Background: Minimal invasive breast biopsy is standard care for the diagnosis of suspicious breast lesions. There are different vacuum biopsy (VB) systems in use. The aim of the study was to determine the differences between the 8-gauge and the 11-gauge needle with respect to a) diagnostic reliability, b) complication rate and c) subjective perception of pain when used for vacuum-assisted breast biopsy.
ZusammenfassungFragestellung: Ist die Komplettentfernung benigner Mammabefunde (Fibroadenome als Indikatorläsion) mit der sonographisch kontrollierten Hand Held Vakuumbiopsie (HHVB) möglich und mit welchen Komplikationen muss man rechnen? Material und Methode: Bei 480 Patientinnen wurden unklare Befunde der Brust mittels sonographischer HHVB (8 und 11 Gauche) abgeklärt, und diese Patientinnen im Rahmen einer retrospektiven Analyse, an der 9 Zentren teilnahmen, nachbeobachtet. Ziele der Nachbeobachtungen waren die sonographische Untersuchung des biopsierten Areals nach Residuen direkt nach dem Eingriff sowie im Rahmen der Nachuntersuchung. Ebenfalls wurden die Komplikationen erfasst und ausgewertet. Der mediane Nachbeobachtungszeitraum lag bei 7 Monaten (3 ± 35 Monate). Alle Biopsien wurden ambulant in Lokalanästhesie durchgeführt. Eingeschlossen wurden ausschlieûlich Patientinnen mit histologisch gesichertem Fibroadenom. Ergebnisse: Bei 480 Eingriffen mit der HHVB konnte in 421 Fällen (88%) direkt nach dem Eingriff und in 402 Fällen (84 %) auch bei der Nachuntersuchung eine Komplettentfernung sonographisch nachgewiesen werden. In nur einem Fall trat eine antibio-Abstract Aim: Is complete removal of a benign breast lesion (fibroadenoma as an indicative lesion) with sonographically controlled handheld vacuum biopsy (HHVB) possible and what type of complications are to be expected? Material and Method: 480 patients with an unclear lesion of the breast were classified using the sonographically guided HHVB (8 and 11 Gauche), retrospectively analysed and followed up. 9 centres were involved. The aim of the follow-up was the sonographic examination of the biopsy area, looking for residuals directly after the procedure as well as in conjunction with the follow-up. Complications were also registered and evaluated. The median time of follow-up was 7 months (3 ± 35 months). All biopsies were done as outpatient procedures under local anaesthesia. Included were only patients with a positive histology of fibroadenoma. Results: Of the 480 procedures using HHVB, 421 cases (88%) were totally removed directly after the procedure and 402 cases (84%) in the follow-up as could be seen by the sonogram. In only one case was antibiotic therapy necessary because of infection.
Neuroendocrine neoplasms (NEN) of the breast are specific tumor entities. According to the literature up to 5% of breast neoplasms are malignant epithelial neoplasms of the breast. They are defined by a neuroendocrine (NE) architecture and cytology combined with an expression of the neuroendocrine vesicle markers chromogranin A and/or synaptophysin. The diagnosis is supplemented by the receptor status and the proliferative activity. According to the World Health Organization (WHO) classification of 2012 the following groups of NEN are distinguished: (1) invasive breast carcinoma with NE differentiation, (2) well-differentiated neuroendocrine tumor (NET) and (3) poorly differentiated small cell carcinoma (NEC). This review article focuses on (1) the definition and basic principles of diagnostics, (2) the history, nomenclature and WHO classification from 2003 and 2012, (3) the frequency of breast NEN, (4) the hereditary background and functional activity, (5) the expression of receptors and (6) the possible clinical implications. In addition, the first results of a retrospective single center study (n = 465 patients with breast cancer over a time period of 4 years) on the frequency of NEN of the breast at the Breast Center of the University Hospital Düsseldorf are presented. In this study a frequency of 4.5% of NEN was found based on a diagnostic cut-off of > 50% Chromogranin A and/or synaptophysin positive tumor cells.
We regard the ultrasound guided hand-held Mammotome-biopsy as diagnostic and surgical instrument that provides the clinician with a flexible and easy to use method of accurate breast diagnosis. Lesions too small, superficial, or deep for conventional core biopsy are indications for a ultrasound guided Mammotome-biopsy as well as abnormalities where wide sampling is considered important or small fibroadenomas. However, standard of care for breast diagnosis remains the conventional hand-held 14-gauge-core-biopsy. For malignant lesions hand held mammotomy must be regarded as a diagnostic and not a therapeutic procedure.
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