Effectiveness of percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions) as an alternative to open surgical biopsy

Giannotti, Elisabetta; James, Jonathan; Chen, Yan; Sun, Rachel; Karuppiah, Amanjot; Yemm, Julia; Lee, Andrew H.S.

doi:10.1007/s00330-021-08060-z

Cited by 14 publications

(13 citation statements)

References 23 publications

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“…Salazar et al 10 reported that the location of lesions was too close to the skin, nipple, or chest muscle, which would reduce the operation space of VAE operators during the operation and increase the risk of adverse events. Giannotti et al 26 further highlighted that when the B3 lesion was too close to the skin or nipple‐areola complex, it was unsuitable for VAE treatment. To avoid being damaged by thermal heat or puncturing of the pleura by the needle tip, saline is used to isolate the lesion and surrounding tissues to widen the surgical field of vision and operation space.…”

Section: Discussionmentioning

confidence: 99%

Comparison of ultrasound‐guided microwave ablation and ultrasound‐guided vacuum‐assisted excision for treating breast lesions of uncertain malignant potential (B3 lesions): A retrospective study

Zhang

Yang

Wang

et al. 2023

J of Obstet and Gynaecol

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To compare the safety and therapeutic effect of ultrasound (US)-guided microwave ablation (MWA) and US-guided vacuum-assisted excision (VAE) for patients with B3 lesions of the breast. Methods: Patients who underwent US-guided MWA or US-guided VAE at Sichuan Tumor Hospital from January 2016 to December 2021 were retrospectively analyzed. The technical success rate and residual rate of the two minimally invasive surgeries were recorded. During follow-up, differences in symptom relief, recurrence or progression, re-intervention, incidence of adverse events, or personal satisfaction were observed between the two groups. Results: The follow-up time was comparable between the two groups. The technical success rate was similar between the two groups; no residue was found in the USguided MWA group, and the residue rate in the US-guided VAE group was 3.4%. The symptoms of the two groups were improved after the operation. The incidence of postoperative adverse events in the US-guided MWA group was significantly lower than that in the US-guided VAE group. Additionally, the MWA group had a lower incidence of adverse events when the tumor diameter was >2.5 cm. Compared to the US-guided VAE group, the US-guided MWA group had a lower rate of tumor recurrence or progression, re-intervention rate, and higher personal satisfaction. Conclusions: The technical success rate of US-guided MWA for B3 lesions was comparable to that of US-guided VAE, but US-guided MWA had a lower incidence of adverse events and a higher degree of personal satisfaction compared with US-guided VAE.

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Section: Discussionmentioning

confidence: 99%

Comparison of ultrasound‐guided microwave ablation and ultrasound‐guided vacuum‐assisted excision for treating breast lesions of uncertain malignant potential (B3 lesions): A retrospective study

Zhang

Yang

Wang

et al. 2023

J of Obstet and Gynaecol

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“…These strategies include a second-opinion assessment of biopsy specimens [ 57 ] (as implemented in our center for borderline cases) or the application of artificial intelligence for upgrade prediction [ 47 ] and could gain widespread application in the future. Another less invasive but still viable approach, particularly in light of recent results, could be the careful integration of VAE with surveillance, provided that the radiologic–pathological correlation is performed and that the removed tissue shows a low presence of atypical cytological features [ 16 , 24 , 25 , 26 , 27 , 28 ]. Of note, however, the need for personalized imaging surveillance (not limited to biennial mammography but potentially including supplemental ultrasound, digital breast tomosynthesis, contrast-enhanced MRI, and contrast-enhanced mammography) could be postulated for all patients with B3 lesions, also after surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The key issue is that the management of these lesions is highly controversial and is therefore the center of a lively debate, that could be fittingly approached by building evidence from large series, which are still sporadically available [ 14 , 15 , 16 ]. If performed with large-caliber needles, VAB seems to consistently improve lesion characterization in B3 lesions [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], even assuming a therapeutic role with vacuum-assisted excision, which is increasingly being proposed with interesting results [ 25 , 26 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies

Girardi

Guaragni

Ruzzenenti

et al. 2021

Cancers

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The rate of upgrade to cancer for breast lesions with uncertain malignant potential (B3 lesions) diagnosed at needle biopsy is highly influenced by several factors, but large series are seldom available. We retrospectively assessed the upgrade rates of a consecutive series of B3 lesions diagnosed at ultrasound- or mammography-guided vacuum-assisted biopsy (VAB) at an EUSOMA-certified Breast Unit over a 7-year timeframe. The upgrade rate was defined as the number of ductal carcinoma in situ (DCIS) or invasive cancer at pathology after excision or during follow-up divided by the total number of B3 lesions. All lesions were reviewed by one of four pathologists with a second opinion for discordant assessments of borderline cases. Excision or surveillance were defined by the multidisciplinary tumor board, with 6- and 12-month follow-up. Out of 3634 VABs (63% ultrasound-guided), 604 (17%) yielded a B3 lesion. After excision, 17/604 B3 lesions were finally upgraded to malignancy (2.8%, 95% confidence interval [CI] 1.8–4.5%), 10/17 (59%) being upgraded to DCIS and 7/17 (41%) to invasive carcinoma. No cases were upgraded during follow-up. B3a lesions showed a significantly lower upgrade rate (0.4%, 95% CI 0.1–2.1%) than B3b lesions (4.7%, 95% CI 2.9–7.5%, p = 0.001), that had a 22.0 adjusted odds ratio for upgrade (95% CI 2.1–232.3). No significant difference was found in upgrade rates according to imaging guidance or needle caliper. Surveillance-oriented management can be considered for B3a lesions, while surgical excision should be pursued for B3b lesions.

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“…These results are in keeping with a large outcome analysis of stereotactic VAEB by Lin et al, 20 where the most common complications reported were mild bleeding or haematoma (285/ 319, 89%) and pain or discomfort (22/319, 7%), with no major complications identified. In their review of 105 VAEBs, Giannotti et al 19 also reported no major complications.…”

Section: Vaeb Complicationsmentioning

confidence: 93%

Vacuum‐assisted excision biopsy for definitive diagnosis of breast lesions of uncertain malignant potential (B3 lesions) on core biopsy – A single centre Western Australian experience

et al. 2023

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Introduction In Australia, the usual approach to breast lesions where core biopsy returns an uncertain result (“B3” breast lesion) is to perform surgical diagnostic open biopsy (DOB). This is associated with patient time off work, costs of hospital admission, risks of general anaesthesia and surgical complications. The majority of B3 lesions return benign results following surgery. Vacuum assisted excision biopsy (VAEB) is a less invasive, lower cost alternative, and is standard of care for selected B3 lesions in the United Kingdom. Similar use of VAEB in Australia, could save many women unnecessary surgery. The aim of this study was to document our experience during the introduction of VAEB as an alternative to DOB for diagnosis of selected B3 lesions. Methods The multidisciplinary team developed an agreed VAEB pathway for selected B3 lesions. Technically accessible papillary lesions, mucocele‐like lesions and radial scars without atypia measuring ≤ 15mm were selected. Results Over a 7 month period, 18 women with 20 B3 lesions were offered VAEB. 16 women (18 lesions) chose VAEB over DOB. Papillomas were the commonest lesion type. All lesions were successfully sampled: 17/18 were benign. One lesion (6%) was upgraded to malignancy (ductal carcinoma in situ on VAEB, invasive ductal carcinoma at surgery). No major complications occurred. Patient satisfaction was high: 15/16 respondents would again choose VAEB over surgery. Conclusion VAEB is a patient‐preferred, safe, well‐tolerated, lower‐cost alternative to DOB for definitive diagnosis of selected B3 breast lesions.

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Effectiveness of percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions) as an alternative to open surgical biopsy

Cited by 14 publications

References 23 publications

Comparison of ultrasound‐guided microwave ablation and ultrasound‐guided vacuum‐assisted excision for treating breast lesions of uncertain malignant potential (B3 lesions): A retrospective study

Comparison of ultrasound‐guided microwave ablation and ultrasound‐guided vacuum‐assisted excision for treating breast lesions of uncertain malignant potential (B3 lesions): A retrospective study

B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies

Vacuum‐assisted excision biopsy for definitive diagnosis of breast lesions of uncertain malignant potential (B3 lesions) on core biopsy – A single centre Western Australian experience

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