A systematic review on the use of the Breast Lesion Excision System in breast disease

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.

Minimally Invasive Excision of Breast Masses under Ultrasound Guidance: A Single Center’s Five-Year Experience on the Breast Lesion Excision System

“…e resection zone in BLES is less than one millimeter with minimal diathermic (i.e., carbonization) effects that provide a confident assessment of border integrity (Figure 6). Complete excision rate of BLES is between 0 and 76% according to previous reports [11][12][13][14]. In this study, this rate was found to be 40%, although the number of malignant cases was too low to reach a solid conclusion regarding this parameter.…”

“…ere was only one case where an empty basket was retrieved. According to the relevant literature, the relative frequency of such an event is 0.6-3.6% [12]. Such cases are usually due to the failure of the basket to deploy or to the presence of a very tight entry point or access path.…”

“…In this study, this rate was found to be 40%, although the number of malignant cases was too low to reach a solid conclusion regarding this parameter. e large variation in the literature regarding the rate of complete excision raises some questions about the use of BLES as a therapeutic device [12,14]. However, it is not uncommon for patients to undergo more than one surgical procedure before achieving tumor-free margin even in surgery [15].…”

Criteria for Excision of Suspicious Calcifications Using the Breast Lesion Excision System (BLES)

“…Breast lesion excision system (BLES) biopsy technique has been used in recent years for percutaneous biopsy of suspicious breast lesions technique in excision of the targeted breast lesions has been recently shown. The literature has reported that BLES performance in excision of suspicious breast lesions is promising and suggestive of potential use of the technique in excision of small [7][8][9][10] breast benign and malignant lesions.…”