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.
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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