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Cullinane C, Byrne J, Kelly L, O Sullivan M, Antony Corrigan M, Paul Redmond H. The positive predictive value of vacuum assisted biopsy (VAB) in predicting final histological diagnosis for breast lesions of uncertain malignancy (B3 lesions): A systematic review & meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1464-1474. [PMID: 35491362 DOI: 10.1016/j.ejso.2022.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION High-risk or B3 breast lesions are considered lesions of uncertain malignant potential and comprise between 5 and 12% of initial biopsy results. We sought to perform a systematic review and meta-analysis of studies published within the last twenty years to determine the pooled Positive Predictive Value (PPV) of VAB in selected B3 lesions. METHODS The study report is based on the guidelines of PRISMA and Meta-Analysis of Observational Studies in Epidemiology. OUTCOMES The primary outcome of this study was to determine the PPV of VAB in determining final histological diagnosis in B3 breast lesions using pooled estimates. The secondary outcomes were to determine if needle gauge or the re-classification of Lobular Carcinoma in Situ(LCIS) introduced in 2012 influenced pooled estimates. RESULTS 78 studies incorporating 6,377 B3 lesions were included in this review, 1214 of which were upgraded to DCIS or invasive malignancy following surgical excision(19%). The pooled PPV of VAB in Atypical Ductal Hyperplasia(ADH) and Lobular Neoplasia(LN) were 0.79(CI 0.76-0.83) and 0.84(CI 0.8-0.88). VAB of Flat Epithelial Atypia(FEA), radial scar and papillary lesions with/without atypia all had a pooled PPV >90% (underestimation rates 7%, 1%, 5% and 3% respectively). Needle gauge size and the change in LCIS classification did not appear to influence underestimation rates on subgroup analysis. CONCLUSION Results from this meta-analysis suggests it is reasonable to perform VAB as definitive treatment for certain B3 lesions, specifically LN, FEA, radial scar, and papillary lesions when specific criteria are fulfilled. Surgical excision should continue as the mainstay of treatment for ADH.
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Byun IH, Koo HK, Kim SJ, Kim HJ, Lee SW. Simultaneous Augmentation Mammoplasty and Vacuum-Assisted Breast Biopsy for Enhanced Cosmesis and Efficacy. Aesthetic Plast Surg 2020; 44:2041-2047. [PMID: 32671448 DOI: 10.1007/s00266-020-01858-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In this era of expanding life expectancy and popularity of aesthetic breast surgeries, more women are likely to live more years with their augmented breasts. Thus, consistent attention to general breast health is crucial, and preoperative ultrasound is helpful to locate suspicious lesions. In this study, we present a combinative procedure of augmentation mammoplasty and vacuum-assisted breast biopsy (VABB). METHODS From January of 2018 to December of 2019, a total of 102 patients received simultaneous augmentation mammoplasty and VABB in our institute. Only patients of primary augmentation mammoplasty who received VABB on unilateral breasts were included. We sought to investigate the results of each breast and safety of adding VABB before performing augmentation within the same incision. RESULTS Among 204 breasts and implants, 28.43% were done via endoscopic transaxillary approach and 71.57% via inframammary approach. The mean implant volume was 329.34 ± 44.79 ml, and the mean follow-up period was 14.23 ± 4.64 months. All of the complication rates exhibited no statistically significant differences between the two groups. CONCLUSION Simultaneous augmentation mammoplasty and VABB prevented unnecessary scars and pain, and the complication rates did not statistically differ from those of augmentation only group. This co-operation is a safe and simple method potentially beneficial to many women interested in breast surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Il Hwan Byun
- Department of Plastic and Reconstructive Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Hyun Kook Koo
- Department of Plastic and Reconstructive Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Soo Jung Kim
- Department of Plastic and Reconstructive Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Hye-Jin Kim
- Department of General Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Sang Woo Lee
- Department of Plastic and Reconstructive Surgery, DA Plastic Surgery, 125 Teheran-ro, Gangnam-gu, Seoul, Korea.
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Sanderink WBG, Strobbe LJA, Bult P, Schlooz-Vries MS, Lardenoije S, Venderink DJ, Sechopoulos I, Karssemeijer N, Vreuls W, Mann RM. Minimally invasive breast cancer excision using the breast lesion excision system under ultrasound guidance. Breast Cancer Res Treat 2020; 184:37-43. [PMID: 32737712 PMCID: PMC7568696 DOI: 10.1007/s10549-020-05814-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/15/2020] [Indexed: 11/08/2022]
Abstract
Purpose To assess the feasibility of completely excising small breast cancers using the automated, image-guided, single-pass radiofrequency-based breast lesion excision system (BLES) under ultrasound (US) guidance. Methods From February 2018 to July 2019, 22 patients diagnosed with invasive carcinomas ≤ 15 mm at US and mammography were enrolled in this prospective, multi-center, ethics board-approved study. Patients underwent breast MRI to verify lesion size. BLES-based excision and surgery were performed during the same procedure. Histopathology findings from the BLES procedure and surgery were compared, and total excision findings were assessed. Results Of the 22 patients, ten were excluded due to the lesion being > 15 mm and/or being multifocal at MRI, and one due to scheduling issues. The remaining 11 patients underwent BLES excision. Mean diameter of excised lesions at MRI was 11.8 mm (range 8.0–13.9 mm). BLES revealed ten (90.9%) invasive carcinomas of no special type, and one (9.1%) invasive lobular carcinoma. Histopathological results were identical for the needle biopsy, BLES, and surgical specimens for all lesions. None of the BLES excisions were adequate. Margins were usually compromised on both sides of the specimen, indicating that the excised volume was too small. Margin assessment was good for all BLES specimens. One technical complication occurred (retrieval of an empty BLES basket, specimen retrieved during subsequent surgery). Conclusions BLES allows accurate diagnosis of small invasive breast carcinomas. However, BLES cannot be considered as a therapeutic device for small invasive breast carcinomas due to not achieving adequate excision.
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Affiliation(s)
- W B G Sanderink
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - P Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M S Schlooz-Vries
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Lardenoije
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - D J Venderink
- Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - I Sechopoulos
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - N Karssemeijer
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - W Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - R M Mann
- Department of Medical Imaging/Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
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Bick U, Trimboli RM, Athanasiou A, Balleyguier C, Baltzer PAT, Bernathova M, Borbély K, Brkljacic B, Carbonaro LA, Clauser P, Cassano E, Colin C, Esen G, Evans A, Fallenberg EM, Fuchsjaeger MH, Gilbert FJ, Helbich TH, Heywang-Köbrunner SH, Herranz M, Kinkel K, Kilburn-Toppin F, Kuhl CK, Lesaru M, Lobbes MBI, Mann RM, Martincich L, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Schiaffino S, Sella T, Thomassin-Naggara I, Tardivon A, Ongeval CV, Wallis MG, Zackrisson S, Forrai G, Herrero JC, Sardanelli F. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 2020; 11:12. [PMID: 32025985 PMCID: PMC7002629 DOI: 10.1186/s13244-019-0803-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022] Open
Abstract
We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as "high-risk" or B3 lesions). Finally, seven frequently asked questions are answered.
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Affiliation(s)
- Ulrich Bick
- Clinic of Radiology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Rubina M Trimboli
- PhD Course in Integrative Biomedical Research, Department of Biomedical Science for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Corinne Balleyguier
- Department of Radiology, Gustave-Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Luca A Carbonaro
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Enrico Cassano
- Breast Imaging Division, European Institute of Oncology, Milan, Italy
| | - Catherine Colin
- Radiology Unit, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Femme Mère Enfant, 59 Boulevard Pinel, 69 677, Bron Cedex, France
| | - Gul Esen
- School of Medicine, Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Andrew Evans
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Tom McDonald Avenue, Dundee, UK
| | - Eva M Fallenberg
- Diagnostic and Interventional Breast Imaging, Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael H Fuchsjaeger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Michel Herranz
- CyclotronUnit, GALARIA-SERGAS, Nuclear Medicine Department and Molecular ImagingGroup, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
| | - Karen Kinkel
- Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, 1224 Chêne-Bougeries, Genève, Switzerland
| | - Fleur Kilburn-Toppin
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Marc B I Lobbes
- Department of Radiology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Laura Martincich
- Unit of Radiodiagnostics ASL AT, Via Conte Verde 125, 14100, Asti, Italy
| | - Pietro Panizza
- Breast Imaging Unit, Scientific Institute (IRCCS) Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Sorbonne Université, APHP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Anne Tardivon
- Department of Radiology, Institut Curie, Paris, France
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthew G Wallis
- Cambridge Breast Unit and NIHR Biomedical Research Unit, Box 97, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | | | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
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Özçağlayan TİK, Gürdal SÖ, Öznur M, Özçağlayan Ö, Doğru M, Topçu B. Effectiveness of the diagnostic pathway of BLES: could it be safely used as a therapeutic method in selected benign lesions? Diagn Interv Radiol 2019; 25:428-434. [PMID: 31650964 PMCID: PMC6837293 DOI: 10.5152/dir.2019.18427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/03/2019] [Accepted: 02/18/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE In this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and a practical alternative technique to surgical biopsy and other percutaneous biopsy methods for suspicious lesions. We also wanted to share our initial experience with BLES and compare it with standard percutaneous biopsy methods. METHODS From July 2015 to December 2016, a total of 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in the study. These lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) 3 or 4, which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively. The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed. RESULTS After BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases (2%), and spontaneous remission was observed. Two patients (4%) complained of pain during the procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 (<0.5 mm) damage in 88%, Grade 1 (0.5-1.5 mm) in 10%, Grade 2 (>1.5 mm or thermal damage in diffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015). CONCLUSION BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and atypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.
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Affiliation(s)
- Tuğba İlkem Kurtoğlu Özçağlayan
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Sibel Özkan Gürdal
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Meltem Öznur
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Ömer Özçağlayan
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Mücahit Doğru
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Birol Topçu
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
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Christou A, Koutoulidis V, Koulocheri D, Nonni A, Zografos CG, Zografos GC. Predictive factors for breast lesion excision system (BLES) accuracy and safety in stereotactic biopsy of suspicious calcifications. Breast J 2019; 26:391-398. [PMID: 31448476 DOI: 10.1111/tbj.13513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/01/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
AIM To retrospectively assess the effectiveness and safety of BLES stereotactic biopsy of suspicious calcifications and investigate possible predictive factors for underestimation. METHODS AND MATERIALS Between January 2014 and January 2016, 400 biopsies of suspicious calcifications were performed in our Department using the BLES stereotactic device. The mean age of our population was 58.5 years (range 39-78 years). The final surgical results were used as gold standard. The effectiveness of the method was statistically evaluated. Mammographic size, grade, molecular type, and presence of comedo type/necrosis were assessed as predictive factors. RESULTS 90/400 (22.5%) cases were cancers (20% invasive cancers, 80% non-invasive cancers). 38/400 cases were atypical lesions (9.5%). No underestimation was found in atypical lesions that underwent surgery (29/38 cases). Downgrade was achieved in 45.5% of cases (with complete removal in 34.4%), concordance in 43.3%, and upgrade was found in 15.5% of the cases; the initial mammographic size and the grade of the cancers were found to be statistically significant predictive factors. The total complication rate was 8.75%. CONCLUSIONS Breast lesion excision system is a highly accurate and safe stereotactic biopsy technique of suspicious calcifications with low underestimations and high downgrade/removal rates with the potential to alter the final surgical decision in selected cases.
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Affiliation(s)
| | - Vassilis Koutoulidis
- First Department of Radiology, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Koulocheri
- Department of Radiology, Breast Unit Hippokration Hospital, Athens, Greece
| | - Afrodite Nonni
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - George C Zografos
- Hippokration General Hospital, A' Surgical Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Performance of breast lesion excision system (BLES) in complete removal of papillomas presented mammographically as groups of calcifications. Clin Imaging 2019; 58:50-58. [PMID: 31238186 DOI: 10.1016/j.clinimag.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/06/2019] [Accepted: 06/14/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To retrospectively assess the stereotactic one-pass BLES performance in excision of small groups of calcifications seen on mammogram that proved to be papillomas. METHODS Between January 2014 and January 2016, 37/400 cases (9.2%) of stereotactic BLES biopsies performed in our department due to suspicious calcifications proved to be papillomas. Lesions with atypia underwent surgical removal and lesions with no atypia were followed up for 2 years. BLES and surgical histology results, radiological removal and 2-years stability were statistically analysed to assess BLES performance in biopsy and excision of papillomas. RESULTS The mean mammographic size of papillomas was 6.54 mm (st dev = 3.85, range 2 mm-17 mm) and within the size excised by the BLES needle (20 mm). 4/37 cases (10.8%) showed atypia. BLES excision was achieved in 29/37 cases (78.4%); radiological removal based on post BLES mammogram was achieved in 25/29 cases (86.2%). In the remaining 8/37 cases the papillomas were seen at the ink of the specimens' margins; 3/8 cases showed residual calcifications on post-BLES mammogram. The BLES histology result of removal and the mammographic size of the papillomas were found to be statistically significant predictive factors of excision (p < 0,001, Fisher's exact test, Mann Whitney test). Follow up mammograms showed no change for a period of 2 years. CONCLUSION BLES is a safe and accurate technique to biopsy papillomas with high success rates of excision which could potentially minimize the need of subsequent radiological or surgical excision.
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Sanderink WBG, Laarhuis BI, Strobbe LJA, Sechopoulos I, Bult P, Karssemeijer N, Mann RM. A systematic review on the use of the breast lesion excision system in breast disease. Insights Imaging 2019; 10:49. [PMID: 31049740 PMCID: PMC6497703 DOI: 10.1186/s13244-019-0737-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/20/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose To outline the current status of and provide insight into possible future research on the breast lesion excision system (BLES) as a diagnostic and therapeutic device. Methods A systematic search of the literature was performed using PubMed, Embase, and the Cochrane databases to identify relevant studies published between January 2002 and April 2018. Studies were considered eligible for inclusion if they evaluated the diagnostic or therapeutic accuracy or safety of BLES. Results Ultimately, 17 articles were included. The reported underestimation rates of atypical ductal hyperplasia and ductal carcinoma in situ (DCIS) ranged from 0 to 14.3% and from 0 to 22.2%, respectively. Complete excision rates for invasive ductal carcinoma and DCIS ranged from 5.3 to 76.3%. Bleeding was the most frequently reported complication (0–11.8%). Device-related complications may arise, with an empty basket being the most common (0.6–3.6%). Thermal damage of the specimen, caused by the use of a radiofrequency cutting wire, was reported in eight of the included studies. Most thermal artifacts were reported as superficial and small (0.1–1.9 mm). Conclusions The BLES, an automated, image-guided, single-pass biopsy system for breast lesions using radiofrequency is designed to excise and retrieve an intact tissue specimen. It is an efficient and safe breast biopsy method with acceptable complication rates, which may be used as an alternative to vacuum-assisted biopsies. The variable rate of complete excision raises questions about the possibility to use BLES as a therapeutic device for the excision of small lesions. Further research should focus on this aspect of BLES.
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Affiliation(s)
- Wendelien B G Sanderink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Babette I Laarhuis
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
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Binboga E, Binboga S. A comparison of the excision methods in breast lesions of classic wire localisation and the advanced breast biopsy system of breast lesion excision system. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04835-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yao K. Intact Excision of Breast Lesions Using BLES™: Is There a Clinical Indication Yet? Ann Surg Oncol 2019; 26:933-935. [PMID: 30737664 DOI: 10.1245/s10434-019-07214-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Katharine Yao
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA.
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Christou A, Koutoulidis V, Koulocheri D, Panourgias E, Nonni A, Zografos CG, Zografos GC. Role of one-pass breast lesion excision system in complete excision of high-risk breast lesions with atypia expressed as clusters of microcalcifications. Eur Radiol 2019; 29:3149-3158. [PMID: 30617496 DOI: 10.1007/s00330-018-5925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/30/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the role of the breast lesion excision system (BLES) in complete removal of clusters of microcalcifications found on mammogram proved histologically to be high-risk lesions with cell atypia. METHODS AND MATERIALS Three hundred ninety-four consecutive women (mean age 58.5 years, range 39-78 years) with 400 clusters of suspicious microcalcifications underwent stereotactic biopsy using the intact BLES device between January 2014 and January 2016. All cases proved histologically to be high-risk lesions were subsequently assessed for complete removal. The underestimation rate was also assessed. RESULTS Thirty-eight out of 400 (9.5%) lesions were high-risk lesions with atypia with mean size 7.63 mm (st. dev. = 4.03 mm) which was within the size that the BLES needle can excise (20 mm). Four (10.5%) papillomas with atypia, 14 (36.8%) cases with flat epithelial atypia (FEA), 10 (26.3%) cases with lobular intraepithelial neoplasia (LIN-LIN 1, LIN 2), 8 (21.2%) with atypical ductal hyperplasia (ADH) and 2 (5.3%) cases with mucocele-like lesions (MLL) with atypia were found. Twenty-nine out of 38 lesions had subsequent surgery. Complete excision was achieved in 23/29 lesions (79.3%). No underestimation was found. Two-year mammographic stability was found in all lesions. Non-parametric statistical analysis showed no other significant predictive factor for complete excision apart from the distance of the lesions from the specimen margins (p = 0.031 Mann-Whitney test). CONCLUSION One-pass BLES intact biopsy technique is a safe method of complete removal of high-risk atypical lesions with high accuracy rates for certain histologies and could be potentially used as an alternative excision method to diagnostic surgery in selected cases. KEY POINTS • Breast lesion excision system (BLES) is an image-guided biopsy technique that uses radiofrequency to remove an intact piece of tissue including the target breast neoplasm. • Breast lesion excision system (BLES) under stereotactic guidance is able to accurately biopsy high-risk breast lesions expressed mammographically as clusters of suspicious microcalcifications. • BLES under stereotactic guidance is an accurate technique for en bloc excision of selected cases of small clusters of suspicious microcalcifications proved to be high-risk lesions with histopathologically disease-free margins of excision.
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Affiliation(s)
| | - Vassilis Koutoulidis
- 1st Department of Radiology Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Koulocheri
- Department of Radiology, Breast Unit Hippokration Hospital, Athens, Greece
| | - Evangelia Panourgias
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens Areteion Hospital, Athens, Greece
| | - Afrodite Nonni
- 1st Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - George C Zografos
- Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Hot S, Coşkun ZÜ, Akçakaya A, Bender Ö, Türkmen ÜA, Nayır PÖ, Sarı A, Hot AB. The breast lesion excision system procedure: An optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety. Saudi Med J 2018; 39:891-896. [PMID: 30251732 PMCID: PMC6201004 DOI: 10.15537/smj.2018.9.22573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the efficacy of the Breast lesion excision system (BLES) procedure as a primary excisional biopsy for the management of breast imaging-reporting and data system (BI-RADS) category 3, small, and solid breast lesions in women having severe breast cancer anxiety. Methods: A retospective study was conducted on 68 patients who underwent a BLES procedure. The study protocol was approved by the local ethical committee of Yeni Yuzyıl University in Istanbul, Turkey. The study was carried out according to the principles of the Helsinki Declaration. Small breast lesions removed using a (12, 15 or 20 mm) wand from September 2011 to November 2014. These were category 3 lesions as determined by ultrasound (US) imaging according to BI-RADS. The radiological and pathological sizes of these lesions, the complete excision rates, the procedure durations, the pathological diagnosis, the complications, and the imaging findings before and after the procedure were all recorded. Results: All the patients had a benign pathology. The mean duration of procedure was 12 (range=8-22) minutes. There was no major complication during the procedure and in the following period. Only some small hematomas were determined in 3 (4.2%) patients, and no additional surgical intervention was performed. Conclusion: The BLES procedure is an optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety.
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Affiliation(s)
- Semih Hot
- Department of Surgery, Okmeydanı Education Research Hospital, University of Health Science, Istanbul, Turkey. E-mail.
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Advances in breast intervention: where are we now and where should we be? Clin Radiol 2017; 73:724-734. [PMID: 29224890 DOI: 10.1016/j.crad.2017.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/31/2017] [Indexed: 11/21/2022]
Abstract
In the past four decades, a variety of methods for minimal or non-invasive diagnosis and treatment of breast cancer have been introduced. Although breast imaging has become more and more specific for diagnosis, specimen biopsy with histopathological confirmation is still necessary. Core-needle biopsy under ultrasound guidance is the appropriate first choice for the diagnosis of most lesions. Fine-needle aspiration is of interest for identification of the presence of metastatic disease in abnormal lymph nodes. For microcalcifications, vacuum-assisted biopsy is recommended, especially with stereotactic guidance. In recent years different therapeutic techniques have been developed for the treatment of solid lesions, including breast cancer. Certainly, with the improvement of technology and medical scientific progress, it is becoming more common to use minimal- or non-invasive therapies. The proposed minimally invasive techniques may offer complete treatment of breast cancer, with better cosmetic results, less psychological stress, and shorter hospital stays. In this article, the strengths and weaknesses of the different diagnostic and therapeutic techniques are presented, and promising techniques for the future are discussed.
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Breast Lesion Excision System in the diagnosis and treatment of intraductal papillomas - A feasibility study. Eur J Surg Oncol 2017; 44:59-66. [PMID: 29169930 DOI: 10.1016/j.ejso.2017.10.213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/08/2017] [Accepted: 10/10/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the feasibility of Breast Lesion Excision System (BLES) in the treatment of intraductal papillomas. MATERIAL AND METHODS All patients with a needle biopsy -based suspicion of an intraductal papilloma who consequently underwent a BLES procedure at Helsinki University Hospital between 2011 and 2016 were included in this retrospective study. The purpose of the BLES procedure was either to excise the entire lesion or in few cases to achieve better sampling. RESULTS In total, 74 patients underwent 80 BLES procedures. Pathological diagnosis after the BLES biopsy confirmed an intraductal papilloma without atypia in 43 lesions, whereas 10 lesions were upgraded to high-risk lesions (HRL) with either atypical ductal hyperplasia or lobular carcinoma in situ. Five cases were upgraded to malignancy, two were invasive ductal carcinomas and three were ductal carcinoma in situ. Additionally, 18 lesions were diagnosed as other benign lesions. Four procedures failed. Complete excision with BLES was achieved in 19 out of 43 intraductal papillomas, 6 out of 10 HRL and two out of five malignant lesions. No major complications occurred. The BLES procedure was adequate in the management of the 71 breast lesions. CONCLUSION The BLES procedure is an acceptable method for the management of small benign and high-risk breast lesions such as intraductal papillomas in selected patients. Thus, a great amount of diagnostic surgical biopsies can be avoided.
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Sklair-Levy M, Rayman S, Yosepovich A, Zbar A, Goitein D, Zippel D. The Intact ® breast lesion excision system as a therapeutic device for selected benign breast lesions. Breast J 2017; 24:304-308. [PMID: 29024205 DOI: 10.1111/tbj.12931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/18/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
The aim of this paper is to evaluate our Unit's initial experience using the Intact breast lesion excision system as a therapeutic excision option for benign or borderline breast lesions, which otherwise would entail open operative excision. The study includes the first 111 patients who underwent therapeutic excision with the intact radiofrequency system between December 2012 and May 2016 performed at the Meirav Center for Breast Health, at the Chaim Sheba Medical Center, Ramat Gan Israel. The indications for the procedure included those patients who have benign, or atypical high risk lesions following a previous core needle biospy (CNB) who would have normally undergone conventional excision biopsy. After reviewing each case separately, we found that the use of the BLES system as a treatment device permitted the avoidance of operations that would have been otherwise indicated, in 98 cases of the total 111 in the cohort (88.3%). Thirteen cases eventually had to undergo surgical excision. In eight cases pathology was upgraded from the initial CNB to invasive or noninvasive carcinoma. Although the INTACT sysytem is most commonly used as an alternative biopsy technique for its diagnostic capabilities, this study assessed its clinical role as a definitive therapeutic excisional modality in selected cases of benign breast disease. It proved valuable in the majority of cases with avoidance of surgery where it was traditionally indicated, (98/111, 88.3%) and as definitive fibroadenoma management in a further 28 patients.
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Affiliation(s)
- Miri Sklair-Levy
- Department of Diagnostic Radiology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Rayman
- Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ady Yosepovich
- Department of Pathology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Andrew Zbar
- Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - David Goitein
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Douglas Zippel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
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Margin-free excision of small solid breast carcinomas using the Intact Breast Lesion Excision System ®: is it feasible? Breast Cancer 2017; 25:134-140. [PMID: 28918560 DOI: 10.1007/s12282-017-0802-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Breast Lesion Excision System® (BLES®) is a stereotactic vacuum-assisted breast biopsy device that utilizes radiofrequency in order to excise non-palpable mammographic lesions for pathologic diagnosis. The purpose of this study was to evaluate the efficacy of BLES® in performing complete, margin-free excisions of small solid carcinomas. METHODS Our retrospective study of prospectively enrolled patients included 50 cases of non-palpable, BIRADS ≥ 4, solid by means of mammography and sonography, lesions. All these patients underwent a BLES® breast biopsy procedure from June 2010 to June 2014 and had a malignant diagnosis. According to each patient's pathologic diagnosis, appropriate surgical treatment was recommended. Postoperatively, surgical specimens were histologically analyzed, aiming to determine whether residual malignant disease was present in the specimen cavity formatted by BLES®. RESULTS Ductal carcinoma in situ (DCIS) was diagnosed in 5 patients and invasive carcinoma (IC) in 45 patients, at primary BLES® pathology report. Tumor-free resection margins (< 0.5 and < 1 mm) were accomplished in only 8/24 subcentimeter cases (33.3%). Absence of residual disease upon surgical excision was confirmed in 23/24 subcentimeter cases (95.8%) and 2/26 of the cases measuring > 1 cm (7.69%). Statistical analysis revealed that mammographic size was the only significant prognostic factor for complete excision (i.e., with no residual disease in the biopsy cavity) of a malignant lesion. CONCLUSIONS Our results indicate that it is possible, when using the BLES® device, to completely excise small (≤ 10 mm) breast carcinomas that appear radiologically as solid lesions. This subset of patients should be investigated regarding the therapeutic potential of this method.
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Milos RI, Bernathova M, Baltzer PA, Pinker-Domenig K, Kapetas P, Rudas M, Helbich TH. The breast lesion excision system (BLES) under stereotactic guidance cannot be used as a therapeutic tool in the excision of small areas of microcalcifications in the breast. Eur J Radiol 2017; 93:252-257. [PMID: 28668423 DOI: 10.1016/j.ejrad.2017.05.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/03/2017] [Accepted: 05/31/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The breast lesion excision system (BLES) is a new, automatic percutaneous breast biopsy device that excises single large specimens using radiofrequency cutting. The aim of this study was to determine whether BLES, under stereotactic guidance, can be used as a therapeutic tool in the assessment of small areas of microcalcifications in the breast by providing samples with clear margins. MATERIAL AND METHODS In this retrospective study, 149 patients with suspicious (BIRADS 4 or 5) small areas of microcalcifications underwent stereotactic-guided BLES. Of these, 34 patients (22.8%) with microcalcifications that had a diameter smaller than the basket size (≤15mm) underwent both BLES and subsequent surgery. Histopathology findings from BLES and subsequent surgery were compared. Identical, underestimation and total excision findings were assessed. RESULTS BLES revealed fourteen (41.1%) high-risk lesions, ten (29.4%) ductal carcinomas in situ, and ten (29.4%) invasive cancers. Identical results between BLES and surgery were seen in 17/34 (50%) lesions. Surgery confirmed total excision of BLES in 15/34 (44.1%) lesions. Underestimation was seen in 2/34 (5.8%) lesions. CONCLUSION BLES allows accurate diagnosis of small areas of microcalcifications, with few underestimates. BLES is a diagnostic, but cannot be considered to be a therapeutic tool in the case of suspicious microcalcifications because total excision was seen in only 44.1% of these lesions. Studies are needed to address the therapeutic benefit of this procedure in solid lesions.
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Affiliation(s)
- Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Katja Pinker-Domenig
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Margaretha Rudas
- Department of Clinical Pathology, Medical University of Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria.
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Evaluation of percutaneous vacuum assisted intact specimen breast biopsy device for ultrasound visualized breast lesions: Upstage rates and long term follow-up for high risk lesions and DCIS. Breast 2017; 33:38-43. [DOI: 10.1016/j.breast.2017.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/10/2017] [Accepted: 02/27/2017] [Indexed: 11/24/2022] Open
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Farshid G, Gill PG. Contemporary indications for diagnostic open biopsy in women assessed for screen-detected breast lesions: A ten-year, single institution series of 814 consecutive cases. Breast Cancer Res Treat 2017; 162:49-58. [PMID: 28062979 DOI: 10.1007/s10549-016-4087-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE In contemporary practice, 5% of women with non-malignant needle biopsies of screen-detected lesions still require diagnostic open biopsy (OBx). Our aims are to (i) capture a snapshot of the contemporary indications for OBx in screen-detected lesions; (ii) determine upgrade rates to malignancy (DCIS or invasive cancer); (iii) identify indications with sufficiently low upgrades to justify avoidance of OBx and (iv) propose plausible non-surgical alternatives. METHODS Between Jan 2005 and Dec 2014, women assessed for a screen-detected lesion and recommended for OBx are included. We retrieved patient, imaging, biopsy and final pathology or follow-up data. RESULTS 814 lesions, mean diameter 16.7 mm, microcalcifications in 353 (43.4%) cases, lesions other than calcifications in 461 (56.6%), mean patient age 58.4 yrs, are included. Surgery was performed in 98.2% cases. Imaging follow-up (1-6.5 yrs) is available in 13 of 15 remaining cases. 27 indications for OBx were identified, with a prevalence of 0.3-13.9%. Borderline lesions (BL) comprised 64% of OBx indications, amongst which atypical ductal hyperplasia was the most prevalent at 13.9%, followed by papillary lesions, radial scars, flat epithelial atypia and lobular neoplasia. Imaging factors contributed 26.3% of OBx. In 9.8% of cases, NCB was not performed due to client, technical or cytologic factors. Overall, 261(32.1%) lesions were malignant at OBx. Upgrade rates varied from 0 to 100%, depending on the specific indication for OBx. CONCLUSIONS Surgical biopsy remains a valuable method of last resort for breast cancer diagnosis but strategies to limit benign breast surgery merit attention as a public health issue.
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Affiliation(s)
- Gelareh Farshid
- BreastScreen SA, Discipline of Medicine, Adelaide University and Directorate of Surgical Pathology, SA Pathology, 167 Flinders Street, Adelaide, SA, 5000, Australia.
| | - P Grantley Gill
- BreastScreen SA and the Department of Surgery, University of Adelaide, Adelaide, SA, Australia
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20
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Cassano E, Trentin C. Integrated Breast Biopsy for Best Radiological Diagnosis of Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scaperrotta G, Ferranti C, Capalbo E, Paolini B, Marchesini M, Suman L, Folini C, Mariani L, Panizza P. Performance and role of the breast lesion excision system (BLES) in small clusters of suspicious microcalcifications. Eur J Radiol 2015; 85:143-149. [PMID: 26724659 DOI: 10.1016/j.ejrad.2015.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the diagnostic performance of the BLES as a biopsy tool in patients with ≤ 1 cm clusters of BIRADS 4 microcalcifications, in order to possibly avoid surgical excision in selected patients. MATERIALS This is a retrospective study of 105 patients undergone to stereotactic breast biopsy with the BLES. It excises a single specimen containing the whole mammographic target, allowing better histological assessment due to preserved architecture. RESULTS Our case series consists of 41 carcinomas (39%) and 64 benign lesions (61%). Cancer involved the specimen margins in 20/41 cases (48.8%) or was close to them (≤ 1 mm) in 14 cases (34.1%); margins were disease-free in only 7 DCIS (17.1%). At subsequent excision of 39/41 malignant cases, underestimation occurred for 5/32 DCIS (15.6%), residual disease was found in 15/39 cancers (38.5%) and no cancer in 19/39 cases (48.7%). For DCIS cases, no residual disease occurred for 66.7% G1-G2 cases and for 35.3% G3 cases (P=0.1556) as well as in 83.3%, 40.0% and 43.8% cases respectively for negative, close and positive BLES margins (P=0.2576). CONCLUSIONS The BLES is a good option for removal of small clusters of breast microcalcifications, giving better histological interpretation, lower underestimation rates and possibly reducing the need of subsequent surgical excision in selected patients.
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Affiliation(s)
- Gianfranco Scaperrotta
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Claudio Ferranti
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuela Capalbo
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Biagio Paolini
- Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Marchesini
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Suman
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Folini
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pietro Panizza
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Importance of anatomopathological-imaging correlations for the validation of a breast biopsy results. Diagn Interv Imaging 2015; 97:247-56. [PMID: 26385837 DOI: 10.1016/j.diii.2015.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
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Waaijer L, Willems SM, Verkooijen HM, Buck DB, van der Pol CC, van Diest PJ, Witkamp AJ. Impact of preoperative evaluation of tumour grade by core needle biopsy on clinical risk assessment and patient selection for adjuvant systemic treatment in breast cancer. Br J Surg 2015; 102:1048-55. [PMID: 26176340 DOI: 10.1002/bjs.9858] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/05/2015] [Accepted: 04/16/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Histological characteristics are important when making a decision on adjuvant systemic treatment in breast cancer. Preoperative assessments of core needle biopsy (CNB) specimens are becoming increasingly relevant as novel minimally invasive ablative techniques are introduced, because a surgical specimen is no longer obtained with these methods. The clinical impact of potential underestimation of tumour grade on preoperative CNB on clinical decision-making was evaluated. METHODS Histological tumour grade was reassessed on CNB and resection specimens from consecutive invasive ductal carcinomas diagnosed between 2010 and 2013. For each patient, the indication for systemic therapy was assessed, based on either CNB or surgical excision, in combination with clinical characteristics and imaging findings. The clinical impact of discordance between tumour grade on CNB versus the resection specimen was assessed. RESULTS The analysis included 213 invasive ductal carcinomas in 199 patients. Discordance in tumour grade between CNB and the resection specimen was observed in 64 (30.0 per cent) of 213 tumours (κ = 0.53, 95 per cent c.i. 0.43 to 0.63). A decision on adjuvant treatment based on CNB would have resulted in overtreatment in seven (3.5 per cent) and undertreatment in three (1.5 per cent) of 199 patients. In the undertreated patients, incorrect omission of adjuvant systemic treatment would have increased the predicted 10-year mortality rate by 2.6-5.2 per cent and 10-year recurrence rate by 8.2-15.3 per cent based on the online risk assessment tool Adjuvant! CONCLUSION The substantial discordance in tumour grading between CNB and resection specimens from breast cancer affects the indication for adjuvant therapy in only a small minority of patients with invasive ductal carcinoma. Assessment of tumour grade by CNB is feasible and accurate for the planning of postoperative treatment.
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Affiliation(s)
- L Waaijer
- Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S M Willems
- Departments of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H M Verkooijen
- Departments of Imaging Division, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - D B Buck
- Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C C van der Pol
- Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P J van Diest
- Departments of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A J Witkamp
- Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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Abstract
OBJECTIVE The purpose of this article is to briefly describe the various techniques used for percutaneous ablation of breast cancer, their preliminary results, and their limitations. The techniques include thermotherapy (radiofrequency ablation, laser irradiation, microwave irradiation, and insonation with high-intensity focused ultrasound waves), cryotherapy, and irreversible electroporation. CONCLUSION The techniques used for percutaneous ablation of breast cancer raise many questions and issues that must be addressed before percutaneous ablation can be adopted for the treatment of early breast cancer.
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Park HL, Hong J. Vacuum-assisted breast biopsy for breast cancer. Gland Surg 2014; 3:120-7. [PMID: 25083505 DOI: 10.3978/j.issn.2227-684x.2014.02.03] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/15/2014] [Indexed: 01/11/2023]
Abstract
Sonographic examination of the breast with state-of-the-art equipment has become an essential part of the clinical work-up of breast lesions and a valuable adjunct to mammographic screening and physical examination. Fine-needle aspiration (FNA) and core-needle biopsy (CNB) are well-established, valuable techniques that are still used in most cases, whereas vacuum-assisted breast biopsy (VABB) is a more recent technique. VABB has proven clinical value and can be used under sonographic, mammographic, and magnetic resonance imaging guidance. The main indication for the use of VABB is for biopsies of clustered microcalcifications, which are usually performed under stereotactic guidance. This method has been proven reliable and should replace surgical biopsies. The ultrasound-guided procedure is still more a matter of discussion, but it should also replace surgical biopsies for nodular lesions, and it should even replace surgery for the complete removal of benign lesions. This viewpoint is gradually gaining acceptance. Different authors have shown increased diagnostic accuracy of VABB compared to FNA and CNB. VABB particularly leads to less histological underestimation. The other indications for VABB are palpable or nonpalpable nodular lesions or American College of Radiology Breast Imaging Reporting and Data System 3 and 4A lesions. For masses that are likely benign or indeterminate, we attempt to completely remove the lesion to eliminate uncertainty on later follow-up images. VABB offers the best possible histological sampling and aids avoidance of unnecessary operations. VABB complications include bleeding or pain during the procedure, as well as postoperative pain, hemorrhaging, and hematomas. But, these hemorrhaging could be controlled by the post-procedural compression and bed resting. Overall, VABB is a reliable sampling technique with few complications, is relatively easy to use, and is well-tolerated by patients. The larger amount of extracted tissue reduces sampling error.
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Affiliation(s)
- Hai-Lin Park
- Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
| | - Jisun Hong
- Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
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Allen SD, Osin P, Nerurkar A. The radiological excision of high risk and malignant lesions using the INTACT breast lesion excision system. A case series with an imaging follow up of at least 5 years. Eur J Surg Oncol 2014; 40:824-9. [PMID: 24742589 DOI: 10.1016/j.ejso.2014.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/14/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the efficacy of a BLES procedure as a primary excisional biopsy rather than a surgical wide local excision for treatment of a high risk or a malignant lesion. METHODS 41 patients underwent a BLES procedure in order to attempt to remove a small breast lesion using a 15 mm or 20 mm wand from August 2007 to January 2009. The lesions were either proven on prior core biopsy to show high risk or malignant pathology or were considered to be indeterminate or suspicious on ultrasound or mammography. The pathology was reviewed to include the final status of lesion excision. If margin involvement was demonstrated then a formal surgical excision was subsequently recommended. Follow up mammography or ultrasound was performed annually in patients following the final pathological diagnosis. RESULTS 9 patients had a primary diagnosis of atypia (columnar cell change with atypia or atypical ductal hyperplasia (ADH)), 23 patients had ductal carcinoma in situ (DCIS) and 9 had an invasive carcinoma (IC) at the original BLES pathology. Clear BLES margins of >1 mm were obtained in 3/9 atypia lesions, 15/23 DCIS and 0/9 IC. 12/13 low grade DCIS were completely excised. Subsequent surgical margin excisions were undertaken in 20 patients. After at least 5 years of follow up (mean 66 months), 1 lesion had recurred on imaging. CONCLUSION A BLES excision has potential as an alternative technique to traditional surgical wide local excision in the management of certain small breast lesions with high risk and low grade malignant potential.
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Affiliation(s)
- S D Allen
- Dept of Imaging, Royal Marsden NHS Foundation Trust, United Kingdom.
| | - P Osin
- Dept of Pathology, Royal Marsden NHS Foundation Trust, United Kingdom
| | - A Nerurkar
- Dept of Pathology, Royal Marsden NHS Foundation Trust, United Kingdom
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Diepstraten SCE, van de Ven SMWY, Pijnappel RM, Peeters PHM, van den Bosch MAAJ, Verkooijen HM, Elias SG. Development and evaluation of a prediction model for underestimated invasive breast cancer in women with ductal carcinoma in situ at stereotactic large core needle biopsy. PLoS One 2013; 8:e77826. [PMID: 24147085 PMCID: PMC3795649 DOI: 10.1371/journal.pone.0077826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 09/11/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We aimed to develop a multivariable model for prediction of underestimated invasiveness in women with ductal carcinoma in situ at stereotactic large core needle biopsy, that can be used to select patients for sentinel node biopsy at primary surgery. METHODS From the literature, we selected potential preoperative predictors of underestimated invasive breast cancer. Data of patients with nonpalpable breast lesions who were diagnosed with ductal carcinoma in situ at stereotactic large core needle biopsy, drawn from the prospective COBRA (Core Biopsy after RAdiological localization) and COBRA2000 cohort studies, were used to fit the multivariable model and assess its overall performance, discrimination, and calibration. RESULTS 348 women with large core needle biopsy-proven ductal carcinoma in situ were available for analysis. In 100 (28.7%) patients invasive carcinoma was found at subsequent surgery. Nine predictors were included in the model. In the multivariable analysis, the predictors with the strongest association were lesion size (OR 1.12 per cm, 95% CI 0.98-1.28), number of cores retrieved at biopsy (OR per core 0.87, 95% CI 0.75-1.01), presence of lobular cancerization (OR 5.29, 95% CI 1.25-26.77), and microinvasion (OR 3.75, 95% CI 1.42-9.87). The overall performance of the multivariable model was poor with an explained variation of 9% (Nagelkerke's R(2)), mediocre discrimination with area under the receiver operating characteristic curve of 0.66 (95% confidence interval 0.58-0.73), and fairly good calibration. CONCLUSION The evaluation of our multivariable prediction model in a large, clinically representative study population proves that routine clinical and pathological variables are not suitable to select patients with large core needle biopsy-proven ductal carcinoma in situ for sentinel node biopsy during primary surgery.
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Affiliation(s)
| | | | - Ruud M. Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra H. M. Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Helena M. Verkooijen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sjoerd G. Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Medjhoul A, Canale S, Mathieu MC, Uzan C, Garbay JR, Dromain C, Balleyguier C. Breast lesion excision sample (BLES biopsy) combining stereotactic biopsy and radiofrequency: is it a safe and accurate procedure in case of BIRADS 4 and 5 breast lesions? Breast J 2013; 19:590-4. [PMID: 24102869 DOI: 10.1111/tbj.12184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of this study was to evaluate the accuracy and safety of breast lesion excision system (BLES) procedure with an Intact system device, under stereotactic and ultrasound guidance. Retrospective data review of 32 breast lesions BI-RADS 4 or 5 underwent Intact procedures, from March 2010 to January 2012. Underestimation rates of atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) were evaluated; percentage of complete radiologic and histologic removal of the breast lesion were analyzed, as were the complications due to procedure. Complete radiologic excision of the target lesion was achieved in all masses and 58.6% of calcifications. Lesion size was less than 11 mm (mean size 5.6 mm). Underestimation of ADH and DCIS was 0% and 10%, respectively. Low complication rate was noted: only one hematoma. BLES appears an accurate and safe biopsy system for sampling nonpalpable breast lesions, especially in case of microcalcifications clusters categorized as BI-RADS 4 and 5.
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Affiliation(s)
- Aicha Medjhoul
- Radiology Department, Institut Gustave Roussy, Villejuif, France
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Razek NA, Eshak SE, el Ghazaly H, Omar OS, Yousef OZ, Shaalan M. Percutaneous breast lesion excision system (BLES): A new tool for complete closed excision of high risk lesions (Egyptian experience). THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Al-Harethee W, Theodoropoulos G, Filippakis GM, Papapanagiotou I, Matiatou M, Georgiou G, Kalles V, Koulocheri D, Nonni A, Konstadoulakis MM, Manouras A, Zografos GC. Complications of percutaneous stereotactic vacuum assisted breast biopsy system utilizing radio frequency. Eur J Radiol 2013; 82:623-6. [DOI: 10.1016/j.ejrad.2011.12.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 12/18/2011] [Accepted: 12/19/2011] [Indexed: 10/14/2022]
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Al-Harethee WA, Kalles V, Papapanagiotou I, Matiatou M, Georgiou G, Nonni A, Koulocheri D, Liakou P, Theodoropoulos G, Zografos GC. Thermal damage of the specimen during breast biopsy with the use of the Breast Lesion Excision System: does it affect diagnosis? Breast Cancer 2013; 22:84-9. [PMID: 23504263 DOI: 10.1007/s12282-013-0458-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/18/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Stereotactic vacuum assisted breast biopsy (VABB) procedures remain of key importance in the diagnostic evaluation of suspicious non-palpable mammographic lesions. The Breast Lesion Excision System(®) (BLES) is an image-guided percutaneous biopsy method that utilizes radiofrequency (RF) in order to retrieve an intact-tissue biopsy specimen. The purpose of this study is to determine the effects of RF application on the tissue specimen and the possible interference with the histopathologic results. METHODS In this study we included 265 patients with suspicious non-palpable mammographic lesions who underwent 273 stereotactic VABB procedures using the BLES. All biopsies were performed by the same surgical-radiology team under local anesthesia. The specimen thermal damage was classified according to the pathology report in 3 categories: Severe (extensive thermal damage or inability to diagnose), medium (ability to diagnose but either circumferential damage >1.5 mm or diffuse areas of thermal damage) and mild (circumferential thermal damage <1.5 mm but >0.5 mm). RESULTS Radiofrequency-associated thermal damage of the specimen was observed in 14 cases (5.13 %), and was classified as severe in 5, medium in 5, and mild in 4 specimens. Within the group of RF damaged specimens, we found a significant (p < 0.05) positive correlation between fat cell content and classification of thermal damage. CONCLUSIONS Although thermal damage is of concern during BLES breast biopsy, the incidence is low, and the outcome of the histopathologic assessment is not affected even in severely damaged specimens. Increased thermal damage seems to correlate with higher fat cell content of the specimen.
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Affiliation(s)
- Wasim Ali Al-Harethee
- Breast Unit, 1st Propaedeutic Surgical Clinic, Hippocratio General Hospital, University of Athens, P. Perimeni 1-2, Nea Smyrni, 17121, Athens, Greece
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Diepstraten SCE, Verkooijen HM, van Diest PJ, Veldhuis WB, Fernandez-Gallardo AM, Duvivier KM, Witkamp AJ, van Dalen T, Mali WPTM, van den Bosch MAAJ. Radiofrequency-assisted intact specimen biopsy of breast tumors: critical evaluation according to the IDEAL recommendations. Cancer Imaging 2011; 11:247-52. [PMID: 22201702 PMCID: PMC3266591 DOI: 10.1102/1470-7330.2011.0034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Radiofrequency-assisted intact specimen biopsy (RFIB) has been introduced for percutaneous biopsy or removal of breast tumors. Using radiofrequency cutting, the system enables the radiologist to obtain an intact sample of the target lesion. According to the IDEAL recommendations, we performed a critical evaluation of our initial experience with RFIB. Between June and November 2010, radiography-guided RFIB was performed in 19 female patients. All patients presented with suspicious microcalcifications (BI-RADS III-V) on mammography. Biopsy specimen integrity, thermal damage and histologic diagnosis were assessed by an expert breast pathologist. Data on technical success, diagnostic and therapeutic accuracy and periprocedural complications were collected and analyzed. The median age of the patients was 59 years. Median lesion diameter on mammography was 8 mm (range 2–76 mm). The procedure was successful in 16/19 (84%) patients and unsuccessful in 3/19 (16%) patients (2 non-representative samples, 1 sample with extensive thermal damage). Histologic analysis of the RFIB specimen revealed 12/19 (63%) benign lesions and 7/19 (37%) malignancies (4 ductal carcinoma in situ (DCIS) lesions and 3 invasive ductal carcinomas). In 1 patient, a DCIS lesion was completely removed with RFIB. Overall, 3 periprocedural complications occurred (1 wound leakage, 1 arterial hemorrhage and 1 infection requiring oral antibiotics). Tissue sampling of suspicious breast lesions can be performed successfully with RFIB. In 1 patient DCIS was radically excised with RFIB, which illustrates its potential as a minimally invasive therapeutic procedure for removal of small breast tumors. This is an interesting focus for further research when larger probe sizes become available.
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Whitworth PW, Simpson JF, Poller WR, Schonholz SM, Turner JF, Phillips RF, Johnson JM, McEachin FD. Definitive diagnosis for high-risk breast lesions without open surgical excision: the Intact Percutaneous Excision Trial (IPET). Ann Surg Oncol 2011; 18:3047-52. [PMID: 21947585 DOI: 10.1245/s10434-011-1911-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Open surgical excision (OSE) is generally recommended when image-guided core-needle breast biopsy demonstrates a high-risk lesion (HRL). We evaluated intact percutaneous excision (IPEX) with standard radiologic and histologic criteria for definitive diagnosis of HRL, particularly atypical ductal hyperplasia (ADH). The primary aim is to confirm criteria associated with <2% risk for upgrade to carcinoma, equivalent to risk associated with Breast Imaging Reporting and Data System (BI-RADS) 3 lesions, for which imaging surveillance is considered sufficient. METHODS In a prospective trial, 1,170 patients recommended for breast biopsy at 25 institutions received IPEX with a vacuum- and radiofrequency-assisted device. ADH patients in whom the imaged lesion had been removed and the lesion adequately centered for definitive characterization were designated as the potential surgical avoidance population (PSAP) before OSE. Subsequent OSE specimen pathology was compared with IPEX findings. RESULTS In 1,170 patients, 191 carcinomas and 83 (7%) HRL, including 32 ADH (3%), were diagnosed via IPEX. None of the 51 non-ADH HRL were upgraded to carcinoma on OSE (n = 24) or, if OSE was declined, on radiologic follow-up (n = 27). No ADH lesions meeting PSAP criteria (n = 10) were upgraded to carcinoma on OSE; 3 (14%) of 22 non-PSAP ADH lesions were upgraded to carcinoma on OSE. In summary, no upgrades to carcinoma were made in patients with non-ADH lesions who underwent IPEX or in ADH patients who had IPEX, met histologic and radiologic criteria, and underwent OSE or follow-up. CONCLUSION IPEX combined with straightforward histologic and radiologic criteria and imaging surveillance constitutes acceptable management of image-detected HRL, including ADH.
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Affiliation(s)
- Pat W Whitworth
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Kettritz U. Minimally Invasive Biopsy Methods - Diagnostics or Therapy? Personal Opinion and Review of the Literature. Breast Care (Basel) 2011; 6:94-97. [PMID: 21673818 PMCID: PMC3104898 DOI: 10.1159/000327889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
SUMMARY: This article provides an overview of different minimally invasive biopsy (MIB) methods for preoperative assessment of suspicious and indeterminate breast lesions. Accuracy depends on the choice of method and on lesion characteristics. An additional aspect deals with the question whether or not MIB is a suitable therapeutic approach in selected lesions.
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Vandromme MJ, Umphrey H, Krontiras H. Image-guided methods for biopsy of suspicious breast lesions. J Surg Oncol 2011; 103:299-305. [PMID: 21337562 DOI: 10.1002/jso.21795] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The widespread use of breast imaging has resulted in the increased detection of clinically occult suspicious breast lesions. Between 1999 and 2004 the number of breast biopsies in the United States has increased steadily. The armamentarium of methods to biopsy suspicious breast lesions has also increased significantly since the early 1990s with technological advancements for both surgical breast biopsy and percutaneous image guided breast biopsies.
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Affiliation(s)
- Marianne J Vandromme
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, UK
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Verschuur-Maes AHJ, Witkamp AJ, de Bruin PC, van der Wall E, van Diest PJ. Progression risk of columnar cell lesions of the breast diagnosed in core needle biopsies. Int J Cancer 2011; 129:2674-80. [PMID: 21225627 DOI: 10.1002/ijc.25926] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 12/13/2010] [Indexed: 11/09/2022]
Abstract
Columnar cell lesions (CCLs) of the breast are recognized as putative precursor lesions of invasive carcinoma, but their management remains controversial. We therefore conducted a retrospective study on 311 CCLs, diagnosed in 4,164 14-gauge core needle biopsies (CNB): 221 CCLs without atypia (CCL), 69 with atypia (CCL-A), and 21 atypical ductal hyperplasias originating in CCL (ADH-CCL). Two groups were identified: "immediate treatment" group undergoing excision within four months after the CNB diagnosis of CCL (N = 52) and the "wait-and-see" group followed up to 8 years (median 3.5 years, N = 259). In 7 of 31 women (22.5%, 1 CCL, 4 CCL-A, 2 ADH-CCL) who underwent immediate surgical excision and were initially biopsied for microcalcifications, ductal carcinoma in situ (DCIS) was present and in 2/31 women (6.5%, 1 CCL, 1 CCL-A) invasive carcinoma. In 2/21 excisions (9.5%, 1 CCL, 1 CCL-A) initially biopsied for a density, DCIS was present and invasive carcinoma in 5/21 excisions (23.8%, 2 CCL, 3 CCL-A). In the wait-and-see group, 9/259 women (3.5%) developed invasive carcinoma, 6 ipsi, and 3 contralaterally. Progression risks of CCL-A and ADH-CCL were 18% and 22%,versus 2% for CCL without atypia (p < 0.001). In conclusion, CCL-A or ADH-CCL in a CNB were associated with a high risk of DCIS/invasive carcinoma in immediate surgical excision biopsies. The 8-years progression risks for CCL-A and ADH-CCL were around 20%. This illustrates that an atypical CCL in a CNB may signal the presence of concurrent lesions or development of advanced lesions in future and may justify ("mini") surgical excision.
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Predictive factors for complete excision and underestimation of one-pass en bloc excision of non-palpable breast lesions with the Intact(®) breast lesion excision system. Eur J Radiol 2011; 81:719-24. [PMID: 21310570 DOI: 10.1016/j.ejrad.2011.01.049] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 01/03/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Image-guided percutaneous biopsy is the recommended initial diagnostic procedure for suspicious mammographic lesions. This study was conducted to determine the accuracy of the Intact(®) breast lesion excision system (BLES) and to identify predictive factors for complete excision and underestimation. MATERIAL AND METHODS A prospective study was conducted between January 28, 2008 and April 30, 2009 on 166 biopsy procedures using Intact(®) biopsy device. Diagnoses obtained from biopsy specimen were compared with to final diagnosis on surgical excision specimen. RESULTS Of the 166 patients, 15 (9%) displayed lesions with cell atypia, 28 (17%) had an intra ductal carcinoma (IDC) and 9 (5%) had an invasive carcinoma. Eight of 15 patients with cell atypia had open surgical excision, and none showed underestimation. All patients with IDC underwent surgical excision: we found an invasive carcinoma in 6 cases (21.4% underestimation) and a complete removal of the lesion by the Intact(®) BLES in 11 cases (39%). All 9 patients with invasive carcinoma had a surgical excision, with 1 complete removal of the lesion by Intact(®) BLES. Multivariate analyses did not identify predictive factors for underestimation; clear margins ≥1mm on biopsy specimen was the only independent predictive factor of complete excision (OR=8.51, p=0.02). CONCLUSIONS Intact(®) BLES provides a safe alternative to vacuum assisted core needle biopsy (VACNB) with an underestimation rate comparable to those previously reported for VACNB. The high rate of complete removal of the lesions, particularly ISC, offers an interesting perspective of avoiding subsequent excisional surgery for small lesions and thus requires further confirmational study.
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Allen SD, Nerurkar A, Della Rovere GUQ. The breast lesion excision system (BLES): a novel technique in the diagnostic and therapeutic management of small indeterminate breast lesions? Eur Radiol 2011; 21:919-24. [PMID: 21240608 DOI: 10.1007/s00330-010-2000-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 09/29/2010] [Accepted: 10/08/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate whether the breast lesion excision system (BLES) could render formal surgery unnecessary in patients with small indeterminate breast lesions. METHODS Following review board ethical permission and the consent of each patient, we aimed to perform a complete excision biopsy, with a margin, of small indeterminate breast lesions that measure less than 1 cm. 76 patients with small BIRADS type 3 breast lesions underwent a BLES biopsy. Mean radiological lesion size was 7.1 mm (range 2-10 mm). RESULTS 61 lesions had a final benign diagnosis, 6 of which underwent subsequent surgery although only 1 showing residual lesion. 15 lesions were malignant but with residual tumour at re-excision present in only 5 cases. CONCLUSION The BLES biopsy is an efficacious technique at excising small indeterminate breast lesions with a complete margin without the need for follow-up diagnostic surgery in the majority.
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Affiliation(s)
- Steven D Allen
- Department of Radiology, The Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK.
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Image-guided breast biopsy: state-of-the-art. Clin Radiol 2010; 65:259-70. [PMID: 20338392 DOI: 10.1016/j.crad.2010.01.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Revised: 12/20/2009] [Accepted: 01/04/2010] [Indexed: 11/16/2022]
Abstract
Percutaneous image-guided breast biopsy is widely practised to evaluate predominantly non-palpable breast lesions. There has been steady development in percutaneous biopsy techniques. Fine-needle aspiration cytology was the original method of sampling, followed in the early 1990s by large core needle biopsy. The accuracy of both has been improved by ultrasound and stereotactic guidance. Larger bore vacuum-assisted biopsy devices became available in the late 1990s and are now commonplace in most breast units. We review the different types of breast biopsy devices currently available together with various localization techniques used, focusing on their advantages, limitations and current controversial clinical management issues.
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Comparison of large-core vacuum-assisted breast biopsy and excision systems. Recent Results Cancer Res 2010; 173:23-41. [PMID: 19763447 DOI: 10.1007/978-3-540-31611-4_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Lui CY, Lam HS. Review of Ultrasound-guided Vacuum-assisted Breast Biopsy: Techniques and Applications. J Med Ultrasound 2010. [DOI: 10.1016/s0929-6441(10)60001-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Dowlatshahi K, Wadhwani S, Alvarado R, Valadez C, Dieschbourg J. Interstitial Laser Therapy of Breast Fibroadenomas With 6 and 8 Year Follow-Up. Breast J 2010; 16:73-6. [DOI: 10.1111/j.1524-4741.2009.00830.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Taourel P, Hoa D, Chaveron C, Balu-Maestro C, Gros D, Baranzelli MC, Ettore F, Bretz-Grenier MF, Roger P. Stereotactic vacuum biopsy of calcifications with a handheld portable biopsy system: a validation study. Eur Radiol 2008; 18:1319-25. [PMID: 18351352 DOI: 10.1007/s00330-008-0897-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 01/29/2008] [Accepted: 02/04/2008] [Indexed: 11/30/2022]
Abstract
To prospectively evaluate a compact portable 10-gauge handheld battery-operated biopsy system for stereotactic biopsy of microcalcifications. The ethics committee of the hospital approved this prospective multicentric study, and informed consent was obtained. Biopsy under stereotactic guidance was performed in 215 patients for 219 lesions consisting of microcalcifications without mass. The feasibility and the tolerance of the procedure were evaluated. The mean weight of the specimen was calculated. In patients with surgical diagnoses, the underestimation rate in biopsy diagnoses of atypical ductal hyperplasia and ductal carcinoma in situ were evaluated. The sampled specimens were separated according to the presence of calcifications on magnified specimen radiographs and to the probe the rotation number in order to evaluate the contribution of each rotation and the contribution of the specimen with and without calcifications on the radiographs. The macrobiopsy was feasible in 98.5% of the patients and was well tolerated in 82% of patients. It identified 4.6% invasive carcinomas, 18.5% ductal carcinomas in situ, 14.8% atypical ductal hyperplasias, 22.2% benign proliferative mastopathies and 39.8% benign non-proliferative mastopathies. The underestimation rate was 26.6% when an atypical ductal hyperplasia was diagnosed at biopsy, and 7.7% when a ductal carcinoma in situ was diagnosed. In the 77 patients with surgical correlation, the accurate diagnosis was obtained in specimens sampled during the first, second, and third in 69%, 9%, and 4% of the biopsies, respectively, and the analysis of specimens without microcalcification had an added value in 8% of patients. The compact portable battery-operated biopsy system can be used successfully for stereotactic biopsy of microcalcifications and constitutes a valid alternative to current systems.
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Affiliation(s)
- P Taourel
- Department of Radiology, CHU Montpellier, Montpellier, France.
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Bassett LW, Mahoney MC, Apple SK. Interventional breast imaging: current procedures and assessing for concordance with pathology. Radiol Clin North Am 2007; 45:881-94, vii. [PMID: 17888775 DOI: 10.1016/j.rcl.2007.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Minimally invasive breast biopsy procedures performed for suspicious imaging findings have expanded the role of breast imaging in the management of breast diseases. The first portion of this article reviews the current procedures for performing a core-needle biopsy under stereotactic, ultrasound, and MR imaging guidance. The second portion of the article addresses the management of the patient after the biopsy, including assessment for concordance of radiology and pathology findings and potential underestimation of disease.
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Affiliation(s)
- Lawrence W Bassett
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, 200 UCLA Medical Plaza, Room 165-47, Box 956952, Los Angeles, CA 90095, USA.
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Philpotts LE. Percutaneous Breast Biopsy: Emerging Techniques and Continuing Controversies. Semin Roentgenol 2007; 42:218-27. [DOI: 10.1053/j.ro.2007.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Peter D, Grünhagen J, Wenke R, Schäfer FKW, Schreer I. False-negative results after stereotactically guided vacuum biopsy. Eur Radiol 2007; 18:177-82. [PMID: 17637996 DOI: 10.1007/s00330-007-0707-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 05/04/2007] [Accepted: 06/04/2007] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to determine the false negative rate of stereotactically guided vacuum biopsy (VB). Data of patients with benign lesions in VB were evaluated retrospectively during a median follow-up period of 21 months. A total of 404 VB were considered benign and representative and were recommended for follow-up. Of these 404 lesions, 195 were completely removed radiologically. Follow-up data were available for 354/404 patients (87.6%), with intervals ranging from 3 to 66 months (median 21, mean 22.4). Reintervention or surgery was necessary in 13/354 (3.7%) cases. Of these cases, 5/354 (1.4%) turned out to be false negatives. Four of these cases showed large areas of microcalcifications or several clusters, and only partial removal was possible due to the size of the lesions. Although VB is an accurate procedure for diagnosing nonpalpable breast lesions with a low cancer miss rate, we consider the exclusion of malignancy in cases of disseminated microcalcifications or several clusters as a limitation. The radiologic-pathologic correlation in these cases is a challenge, particularly in terms of the residuals. Strict follow-up of benign lesions is essential to avoid delayed cancer diagnosis.
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Affiliation(s)
- D Peter
- Breast Center, Department of Radiology, University Schleswig-Holstein, Campus Kiel, Michaelisstr. 16, 24105 Kiel, Germany.
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Barranger E, Morel O, Coutant C, Delpech Y, Uzan S. [Surgical management of breast microclacifications]. ACTA ACUST UNITED AC 2007; 36:468-72. [PMID: 17555888 DOI: 10.1016/j.jgyn.2007.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 04/04/2007] [Accepted: 04/23/2007] [Indexed: 10/28/2022]
Abstract
The breast infraclinic lesions, as microcalcifications, are images found very often within the framework of the tracking of the breast cancer. The majority of them correspond to benign lesions. The therapeutic strategy of these microcalcifications depends on the evaluation of the degree of suspicion of the image which classification BI-RADS makes it possible to make more precise and more reproducible. In certain cases where a histological diagnosis is necessary, the macrobiopsies make it possible to limit the surgery to the only cases where the antomo-pathological analysis impose it. Thus, the percutaneous procedure performed under local anaesthesia give the possibility of avoiding an useless intervention for a benign lesion, or of avoiding, for a malignant lesion, an operational time with aiming diagnoses followed by a therapeutic surgical recovery. The stereotaxic percutaneous procedures, by confirming a invasive malignant lesion, also follow to perform sentinel lymph node biopsy, or to program an axillary dissection. It also can in the event of large infraclinic lesion, confirmed by two macrobiopsies spaced of more than 3 cm, to perform a mastectomy associated to immediate breast surgical reconstruction.
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Affiliation(s)
- E Barranger
- Service de gynécologie-obstétrique, APHP, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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