Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision

Abstract

Background The management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions. Methods We retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe. Results Most patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low. Conclusions Breast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.

Ultrasound-guided vacuum-assisted breast biopsy in the diagnosis of cancer recurrence at the surgical scar: a report of three cases

“…Recently, the role of ultrasound-guided VAB has become well recognized in the diagnosis of breast lesions. It is worth mentioning that vacuum-assisted excision (VAE) is performed under ultrasound guidance in the therapeutic excision of certain high-risk lesions ( 19 ) . Current indication for US-guided VAB include lesions that will benefit from obtaining larger tissue samples ( 2 ) .…”

Papillary Neoplasm of Breast-Changing Trends in Diagnosis and Management

“…The surgical excision of all papillary lesions is recommended for definitive diagnosis and standard management for malignant papillary lesions [24,30]. Li X et al suggested the vacuum assisted excision is applicable for complete excision of small papillomas, even papillomas with atypical hyperplasia [31]. Bianchi et al also emphasized that, in addition to surgery, vacuum assisted excision of beingn intraductal papilloma may be done [32].…”

Value of ultrasound BI‑RADS classification in preoperative evaluation of the ultrasound‑guided Mammotome‑assisted minimally invasive resection of breast masses: A retrospective analysis

“…With the continuous development of minimally invasive breast technology and focus on the aesthetic needs of patients, minimally invasive resection using the ultrasound (US)-guided Mammotome system has been widely used for the accurate biopsy of suspicious lesions or removal of benign breast masses (2,3), which is particularly efficient for multifocal, tiny and impalpable breast lesions. It has the advantages of being minimally invasive, resulting in tiny scars, having a high accuracy and good performance, and being safe while providing real-time visualization (4,5). Despite these advantages, it is nonetheless an invasive procedure and varying degrees of breast tissue injury can occur.…”