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Kellow ZS, Alikhassi A, Bane A, Bissell MB, Cordeiro E, Dhamanaskar K, Jessup J, Kirwan RC, Ko G, Kos Z, Kulkarni A, Lambert CC, Martin T, McKevitt E, Solorzano S, Zahra S, Ward C. Canadian Recommendations on Optimal Breast Biopsy Practices Developed Using a Modified Delphi Panel. Can Assoc Radiol J 2025:8465371251325500. [PMID: 40167651 DOI: 10.1177/08465371251325500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025] Open
Abstract
There are few recommendations in Canada to assist clinicians in selecting appropriate biopsy techniques (fine-needle aspiration, core-needle biopsy, vacuum-assisted biopsy, vacuum-assisted excision) and imaging technologies (mammography, ultrasound, magnetic resonance imaging, contrast-enhanced mammography) for biopsy guidance. Limited existing recommendations from other countries do not consider the unique aspects of the Canadian healthcare system. To address this gap, 17 experts participated in a modified Delphi panel to reach consensus on biopsy-related topics and provide recommendations. The panel was comprised of 12 radiologists, 2 pathologists, and 3 surgeons from 6 provinces across Canada. Panelists engaged in two rounds of anonymized voting, with an in-person discussion held between the rounds. The modified Delphi panel adhered to best practices, including establishing consensus definitions prior to voting, utilizing anonymized voting, and abstaining from communication among panelists before the in-person meeting. A rigorous statistical approach was utilized to analyze the points of agreement and disagreement. Consensus findings covered a wide range of topics, including recommendations for initial biopsy technique based on lesion type and imaging modality, patient management or rebiopsy considerations after the initial biopsy, procedural recommendations (i.e., gauge size, number of samples), patient considerations (i.e., drug allergies, pregnancy). Overall, 347 individual items were included in the final analysis, 286 (82%) of which achieved consensus. These consensus recommendations intend to offer general recommendations to help standardize and improve practices across Canada and were endorsed by the Canadian Society of Breast Imaging. However, they should be evaluated in the context of each individual case and emerging evidence.
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Affiliation(s)
- Zina S Kellow
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Afsaneh Alikhassi
- Medical Imaging Department, Breast Imaging Division, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Anita Bane
- Department of Laboratory Medicine & Pathobiology, Toronto General Hospital, Toronto, ON, Canada
| | - Mary Beth Bissell
- Department of Radiology Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Kavita Dhamanaskar
- Princess Margaret Cancer Centre, Joint Department of Medical Imaging, University of Toronto Faculty of Medicine, Toronto, ON, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Jenny Jessup
- Department of Radiology, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Ryan Conor Kirwan
- Radiology Associates Inc, Lethbridge, AB, Canada
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Gary Ko
- Sinai Health System, Mount Sinai Hospital, General Surgery, Toronto, ON, Canada
| | - Zuzana Kos
- Department of Pathology, British Columbia Cancer Agency, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ameya Kulkarni
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | | | - Tetyana Martin
- Breast Imaging, BC Cancer - Vancouver, Vancouver, BC, Canada
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada
| | - Elaine McKevitt
- Mount Saint Joseph Hospital, Providence Breast Centre, Vancouver, BC, Canada
- Department of Surgery, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Silma Solorzano
- Department of Radiology, McGill University Health Centre, Montreal, QC, Canada
| | - Saly Zahra
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
- Moncton Hospital, Montreal, QC, Canada
| | - Caitlin Ward
- Huron Perth Healthcare Alliance, Stratford, ON, Canada
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Aziminezhadan P, Pouramini A, Ghassemof H, Hosseinzadeh F, Hosseinzadeh F, Seyedipour S, Abbasi D, Sheikhbahaei E. Ultrasound-guided seven-gauge vacuum-assisted excision for benign breast lesions: A single expert surgeon experience. ULTRASOUND (LEEDS, ENGLAND) 2025:1742271X241305025. [PMID: 40028632 PMCID: PMC11871581 DOI: 10.1177/1742271x241305025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 11/10/2024] [Indexed: 03/05/2025]
Abstract
Background A large percentage of women fear benign breast lesion surgery, and it is a burden to the healthcare system. Ultrasound-guided vacuum-assisted excision (VAE) is as effective as surgery but does not require general anaesthesia, leaves no scars, and improves patient satisfaction. Methods A retrospective analysis of a prospective cohort research carried out on recorded data of a single breast surgeon. VAE was performed on 611 patients with ACR BIRADS 3 or 4a lesions utilising EnCor Enspire equipment and a 7G probe. The average follow-up time was 30.25 ± 9.12 months. Results A total of 772 VAEs were performed on lesions with an average diameter of 18.81 ± 8.63 mm. Pathology results revealed fibroadenoma in 70.85% of cases and papilloma in 19.43%. The overall removal rate was 99.2%, and the upgrade rate was <1%. Fibroadenoma was significantly more common in younger people, had a larger width, and was located farther away from the nipple than papilloma. Individuals with a lesion size of 13.5 mm or less and an age of 36.5 years or older were more likely to have papilloma than fibroadenoma. The reported issues consisted of temporary localised discomfort and haematoma. There were no serious complications, no hospitalisation or operation as a result of a complication, and no infection or antibiotic use was reported. Conclusion VAE is a safe and effective alternative to open surgery for those with benign breast lesions. VAE can be utilised for both diagnostic and therapeutic purposes, making it a more cost-effective choice while also increasing patient satisfaction.
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Affiliation(s)
| | - Alireza Pouramini
- Kerman Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | | | - Sina Seyedipour
- Department of Surgery, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Danial Abbasi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Yeow YJ, Yu CC, Cheung YC, Chen SC. A cohort study of mammography-guided vacuum-assisted breast biopsy in patients with compressed thin breasts (≦ 3 cm). Asian J Surg 2023; 46:4296-4301. [PMID: 37150735 DOI: 10.1016/j.asjsur.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVES In the women with compressed thin thickness (≦ 3 cm), mammographic guiding vacuum-assist breast biopsy (MG-VABB) is a technical challenge. We herein report their performance of MG-VABB on suspicious microcalcification by modern mammography. METHODS We retrospectively reviewed the consecutive MG-VABB in our hospital from February 2019 to January 2021. All the patients received biopsy because of suspicious microcalcifications discovered by mammography and had at least one-year post-biopsy follow-up. RESULTS We reviewed 745 consecutive patients revealing 195 with compressed thin breasts ≦ 3 cm (mean age: 50.12 ± 7.0; breast thickness: 24.99 mm range 11.6-30 mm). Of the 191 patients received biopsy, the microcalcification retrieval rate was 97.9%. Using the half-open notch biopsy or horizontal needle approach, the biopsies were technically achieved in 30.4% and 9.4% of patients respectively. Regarding to the gold standard of surgicohistology, the cancer sensitivities was 88.46% and the atypia upgrade rate was 16.67%. There was no statistical difference of the procedure time between stereotactic guided and tomosynthesis guided. CONCLUSIONS The modern MG-VABB has technically improve the performance of biopsy to the patients with compressed thin breasts (≦ 3 cm), revealing approximate results to those breasts > 3 cm. The diagnosis helps the management of suspicious microcalcifications discovered by mammography.
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Affiliation(s)
- Yun-Jen Yeow
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Yun-Chung Cheung
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan, Taoyuan, Taiwan; Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan.
| | - Shin-Cheh Chen
- Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Taiwan
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Björnström M, Niinikoski L, Arlan K, Meretoja TJ, Ståhls A, Hukkinen K. Vacuum-assisted excision of small breast cancers under ultrasound guidance. Eur J Radiol 2023; 167:111049. [PMID: 37611442 DOI: 10.1016/j.ejrad.2023.111049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The purpose of this study was to evaluate if it is possible to completely remove small breast cancer tumours with vacuum-assisted excision (VAE) under ultrasound guidance. METHODS Women ≥ 50 years old with a biopsy proven invasive cancer ≤ 10 mm were selected between October 2021 and November 2021 based on referrals and enrolled in this prospective study. The patients underwent VAE within six weeks following biopsy to remove the tumour. After the tumour was excised and the biopsy cavities margins were shaved, a radioactive seed was inserted into the biopsy cavity. The VAE excision cavity and surrounding tissue were surgically excised. Preliminary VAE results were evaluated after ten patients. For the study to proceed at least 80 % of the breast cancer tumours had to be completely removed by VAE. RESULTS The tumours median size in mammography was 8.5 mm (6-9 mm) and in ultrasound 6.5 mm (4-9 mm). The shape of the lesion was round in three (30 %), oval in two (20 %) and irregular in five (50 %) patients. None of the tumours were completely removed in the first VAE specimen, meaning that there was invasive cancer or ductal carcinoma in situ (DCIS) in the "shaved margins" and/or the surgical specimen. In five (50 %) cases, the surgical specimen was free of invasive cancer and DCIS. CONCLUSIONS None of the small invasive breast cancers were completely excised with VAE under ultrasound guidance, therefore it is not a reliable method to remove small breast cancers.
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Affiliation(s)
- Michaela Björnström
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Laura Niinikoski
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Kirill Arlan
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Tuomo J Meretoja
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Anders Ståhls
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Katja Hukkinen
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
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Tu S, Yin Y, Yuan C, Chen H. Management of Intraductal Papilloma of the Breast Diagnosed on Core Needle Biopsy: Latest Controversies. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:190-203. [PMID: 37197642 PMCID: PMC10110831 DOI: 10.1007/s43657-022-00085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 05/19/2023]
Abstract
Intraductal papillomas (IDPs), including central papilloma and peripheral papilloma, are common in the female population. Due to the lack of specific clinical manifestations of IDPs, it is easy to misdiagnose or miss diagnose. The difficulty of differential diagnosis using imaging techniques also contributes to these conditions. Histopathology is the gold standard for the diagnosis of IDPs while the possibility of under sample exists in the percutaneous biopsy. There have been some debates about how to treat asymptomatic IDPs without atypia diagnosed on core needle biopsy (CNB), especially when the upgrade rate to carcinoma is considered. This article concludes that further surgery is recommended for IDPs without atypia diagnosed on CNB who have high-risk factors, while appropriate imaging follow-up may be suitable for those without risk factors.
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Affiliation(s)
- Siyuan Tu
- Department of Breast Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200030 China
| | - Yulian Yin
- Department of Breast Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200030 China
| | - Chunchun Yuan
- Spine Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200030 China
| | - Hongfeng Chen
- Department of Breast Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200030 China
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Andrade AVD, Lucena CÊMD, Santos DCD, Pessoa EC, Mansani FP, Andrade FEMD, Tosello GT, Pasqualette HAP, Couto HL, Francisco JLE, Costa RP, Teixeira SRC, Moraes TP, Filho ALDS. Accurate diagnosis of breast lesions. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:215-220. [PMID: 37224844 PMCID: PMC10208726 DOI: 10.1055/s-0043-1769468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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He P, Lei YT, Chen W, Shen WW, Fu P, Zhao HM, Cui LG. Ultrasound-Guided Vacuum-Assisted Excision to Treat Intraductal Papilloma. World J Surg 2023; 47:699-706. [PMID: 36624311 DOI: 10.1007/s00268-022-06735-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND To evaluate the value of ultrasound-guided vacuum-assisted excision (US-guided VAE) in the treatment of intraductal papillomas, including intraductal papillomas with atypical ductal hyperplasia (ADH), and to evaluate the lesion characteristic features affecting the local recurrence rate. MATERIALS AND METHODS Between August 2011 and December 2020, 91 lesions of 91 patients underwent US-guided VAE and were diagnosed with intraductal papilloma with or without ADH. The recurrence rate of intraductal papilloma was evaluated on follow-up US. The lesion characteristic features were analyzed to identify the factors affecting the local recurrence rate. RESULTS The local recurrence rate of intraductal papillomas removed by US-guided VAE was 7.7% (7/91), with the follow-up duration 12-92 months (37.4 ± 23.9 months). Of the 91 patients, five cases diagnosed as intraductal papilloma with ADH did not recur, with the follow-up time 12-47 months (26.4 ± 14.4 months). There were no malignant transformation in all 91 cases during the follow-up period. All 7 patients recurred 7-58 months (22.8 ± 19.2 months) after US-guided VAE. There were no significant differences between the non-recurrence and recurrence groups in terms of age, side, distance from nipple, lesion size, BI-RADS category, with ADH, or history of excision (p > 0.05). CONCLUSIONS US-guided VAE is an effective method for the treatment of intraductal papilloma, including intraductal papilloma with ADH. It avoids invasive surgical excision, but regular follow-up is recommended to prevent recurrence or new onset due to multifocality. Any suspicious lesions during the follow-up should be actively treated.
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Affiliation(s)
- Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Yu-Tao Lei
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Wei-Wei Shen
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Peng Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Hong-Mei Zhao
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China.
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He P, Lei YT, Zhao HM, Chen W, Shen WW, Fu P, Cui LG. High-Risk Breast Lesions Diagnosed by Ultrasound-Guided Vacuum-Assisted Excision. World J Surg 2023; 47:1247-1252. [PMID: 36752860 DOI: 10.1007/s00268-023-06930-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The aim of this study was to analyze the role of ultrasound-guided vacuum-assisted excision (US-guided VAE) in the treatment of high-risk breast lesions and to evaluate the clinical and US features of the patients associated with recurrence or development of malignancy. MATERIALS AND METHODS Between April 2010 and September 2021, 73 lesions of 73 patients underwent US-guided VAE and were diagnosed with high-risk breast lesions. The incidence of recurrence or development of malignancy for high-risk breast lesions was evaluated at follow-up period. The clinical and US features of the patients were analyzed to identify the factors affecting the recurrence or development of malignancy rate. RESULTS Only benign phyllodes tumors on US-guided VAE showed recurrences, while other high-risk breast lesions that were atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ), radial scar, and flat epithelial atypia did not show recurrences or malignant transformation. The recurrence rate of the benign phyllodes tumor was 20.8% (5/24) in a mean follow-up period of 34.3 months. The recurrence rate of benign phyllodes tumor with distance from nipple of less than 1 cm was significantly higher than that of lesions with distance from nipple of more than 1 cm (75% vs. 10%, p < 0.05). CONCLUSIONS Benign phyllodes tumors without concurrent breast cancer could be safely followed up instead of surgical excision after US-guided VAE when the lesions were classified as BI-RADS 3 or 4A by US.
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Affiliation(s)
- Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Yu-Tao Lei
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Hong-Mei Zhao
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Wei-Wei Shen
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Peng Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China.
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Nishimura R, Oiwa M. Combined Use of Cell Block and Smear Improves the Cytological Diagnosis of Malignancy in Non-Palpable Breast Lesions Screened by Imaging. Anal Cell Pathol (Amst) 2023; 2023:1869858. [PMID: 37181945 PMCID: PMC10171971 DOI: 10.1155/2023/1869858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/17/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Background Currently, core needle biopsy is replacing fine needle aspiration biopsy (FNAB) for pathological diagnosis of breast lesions. However, FNAB is extensively used for diagnosing breast lesions, including screened lesions, at our hospital. Furthermore, direct smears as well as cell blocks (CBs) from the FNAB specimens have been used. To prepare the CBs, hematoxylin and eosin (HE) staining as well as immunostaining with a mixture of p63 and cytokeratin 5/6 antibodies are routinely used. Therefore, in the current study, we sought to assess the efficacy of diagnosing breast lesions using conventional smears and CB immunostaining. Methods Breast FNAB reports of direct smears and CBs from The Nagoya Medical Center between December 2014 and March 2020, were reviewed. The efficiency of diagnoses made with direct smears and CBs were compared using histology-based diagnoses. Results Among the 169 histologically confirmed malignant lesions, 12 lesions that were reported as unsatisfactory, benign, or atypia probably benign, using direct smears were diagnosed as malignant using CB. Histologically, these lesions were diagnosed as carcinomas with mild atypia or papillary structures. Ten (83.3%) of the twelve lesions were non-palpable and only detected upon imaging. Conclusion Combined use of CB and conventional smear leads to the detection of more malignant lesions in breast FNAB specimens, particularly in lesions detected by imaging alone. Immunostaining of CB sections using a mixture of p63 and cytokeratin 5/6 antibodies provides more information than HE staining alone. Breast FNAB with CB preparation can be successfully applied for evaluation of breast lesions in developed countries.
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Affiliation(s)
- Rieko Nishimura
- Department of Pathology, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Mikinao Oiwa
- Department of Radiology, Nagoya Medical Center, Nagoya, Aichi, Japan
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Garlaschi A, Valente I, Brunetti N, De Giorgis S, Massa B, Calabrese M, Tagliafico AS. Is 9-G DBT-Guided Vacuum-Assisted Breast Biopsy Sufficient to Completely Remove T1 Breast Cancers (below 20 mm)? Analysis of 146 Patients with Histology as Reference Standard. Breast Care (Basel) 2022; 17:443-449. [PMID: 36684401 PMCID: PMC9851065 DOI: 10.1159/000523909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/14/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Vacuum-assisted breast biopsy (VABB) is a safe procedure comparable to surgical biopsy for the characterization of distortions, microcalcifications, and mass lesions. Vacuum-assisted excision of T1 breast tumors could be on potential management in alternative to surgery. The primary objective of this work was to assess the therapeutic success of the stereotaxic vacuum breast biopsy in small breast cancer (T1N0M0) lesions excision. METHODS From our electronic database, all the vacuum breast biopsies performed from January 1, 2015, to December 1, 2019, have been retrospectively reevaluated. N = 2,200 cases were identified and n = 145 ensured "mammographic complete removal" at the end of vacuum-assisted excision treatment and were considered for analysis. Surgical gold standard was used. RESULTS N = 143 procedures were successfully completed with complete removal of mammographic calcifications. The mean size of the lesions completely excised with VABB was 8.9 ± 3.6 mm (range, 3-23 mm). Lesions below 10 mm were n = 118 and lesion with diameter >10 mm were n = 28. N = 3/146 cases (4.4%), relapses were observed in follow-up (at 12-24 up to a maximum of 60 months): the mean size of relapsed lesions completely excised was 3.6 ± 2.1 mm (range, 2-6 mm). No relapse before 12 months were observed. The mean size of the lesions in these patients with relapse at the time of the first VABB procedures was 13 ± 6.5 mm (range, 7-12 mm). N = 117/118 (99%) lesions excised using VABB without relapse after 1 year of follow-up had a diameter below 10 mm. CONCLUSIONS Vacuum breast biopsy could safely remove small breast cancers (T1N0M0) with few relapses.
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Affiliation(s)
| | | | - Nicole Brunetti
- cDepartment of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Sara De Giorgis
- cDepartment of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Barbara Massa
- aIRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Alberto Stefano Tagliafico
- aIRCCS Ospedale Policlinico San Martino, Genoa, Italy
- cDepartment of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Niaz M, Khan AA, Ahmed S, Rafi R, Salim H, Khalid K, Kazi F, Anjum A, Waheed Y. Risk of Malignancy in Breast FNAB Categories, Classified According to the Newly Proposed International Academy of Cytology (IAC) Yokohama System. Cancer Manag Res 2022; 14:1693-1701. [PMID: 35573260 PMCID: PMC9093610 DOI: 10.2147/cmar.s362155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A new category system comprising five classes (C1-insufficient material, C2-benign, C3-atypical, C4-suspicious, and C5-malignant) has been proposed by the International Academy of Cytology (IAC) for fine needle aspiration biopsy cytology (FNAB) for proper diagnosis of breast cancer. AIMS AND OBJECTIVES This study is designed to categorize institutional FNAB data according to the new system and calculation of the absolute risk of malignancy (ROM), sensitivity, specificity, positive predictive values, false negative and false-positive rate. STUDY DESIGN We conducted a retrospective cross-sectional study involving 2133 cases collected between June, 2008 and August, 2019, at Foundation University Medical College's Department of Histopathology and the Surgery and Oncology Department at the Fauji Foundation Hospital. All cases fulfilling the inclusion and exclusion criteria were retrieved from the archives and reviewed by two expert pathologists. Matching histopathology was compared with the cytology reports for concordance or discordance of results. FINDINGS We found 6.9% (n = 147) insufficient, 65.8% (n = 1403) benign, 7.2% (n = 153) atypical, 7.5% (n = 160) suspicious and 12.6% (n = 270) malignant cases. Cyto-histological correlation was found in 421 cases from the year 2014 to 2019 with 370 concordant and 51 discordant cases. The maximum number of concordant cases was 151 in the C5 category and discordant cases had a diagnosis of C3 and C4 on cytology with 16 cases in each category. The calculated values of ROM were 45.45%, 10.3%, 30.6%, 82.79% and 99.34% from C1 to C5, respectively. We calculated 83.42% absolute sensitivity and 85.24% specificity. The positive predictive value for category 3, 4 and 5 was 67.34%, 82.7% and 99.34%, respectively, while false-negative rate was 7.9% and false-positive rate was 0.66%. CONCLUSION The ROM for C1 category calculated from this study is quite high (45.45%) compared to previous studies; therefore, it is recommended to perform core needle biopsy in all these cases. The higher sensitivity and specificity of this method of diagnosing malignant lesions supports its use.
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Affiliation(s)
- Mahwish Niaz
- Department of Pathology, Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
- Department of Pathology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Azmat Ali Khan
- Pharmaceutical Biotechnology Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Safina Ahmed
- Department of Pathology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Rabia Rafi
- Department of Pathology, Isfand Bukhari District Hospital, Attock, Pakistan
| | - Hassan Salim
- Department of Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Kashaf Khalid
- Clinical and Biomedical Research Center, Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
| | - Faiza Kazi
- Department of Pathology, Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
- Department of Pathology, PAEC Hospital, Islamabad, Pakistan
| | | | - Yasir Waheed
- Clinical and Biomedical Research Center, Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
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Tahoun LA, Maraqa B. Ultrasound-guided vacuum-assisted breast biopsy in the diagnosis of cancer recurrence at the surgical scar: a report of three cases. J Ultrason 2022; 22:e57-e63. [PMID: 35449697 PMCID: PMC9009348 DOI: 10.15557/jou.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/17/2021] [Indexed: 12/05/2022] Open
Abstract
Aim of the study Ultrasound-guided vacuum-assisted biopsy is being increasingly used in the diagnosis of breast lesions. The advantages of vacuum-assisted biopsy over core needle biopsy include large sample and higher diagnostic accuracy. Indications for ultrasound-guided vacuum-assisted biopsy include suspicious calcifications visible on ultrasound, architectural distortion, and very subtle or insinuating lesions. Case description We present three patients treated for breast cancer with breast-conserving surgery who developed suspicious findings on mammogram and MRI at or near the surgical scar. The findings were subtle, small, or atypical lesions on ultrasound. Ultrasound-guided vacuum-assisted biopsy was performed, and recurrence was diagnosed. The technique was advantageous due to real-time imaging, ability to control the path of the needle, obtaining multiple cores with a single skin puncture and single pass, supine position, no radiation, and no IV contrast. Conclusions Ultrasound-guided vacuum-assisted biopsy should be considered in cases involving multiple suspicious findings at or near the surgical scar, with subtle or atypical sonographic correlates. Vacuum-assisted biopsy is indicated; yet ultrasound guidance is more comfortable, no radiation and no contrast.
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Affiliation(s)
- Laila Abu Tahoun
- Department of Diagnostic Radiology - Breast Imaging Unit, King Hussein Cancer Center, Jordan
| | - Bayan Maraqa
- Department of Laboratory Medicine and Pathology, King Hussein Cancer Center, Jordan
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14
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Kim BK, Ahn SG, Oh SJ, Kim H, Kang E, Jung Y, Do Byun K, Lee J, Sun WY. Survival Outcomes of Patients With Breast Cancer Diagnosed Using Vacuum-Assisted Biopsy: A Nationwide Study From the Korean Breast Cancer Society. J Breast Cancer 2022; 25:13-24. [PMID: 35133091 PMCID: PMC8876540 DOI: 10.4048/jbc.2022.25.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/09/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Breast cancer is mainly diagnosed using core needle biopsy (CNB), although other biopsy methods, including vacuum-assisted biopsy (VAB), may also be used. We compared differences in clinical characteristics and prognoses of patients with breast cancer according to biopsy methods used for diagnosis. METHODS A total of 98,457 patients who underwent various biopsy methods (CNB, fine-needle aspiration [FNA], VAB, and excisional biopsy) for diagnosing breast cancer were recruited. Using CNB as a reference, related clinicopathological factors and prognostic differences between biopsy methods were analyzed retrospectively using large-scale data from the Korean Breast Cancer Society Registration System. The associations between biopsy methods and clinicopathological factors were compared using multinomial logistic regression analysis, and the prognoses of patients undergoing the different biopsy methods, as breast cancer-specific survival (BCSS) and overall survival (OS), were compared using the Kaplan-Meier method and Cox proportional hazard model. RESULTS Univariate and multivariate analyses showed that unlike FNA, both VAB and excisional biopsy were significantly associated with tumor size, palpability, tumor stage, and histologic grade as relatively good prognostic factors compared to CNB. In particular, VAB showed lower odds ratios for these factors than excisional biopsy. In the univariate analysis, the prognosis of patients undergoing VAB was better than that of those undergoing CNB with respect to BCSS (hazard ratio [HR], 0.188, p < 0.001) and OS (HR, 0.359; p < 0.001). However, in the multivariate analysis, there were no significant prognostic differences from CNB in both BCSS and OS; differences were only evident for FNA. CONCLUSION In this study, we showed that the characteristics of breast cancer differed according to various biopsy methods. Although VAB is not a standard method for breast cancer diagnosis, it showed no prognostic differences to CNB.
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Affiliation(s)
- Bong Kyun Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Jeong Oh
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hakyoung Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yongsik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Do Byun
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Jina Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Young Sun
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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15
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Ultrasound-guided interventional procedures in breast imaging. RADIOLOGIA 2022; 64:76-88. [DOI: 10.1016/j.rxeng.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
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Björnström M, Niinikoski L, Meretoja TJ, Leidenius MHK, Hukkinen K. Comparison of vacuum-assisted excision (VAE) and breast lesion excision system (BLES) in the treatment of intraductal papillomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:67-72. [PMID: 34728140 DOI: 10.1016/j.ejso.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aims to compare the feasibility of VAE and BLES in the treatment of intraductal papillomas. MATERIAL AND METHODS Patients with a suspected intraductal papilloma who underwent a BLES or a VAE procedure were included in this retrospective study. The BLES procedures were performed between November 2011 and June 2016 and the VAE procedures between May 2018 and September 2020 at the Department of Radiology of Helsinki University Hospital (HUH). The procedures were performed with an intent of complete removal of the lesions. RESULTS In total, 72 patients underwent 78 BLES procedures and 95 patients underwent 99 VAE procedures. Altogether 52 (60%) papillomas with or without atypia were completely removed with VAE, whereas 24 (46%) were completely removed with BLES, p = 0.115. The median radiological size of the high-risk lesions completely removed with BLES was 6 mm (4-12 mm), whereas with VAE it was 8 mm (3-22 mm), p = 0.016. Surgery was omitted in 90 (94.7%) non-malignant breast lesions treated with VAE and in 66 (90.4%) treated with BLES, p = 0.368. CONCLUSION Both VAE and BLES were feasible in the treatment of intraductal papillomas. In most non-malignant lesions surgery was avoided, but VAE was feasible in larger lesions than BLES. However, follow-up ultrasound was needed more often after VAE. The histopathologic assessment is more reliable after BLES, as the lesion is removed as a single sample.
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Affiliation(s)
- Michaela Björnström
- Radiology, HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 140, 00029, HUS, Finland.
| | - Laura Niinikoski
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 281, 00029, HUS, Finland.
| | - Tuomo J Meretoja
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 281, 00029, HUS, Finland.
| | - Marjut H K Leidenius
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 281, 00029, HUS, Finland.
| | - Katja Hukkinen
- Radiology, HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 140, 00029, HUS, Finland.
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17
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Oliver Goldaracena J. Intervencionismo ecográfico en imagen mamaria. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Panzironi G, Moffa G, Galati F, Pediconi F. Ultrasound-guided 8-Gauge vacuum-assisted excision for selected B3 breast lesions: a preliminary experience. Radiol Med 2021; 127:57-64. [PMID: 34800217 DOI: 10.1007/s11547-021-01429-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Nowadays, surgical excision is no longer justified for all B3 lesions and a minimally-invasive therapeutic treatment has been encouraged. The aim of this study was to evaluate the feasibility and the therapeutic efficacy of ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of selected breast lesions of uncertain malignant potential (B3). MATERIAL AND METHODS From July 2018 to December 2019, 11/48 breast lesions classified as B3 after ultrasound-guided core needle biopsy were treated with US-VAE in our Institution. Inclusion criteria were: B3 nodules ultrasonographically detectable for which VAE is recommended by international guidelines2, size ranging between 5 and 25 mm, circumscribed margins, and lesion position at least 5 mm from the skin and the nipple. A radiological follow-up to evaluate the completeness of excision, the presence of post-procedural hematoma or of residual disease/recurrence was performed after 10 and 30 days and 6 and 12 months. 12-month ultrasound was considered the gold standard. All patients were asked to complete a satisfaction survey and a full assessment of the costs of US-VAE was performed. RESULTS Complete excision was achieved in 81.8% of US-VAE. No lesions were upgraded to carcinoma and no patients had to undergo surgery. No complications occurred during or after US-VAE. All patients were satisfied with the procedure and the cosmetic result (100%). US-VAE cost approximately 422 Euros per procedure. CONCLUSION US-VAE has proven to be an optimal tool for the therapeutic excision of selected B3 lesions, with high success rate, good patient compliance and considerable money savings compared to surgery. This technique has the potential to reduce unnecessary surgery and healthcare costs.
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Affiliation(s)
- Giovanna Panzironi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza - University of Rome, Rome, Italy
| | - Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences, Sapienza - University of Rome, Rome, Italy.
| | - Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza - University of Rome, Rome, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza - University of Rome, Rome, Italy
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Yoo HS, Kang WS, Pyo JS, Yoon J. Efficacy and Safety of Vacuum-Assisted Excision for Benign Breast Mass Lesion: A Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1260. [PMID: 34833479 PMCID: PMC8621526 DOI: 10.3390/medicina57111260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
Abstract
Background and Objective: Breast mass lesions are common; however, determining the malignant potential of the lesion can be ambiguous. Recently, to evaluate breast mass lesions, vacuum-assisted excision (VAE) biopsy has been widely used for both diagnostic and therapeutic purposes. This study aimed to investigate the therapeutic role of VAE. Materials and Methods: Relevant articles were obtained by searching PubMed and EMBASE on 3 September 2021. Meta-analyses were performed using odds ratios and proportions. To assess heterogeneity, we conducted a subgroup analysis and meta-regression tests. Results: Finally, 26 studies comprising 18,170 patients were included. All of these were observational studies. The meta-analysis showed that the complete resection rate of VAE was 0.930. In the meta-regression test, there was no significant difference. The meta-analysis showed a recurrence rate of 0.039 in the VAE group. The meta-regression test showed no statistical significance. Postoperative hematoma, pain, and ecchymosis after VAE were 0.092, 0.082, and 0.075, respectively. Conclusion: VAE for benign breast lesions showed favorable outcomes with respect to complete resection and complications. This meta-analysis suggested that VAE for low-risk benign breast lesions is a reasonable option for both diagnostic and therapeutic purposes.
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Affiliation(s)
- Hee-Seon Yoo
- Department of Surgery, Mizpia Hospital, Gwangju-si 61963, Gyeonggi-do, Korea;
| | - Wu-Seong Kang
- Department of Trauma Surgery, Cheju Halla General Hospital, Jeju-si 63127, Jeju-do, Korea;
| | - Jung-Soo Pyo
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Dongil-ro, Uijeongbu-si 11759, Gyeonggi-do, Korea
| | - Junghan Yoon
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-eup 58128, Jeollanam-do, Korea
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20
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Bhatt AA, Whaley DH, Lee CU. Ultrasound-Guided Breast Biopsies: Basic and New Techniques. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1427-1443. [PMID: 32997819 PMCID: PMC8246574 DOI: 10.1002/jum.15517] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/18/2020] [Accepted: 09/11/2020] [Indexed: 05/28/2023]
Abstract
Ultrasound-guided breast biopsies can be challenging to perform, especially when the target is adjacent to the nipple, skin, or implant or when the target is small and in very posterior, dense fibroglandular tissue. Oftentimes, a slightly modified approach can result in a diagnostic biopsy specimen with minimal complications. After a brief review of basic techniques for ultrasound-guided breast biopsies that includes a review of conventional breast biopsy devices, a presentation of procedural modifications and techniques to consider for more challenging cases is described. In particular, novel open-trough and tandem-needle techniques are detailed. Several cases using these techniques are then presented.
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Affiliation(s)
- Asha A. Bhatt
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
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21
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Clinical practice guidelines for ultrasound-guided vacuum-assisted breast biopsy: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021. Chin Med J (Engl) 2021; 134:1390-1392. [PMID: 34074845 PMCID: PMC8213308 DOI: 10.1097/cm9.0000000000001508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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22
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Song RF, Jiang YX, Cui JC, Yu XW, Gao Y, Li L, Pei XH. Horizontal Rotary Cutting Technique for Skin Injury Avoidance in Superficial Benign Breast Masses. Int J Gen Med 2021; 14:1379-1387. [PMID: 33907442 PMCID: PMC8064672 DOI: 10.2147/ijgm.s303183] [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: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 12/26/2022] Open
Abstract
Objective This study aims to investigate the feasibility of the horizontal rotary-cut technique in the removal of superficial benign breast tumors with a ≤1.0 cm distance between the upper margin of the tumor and the skin. Patients and Methods A total of 69 patients with superficial benign breast tumors received horizontal rotary-cut surgery between July 2018 and June 2019 (horizontal group). The rotary cutter groove was in the true lateral position of the tumor and the ultrasonic probe was vertical to the rotary cutter groove. The patients were compared with 33 patients who underwent the traditional vertical rotary-cut surgery between July 2017 and June 2018 (traditional group) regarding the aspects of operation time, intraoperative bleeding volume, postoperative skin ecchymosis, skin damage, and tumor residue. The rotary cutter groove was directly below the tumor and the ultrasonic probe was parallel to the rotary cutter groove in the traditional vertical rotary-cut surgery. Results The operation time in the horizontal group was significantly shorter than in the traditional group (7.7 ± 1.1 minutes vs 9.5 ± 1.3 minutes, with t = -7.458 and p = 0.000) and there was significantly less skin damage in the horizontal group than in the traditional group (0 cases vs 3 cases, with p = 0.032). The differences in intraoperative bleeding and postoperative skin ecchymosis between the two groups were not statistically significant (6.0 ± 1.3 mL vs 6.5 ± 1.5 mL, with t = -1.853 and p = 0.067; 4 cases vs 2 cases, with χ 2 = 0.003 and p = 0.958). Ninety-seven patients attended follow-ups for 6-30 (16.5 ± 4.5) months. No residues or recurrences were observed under ultrasound reviews in either group. Conclusion In superficial benign breast tumor removal, the horizontal rotary-cut breast technique can help avoid skin injury, shorten the operation time, and reduce tumor residue more effectively compared with the traditional vertical rotary-cut technique. It has certain popularization and application values.
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Affiliation(s)
- Ren-Feng Song
- Department of General Surgery, The First People's Hospital of Huangzhong District, Xining, 811600, People's Republic of China
| | - Yu-Xia Jiang
- Department of Thyroid and Breast Surgery, The Chinese Medicine Hospital of Shexian, Handan, 056400, People's Republic of China
| | - Jian-Chun Cui
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University (Liaoning Provincial People's Hospital), Shenyang, 110015, People's Republic of China
| | - Xue-Wei Yu
- Department of General Surgery, The First People's Hospital of Huangzhong District, Xining, 811600, People's Republic of China
| | - Yang Gao
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University (Liaoning Provincial People's Hospital), Shenyang, 110015, People's Republic of China
| | - Li Li
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University (Liaoning Provincial People's Hospital), Shenyang, 110015, People's Republic of China
| | - Xiao-Hua Pei
- Department of General Surgery, Xiamen Hospital of Beijing University of Traditional Chinese Medicine, Xiamen, 361001, People's Republic of China
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23
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Bennett I, de Viana D, Law M, Saboo A. Surgeon-Performed Vacuum-Assisted Biopsy of the Breast: Results from a Multicentre Australian Study. World J Surg 2020; 44:819-824. [PMID: 31712841 DOI: 10.1007/s00268-019-05266-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Image-guided interventional techniques such as vacuum-assisted biopsy are being increasingly utilised in the diagnosis and management of breast conditions. The purpose of this study was to report the outcome of a series of vacuum-assisted biopsies and vacuum-assisted excisions performed by specialist breast surgeons in a largely outpatient setting. METHODS An Australian multicentre trial of ultrasound-guided surgeon-performed vacuum-assisted biopsy (VAB) and vacuum-assisted excision (VAE) of breast lesions was conducted involving three surgeons in three participating centres. VAEs were performed for presumed or proven benign breast lesions only. RESULTS A total of 225 surgeon-performed ultrasound-guided vacuum-assisted procedures were undertaken in 197 patients. Of the 225 VAB procedures, 51 (22.7%) were performed as diagnostic cores and 174 (77.3%) were undertaken as core excisions. Of the 174 VAE procedures undertaken with intent of completely excising the lesion, successful excision of the lesion was achieved in 165 of these cases (94.8%), with complete excision being judged by the absence of any lesion seen on ultrasound following the procedure or the absence of the lesion on a subsequent interval ultrasound examination. A total of 199 procedures were performed in the outpatients setting under local anaesthesia, and 26 procedures were performed in an operating theatre setting under neurolept anaesthesia. The average size of lesions was 19.3 mm in the diagnostic core group and 10.6 mm in the core excision group. The average time for either procedure was approximately 14 min. CONCLUSION Specialist breast surgeons familiar with ultrasound can be readily upskilled to perform vacuum-assisted procedures safely and expeditiously. VAE represents a minimally invasive method of breast lesion management and is a technique with which breast surgeons should become adept.
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Affiliation(s)
- Ian Bennett
- Princess Alexandra Hospital, Brisbane, Australia. .,University of Queensland, Brisbane, Australia. .,Silverton Place, Suite 60, Level 5, 101 Wickham Terrace, Brisbane, QLD, 4000, Australia.
| | - Daniel de Viana
- Premion Place, Southport, Australia.,Breastscreen Queensland Gold Coast, Southport, Australia
| | - Michael Law
- Breast and Endocrine Surgery Unit, Eastern Health, Box Hill, VIC, Australia
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24
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Civantos FJ, Vermorken JB, Shah JP, Rinaldo A, Suárez C, Kowalski LP, Rodrigo JP, Olsen K, Strojan P, Mäkitie AA, Takes RP, de Bree R, Corry J, Paleri V, Shaha AR, Hartl DM, Mendenhall W, Piazza C, Hinni M, Robbins KT, Tong NW, Sanabria A, Coca-Pelaz A, Langendijk JA, Hernandez-Prera J, Ferlito A. Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era. Front Oncol 2020; 10:593164. [PMID: 33244460 PMCID: PMC7685177 DOI: 10.3389/fonc.2020.593164] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background Patients with metastases in the lymph nodes of the neck and no obvious primary tumor, neck cancer with unknown primary (NCUP), represent a management challenge. A majority of patients have metastatic squamous cell carcinoma (SCC), although other histologies do occur. Methods We comprehensively reviewed the literature, compared available guidelines, and conferred with an international team of experts. Results Positron emission tomography-computed tomography (PET-CT) and fine needle aspiration (FNA) under ultrasound guidance increase accuracy of diagnosis. Immunohistochemistry (IHC), determination of human papilloma virus (HPV) status, by p16 staining or by in situ hybridization (ISH), and next-generation gene sequencing can guide us regarding probable primary sites and tumor biology. Narrow Band Imaging (NBI) has been introduced for the early detection of subtle mucosal lesions. Direct laryngoscopy (DL) and tonsillectomy have long been procedures used in the search for a primary site. More recently, TransOral Robotic Surgery (TORS) or Transoral LASER Microsurgery (TLM) have been introduced for lingual tonsillectomy. Conclusions New technologies have been developed which can better detect, diagnose, and treat occult primary tumors. Decisions regarding therapy are based on the primary tumor site (if discovered) and N stage. Options include neck dissection with or without postoperative adjuvant therapy, primary irradiation, or combined chemotherapy with irradiation. The preferred treatment of patients whose primary remains unidentified is controversial.
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Affiliation(s)
- Francisco J Civantos
- Department of Otolaryngology, Sylvester Cancer Center, University of Miami, Miami, FL, United States
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paolo, Brazil.,Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Kerry Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Primoz Strojan
- Department of Radiation Oncology Institute of Oncology, University of Ljubljana, Ljubljana, Slovenia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - June Corry
- Department of Medicine Division Radiation Oncology, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ashok R Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Dana M Hartl
- Division of Surgical Oncology, Gustave Roussy Cancer Center and Paris-Sud University, Paris, France
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michael Hinni
- Department of Otolaryngology, Mayo Clinic, Phoenix, AZ, United States
| | - K Thomas Robbins
- Southern Illinois University School of Medicine, Department of Otolaryngology, Springfield, IL, United States
| | - Ng Wai Tong
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Hospital Universitario San Vicente Fundacion. CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Universidad de Antioquia, Medellín, Colombia
| | - Andres Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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25
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Whitworth P, Hogan A, Ferko N, Son D, Wang F, Xiong Y, Suri H, Barclay B. Reduced Hospital Costs for Ultrasound-guided Vacuum-assisted Excision Compared with Open Surgery in Patients with Benign Breast Masses and High-risk Lesions. JOURNAL OF BREAST IMAGING 2020; 2:452-461. [PMID: 38424905 DOI: 10.1093/jbi/wbaa055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Benign breast masses represent a substantial proportion of breast cancer screening results and may require multiple follow-up visits and biopsy. Even with a preceding benign core biopsy, benign masses have been excised via open surgery for a variety of reasons. This study compared the procedural costs of US-guided vacuum-assisted excision (US-VAE) versus open surgical excisions for benign breast masses and high-risk lesions (HRL). METHODS In this retrospective cohort study, female outpatients receiving US-VAE or open excision of benign breast masses between 2015 and 2018 were identified within the Premier Healthcare Database. A secondary analysis was conducted for patients with HRLs. Propensity score matching and multivariate regression adjusted for patient demographics, encounter level covariates, and hospital characteristics. The total procedural costs were reported from a hospital perspective. RESULTS A total of 33 724 patients underwent excisions for benign breast masses (8481 US-VAE and 25 242 open surgery). Procedural costs were significantly lower in unmatched patients who received US-VAE ($1350) versus open surgery ($3045) (P < 0.0001). After matching, a total of 5499 discharges were included in each group, with similar findings for US-VAE ($1348) versus open surgery ($3101) (P < 0.0001). A secondary analysis of matched HRL patients (41 discharges in each group) also showed significantly lower procedural costs with US-VAE ($1620) versus open surgery ($3870) (P < 0.0001). CONCLUSION Among patients with benign breast masses or HRLs, US-VAE was associated with significantly lower procedural costs versus open surgery. If excision is performed and expected clinical outcomes are equal, US-VAE is preferable to reduce costs without compromising the quality of care.
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Affiliation(s)
| | | | | | | | - Faye Wang
- Becton, Dickinson and Company, Tempe, AZ
| | - Yan Xiong
- Becton, Dickinson and Company, Franklin Lakes, NJ
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26
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Lester SC. How image-guided core needle biopsies altered the treatment of breast disease: Challenges accepted and opportunities taken. Breast J 2020; 26:1156-1159. [PMID: 32388912 DOI: 10.1111/tbj.13862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/30/2022]
Abstract
The technique of combining stereotactic targeting of breast lesions with an automated spring-loaded needle biopsy gun reported in 1990 by Steve Parker and colleagues not only ushered in the era of diagnosis almost exclusively by image guided core needle biopsy, but also profoundly changed the practice of pathologists, radiologists, surgeons, and medical oncologists and had major effects on the treatment of women with breast cancer. In this special issue of The Breast Journal celebrating 25 years of publication, it is of value to reflect back on these changes, some expected and some unanticipated, which have occurred over the past three decades and to consider the reasons why core needle biopsies should be considered a milestone in breast pathology.
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Affiliation(s)
- Susan C Lester
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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27
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Morita M, Tanaka H, Kumamoto Y, Nakamura A, Harada Y, Ogata T, Sakaguchi K, Taguchi T, Takamatsu T. Fluorescence-based discrimination of breast cancer cells by direct exposure to 5-aminolevulinic acid. Cancer Med 2019; 8:5524-5533. [PMID: 31385432 PMCID: PMC6746108 DOI: 10.1002/cam4.2466] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 12/24/2022] Open
Abstract
Protoporphyrin IX-fluorescence measurement is a powerful in situ approach for cancer detection after oral/topical administration of 5-aminolevulinic acid. However, this approach has not been clinically established for breast cancer, probably due to insufficient delivery of 5-aminolevulinic acid to the mammary glands. In the present study, we directly exposed breast cancer cells to 5-aminolevulinic acid to assess their discrimination via protoporphyrin IX-fluorescence. Fluorescence intensity (FI) was measured in the human breast cancer cell lines MCF7 and MDA-MB-231 and breast epithelial cell line MCF10A by confocal microscopy and flow cytometry. After 5-aminolevulinic acid exposure for 2 hours, protoporphyrin IX-FI in MCF7 and MDA-MB-231 cells significantly increased with marked cell-to-cell variability, whereas that in MCF10A cells increased moderately. Combined exposure of the cancer cells to 5-aminolevulinic acid and Ko143, a specific inhibitor of ATP-binding cassette transporter G2, further increased protoporphyrin IX-FI and alleviated the cell-to-cell variability in MCF7 and MDA-MB-231 cells, indicating improvement in the reproducibility and accuracy for fluorescence-based cancer detection. The increased FI by combined administration of these two drugs was also demonstrated in cells obtained via fine needle aspiration from mouse xenograft models inoculated with MDA-MB-231 cells. Furthermore, a cutoff value for increased protoporphyrin IX-FI ratio, before and after exposure to these drugs, clearly discriminated between cancer and noncancer cells. Taken together, direct exposure to 5-aminolevulinic acid and Ko143 may be a promising strategy for efficient fluorescence-based detection of breast cancer cells ex vivo using fine needle aspiration.
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Affiliation(s)
- Midori Morita
- Department of Pathology and Cell Regulation, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
- Department of Endocrine and Breast Surgery, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Hideo Tanaka
- Department of Pathology and Cell Regulation, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Yasuaki Kumamoto
- Department of Pathology and Cell Regulation, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Akihiro Nakamura
- Department of Pathology and Cell Regulation, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Yoshinori Harada
- Department of Pathology and Cell Regulation, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Takehiro Ogata
- Department of Pathology and Cell Regulation, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Koichi Sakaguchi
- Department of Endocrine and Breast Surgery, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Tetsuya Taguchi
- Department of Endocrine and Breast Surgery, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Tetsuro Takamatsu
- Department of Medical PhotonicsKyoto Prefectural University of MedicineKyotoJapan
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