En bloc excision of nonpalpable breast lesions using the advanced breast biopsy instrumentation system: an alternative to needle guided surgery?

Abstract

This study was prospectively conducted to evaluate the clinical potential of the advanced breast biopsy instrumentation (ABBI) system as an alternative to needle localization and open surgery in the management of nonpalpable breast lesions (NPBL). One hundred and eighty-six consecutive patients were referred for management of NPBL. Thirty-six underwent an ABBI procedure, offered as a first step before possible surgery for lesions which would in any case have required complete excision. The 18 patients with a malignant ABBI biopsy underwent re-excision of the biopsy site and axillary dissection was carried out in cases of infiltrating carcinoma. The other 150 patients underwent image-guided needle biopsy. Following these procedures, 60/150 (40%) patients underwent needle-guided surgery. Finally, 96/186 (51%) patients required complete excision. A total of 43 benign lesions and 53 carcinomas were confirmed. Thirty-six out of 96 (38%) excisions were obtained with the ABBI system; 17/43 (40%) benign lesions and 11/53 (21%) carcinomas were completely removed with the ABBI system. Out of 9 malignant specimens with a pathological size less than 10 mm, 5/9 (55%) had tumor-free margins and in 8/9 (89%) no residual disease was found at re-excision. The preliminary results of this study suggest that, in selected cases, en bloc excision using the ABBI procedure could be an alternative to conventional surgery.

An experience with the Advanced Breast Biopsy Instrumentation (ABBI) system in the management of non-palpable breast lesions

“…The literature reviewed shows the current status of controversy: except for Damascelli et al [16], the remainder of the radiologists are sceptical or clearly adverse to the procedure [2,3,4,5,6]. Surgeons are divided: some of them are enthusiastic about the procedure [17,18,19,20,21,22,23,24,25,26,27,28,29], but others not [7,8,9]. The reasons argued against the ABBI are multiple.…”

Percutaneous stereotactic en bloc excision of nonpalpable breast carcinoma: a step in the direction of supraconservative surgery

“…In an earlier study we confirmed that the ABBI method was a safe and accurate biopsy procedure. 20 We established that an ABBI excision was feasible and adequate for less than 40% (17/43) of the benign lesions that would otherwise have been surgically excised in our department, and for only 21% (11/53) of the nonpalpable mammograhically detected carcinomas. Many (62%) of the excised NPBL in that study were not amenable to an ABBI procedure, primarily due to technical limitations.…”

“…20 However, for invasive lesions we need to develop less invasive alternatives to lymph node dissection for prognostic axillary evaluation. The benefit of systematic lymph node dissection for all invasive lesions is now being questioned.…”

“…6 19 In a previous study, we evaluated the proportion of our patients in whom NPBL would have unequivocally required complete excision but could be adequately removed with ABBI. 20 The present prospective nonrandomized study was conducted to evaluate the potential of the ABBI method for the locoregional management of a consecutive series of nonpalpable breast carcinomas.…”

Zwischenbericht über die Anwendung des ‘Advanced Breast Biopsy Instrumentation’- Systems im Rahmen einer Multizenterstudie

“…Die absoluten Vorteile sind die radiologisch hohe Sicherheit, der Komfort und die Zufriedenheit der Patientin und die vollständige Entfernung der verdächtig-ten Läsion [1][2][3][4][5]8].…”