal of epithelial cells. There was no recurrence, with good visual and cosmetic recovery. Intracorneal epithelial cysts can be successfully managed with drainage, 96% ethanol irrigation, and vacuum-assisted cyst wall excision.

Clinical outcomes of 1,578 Chinese patients with breast benign diseases after ultrasound-guided vacuum-assisted excision: recurrence and the risk factors

BackgroundThe aim of this study was to evaluate the clinical outcomes of 1,578 patients with breast benign diseases after excisions and the risk factors. Methods and resultsWith a median follow-up of 34 months, 69 patients were identified to have recurrence (local recurrence: 45; new lesion: 24). Univariate and multivariate analyses revealed that multiple lesions, a larger lesion size, and a hematoma were independent risk factors for recurrence. Patients with in situ recurrence tended to have fewer lesions and more samples taken per lesion. Patients with new lesions tended to have multiple lesions. After re-excisions, there was no second recurrence events observed in the patients with local recurrence (0/30), whereas 5 patients with new lesions (5/14) were noted to have second recurrence events. ConclusionsUltrasound-guided vacuum-assisted biopsy for the complete excision of breast benign diseases is safe and effective. Local recurrence and new lesions may have different clinicopathological features and underlying mechanisms. Different management might be given to patients with a different pattern of recurrence.

Is US-guided Core Needle Biopsy (CNB) enough in Probably Benign Nodules with Interval Growth?

To investigate whether ultrasound-guided 14-gauge core needle biopsy (US-CNB) is efficient in the diagnosis of probably benign lesions showing interval growth on follow-up US. From March 2008 to August 2009, 116 breast lesions in 113 women (mean age: 41.2 years, range: 19 - 63 years) which were initially assessed as category 3 showing interval growth on follow-up US underwent US-CNB, and subsequent US-guided vacuum-assisted excision, surgical excision or follow-up US for at least 12 months. Diagnostic performances of US-CNB were evaluated with histopathologic results and follow-up US as standard reference. Clinical features of the patient and lesions characteristics including follow-up interval (I), the most increased diameter (D), D per I, increased volume (%V) and %V per I were calculated and compared. Of the 116 lesions, 4 lesions were diagnosed as malignancy and 112 as benign on final pathology. Malignancy rate of probably benign lesions showing interval growth was 3.4 % (4/116). Incorrect biopsy rate was 0.9 % (1/116). Palpability or newly developed suspicious US features were more associated with malignancy, 75.0 to 13.4 % and 50.0 to 25.9 %, respectively, but without significance (p = 0.063 and 0.290). Significant differences were seen in average rank when comparing between benign and malignancy in D, %V, D per follow-up interval (I), and %V/I (p = 0.037, 0.017, 0.043 and 0.009, respectively). US-CNB is an efficient diagnostic method for probably benign lesions showing interval growth, with discordant biopsy rate of 0.9 %.

Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: Analysis of 49 cases from a single-centre and review of the literature

The purpose of this study was to evaluate the reliability of image-guided 14-gauge needle core biopsy in the diagnosis of radial scar without associated atypical epithelial proliferation, by comparison with definitive histological diagnosis on surgical excision. The records of 8792 consecutive image-guided 14-gauge needle core biopsy of the breast performed from January 1996 to December 2009 were reviewed. Forty-nine cases of radial scar without associated atypical epithelial proliferation were identified and compared with definitive histological diagnosis on surgical excision.The definitive histological diagnosis on surgical excision confirmed the results of image-guided 14-gauge needle core biopsy in 36 of 49 cases (73.5%), in 9 cases (18.3%) radial scar was associated with atypical epithelial proliferation, while 4 cases out of 49 cases were upgraded to carcinoma (3 cases of ductal carcinoma in situ and one case of invasive lobular carcinoma), with an underestimation rate of 8.2%.A diagnosis of radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy does not exclude a malignancy on surgical excision; consequently during the multidisciplinary discussion further assessment by surgical excision or vacuum-assisted excision, as recently reported, needs to be considered to obtain a definitive histological diagnosis.

Potential Application of Ultrasound-Guided Vacuum-Assisted Excision (US-VAE) for Well-selected Intraductal Papillomas of the Breast: Single-Institutional Experiences

The study objective was to evaluate our experiences of ultrasound-guided vacuum-assisted excision (US-VAE) of benign intraductal papillomas, and to discuss its potential application as a minimally invasive treatment We reviewed the sonographic and histologic features of 29 benign intraductal papillomas removed by US-VAE. The procedure was recommended on the basis of our indications. For validation of selection criteria, the sonographic and pathologic characteristics of surgically excised 94 papillary lesions during the same period were also evaluated. The mean diameter of the lesions was 9.8 mm (range 5-15 mm). There was no mass that abutted the skin or pectoralis muscle and extended the branching ducts. All lesions were category 3 or category 4a. The pathologic diagnoses of all removed masses were benign. Local recurrence was observed in one patient. According to the validation study, papillary lesions less than 1.5 cm of category 3 or 4a were mostly reported to be benign (95.9%, 47 of 49). US-VAE may be a useful alternative to surgical excision in well-selected benign intraductal papillomas.

US-Guided Vacuum-Assisted Percutaneous Excision for Management of Benign Papilloma Without Atypia Diagnosed at US-Guided 14-Gauge Core Needle Biopsy

To assess the diagnostic accuracy of ultrasound (US)-guided vacuum-assisted excision (VAE) for the postbiopsy management of benign papilloma without atypia after US-guided 14-gauge core needle biopsy (CNB). This was an institutional review board-approved retrospective study, with a waiver of informed consent. After a review of the histologic results and postbiopsy management of US-guided CNB performed from January 2007 through April 2009, 122 benign papillomas without atypia were diagnosed at CNB and excised percutaneously with US-guided VAE. Among them, a total of 67 papillomas having surgical excision (n = 5) or at least 2 years' US follow-up (n = 62) after VAE were enrolled onto this study. We reviewed the medical records, US findings, and pathologic results obtained before and after VAE. Over the follow-up period, whether any malignancy at the site of the VAE was diagnosed was evaluated. The pathologic results of 67 VAEs were benign in 63 (94%) and atypical in four (6%). None of 63 benign lesions proved to be malignant after surgical excision (n = 1) or US follow-up (n = 62). Of four atypical lesions, however, one was upgraded to ductal carcinoma-in-situ (25%) after surgical excision. Of 62 benign VAE results having US follow-up, 56 (90.3%) showed no residual lesion at the site of the VAE. For the postbiopsy management of benign papilloma without atypia after US-guided CNB, US-guided VAE was accurate and could be alternative to surgery. In cases of diagnosis of atypical lesion at VAE, however, surgery should be performed for a definitive diagnosis.

Management of Benign Papilloma Without Atypia Diagnosed at US-Guided 14-Gauge Core Needle Biopsy: US-Guided Vacuum-Assisted Percutaneous Excision as an Alternative to Surgical Excision

To evaluate the performance of sonographically (US) guided vacuum-assisted excision (VAE) for the postbiopsy management of benign papilloma without atypia after US-guided 14-gauge core needle biopsy (CNB).

Evaluation of minimally invasive excisional brain biopsy and intracranial brachytherapy catheter placement in dogs

To evaluate a technique for minimally invasive excisional brain biopsy and intracranial brachytherapy catheter placement in dogs. 5 healthy adult female dogs. Computed tomographic guidance was used to plan a biopsy trajectory to a selected area of brain with reference to a localizer grid. The procedure was performed through a 1-cm skin incision and 6-mm burr hole by use of a 9-gauge biopsy device. Five cylindrical samples (3 to 4 mm in diameter and 7 to 12 mm in length) were removed over 5 cycles of the vacuum-assisted tissue excision system, leaving approximately a 2-cm³ resection cavity. A balloon-tipped intracranial brachytherapy catheter was placed through the burr hole into the resection cavity, expanded with saline (0.9% NaCl) solution, and explanted 7 days later. 4 of 5 dogs survived the procedure. The fifth died because of iatrogenic brain damage. Neurologic deficits were unilateral and focal. Twenty-four hours after surgery, all surviving dogs were ambulatory, 2 dogs exhibited ipsiversive circling, 4 had contralateral proprioceptive deficits, 3 had contralateral menace response deficits, 2 had a reduced contralateral response to noxious nasal stimulation, and 1 had dull mentation with intermittent horizontal nystagmus and ventrolateral strabismus. Neurologic status improved throughout the study period. Histologic quality of biopsy specimens was excellent. This technique enabled histologic diagnosis from high-quality biopsy specimens obtained through a minimally invasive technique and has potential applications for multimodal treatment of deep brain tumors in dogs.

Breast core needle biopsy: issues and controversies

Core needle biopsy (CNB) is increasingly being used in the investigation of breast disease whether this is asymptomatic and suspected after screening mammography, or presents symptomatically in the patient. In most cases, the result of the procedure provides a definitive diagnosis or at least provides information that is used to plan the further management of the patient. There are, however, a number of unresolved issues with the use of CNB; for example, with regard to the amount of information that can be reliably derived from CNB or with regard to the management of the patient after some CNB diagnoses. Oestrogen and progesterone receptors and HER2 are reported on both core biopsies and excision specimens, but there continues to be debate over which represents the more appropriate specimen type on which to perform these tests. There are a number of possible diagnoses after CNB for which the management is not straightforward and around which there may be controversy, or just a lack of sufficient evidence to support a definite management plan. These ‘lesions of uncertain malignant potential’ include papillary lesions, fibroepithelial lesions with cellular stroma, mucocoele-like lesions and radial scars. Currently, these are removed surgically but there may be an argument for more conservative management including vacuum-assisted core excision in some cases.

Treating Gynecomastia with Ultrasound-guided Vacuum-assisted Biopsy Device as a Cosmetic Method

Purpose: Gynecomastia can cause severe emotional phobia for breast cancer in elderly male and physical distress in young men. To select the appropriate cosmetic surgical approach for gynecomastia, I evaluated the usefulness of performing ultrasound-guided vacuum-assisted device excision of it. Methods: Twenty-two cases of gynecomastia in 18 male were treated by vacuum-assisted biopsy device excision from November 2005 to June 2007. Their age range was 14-72 years old (mean, 34). The vacuum-assisted biopsy device excision was performed by 11G needle in 7 cases and 8G needle in 15 cases. I checked the number of extracted tissue pieces, the duration time of the procedure, immediate complications, and breast ultrasound after 3 months. Results: The mean number of extracted tissue pieces was 69, and the average procedure duration was 25 minutes. There were no significant immediate complications such as bleedings and skin necrosis, and there were no clinically serious complications on 3 months follow-up examinations. During operation under local anesthesia, all patients tolerated the procedure. After vacuum-assisted biopsy device procedure, the cosmetic results were good to excellent for all the patients. Conclusion: Vacuum-assisted biopsy device excision was an effective surgical option, especially for small and glandular gynecomastia. I suggest this is a useful alternative procedure to surgery and liposuction, or it could be used effectively as a co-operative procedure with liposuction.