Margin-free excision of small solid breast carcinomas using the Intact Breast Lesion Excision System®: is it feasible?

Papapanagiotou, Ioannis; Koulocheri, Dimitra; Kalles, Vasileios; Liakou, Paraskevi; Michalopoulos, Nikolaos V.; Al-Harethee, W.; Γεωργίου, Γεωργία; Matiatou, Maria; Nonni, Afroditi; Pazaiti, Anastasia; Théodoropoulos, Georgios; Menenakos, Evangelos; Zografos, Georgios

doi:10.1007/s12282-017-0802-z

Cited by 7 publications

(21 citation statements)

References 19 publications

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“…Five hundred eighteen articles were excluded because they did not use the BLES device or a prototype. We identified 19 full-text versions of studies that used the BLES as a diagnostic or therapeutic device and that fulfilled all the inclusion criteria [4][5][6][7][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Figure 3 shows the results of the study search and identification of eligible studies.…”

Section: Studiesmentioning

confidence: 99%

“…The number of lesions ranged from 19 to 1170. Ten studies used stereotactic guidance during the BLES procedure [4,6,7,9,11,13,15,16,20,22]. Six studies used stereotactic or ultrasound guidance [5,10,12,14,21,23]; only Graham [17] performed all BLES procedures with ultrasound guidance.…”

Section: Studiesmentioning

confidence: 99%

“…In two studies, one or more biopsies were performed to remove benign lesions for which histology was already known [21,23]. One study aimed at a complete, tumor-free margin excision of small solid carcinomas [22].…”

Section: Studiesmentioning

confidence: 99%

“…The decision to use the BLES was entirely based on the radiologist's assessment. Presence of bias risk of the index test was uncertain in 11 studies [6,7,9,12,13,[15][16][17][20][21][22] and high in two studies [10,23]. The risk of bias in the "reference standard" domain was generally scored low.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…The risk of bias in the flow and timing was generally scored as high, because not all patients with a high-risk lesion (HRL) or malignancy based on the BLES received surgical excision. Only five studies [15,[20][21][22][23] were scored with a low risk of this bias and one [7] with an unclear risk of bias. All studies were deemed applicable to the research question.…”

Section: Quality Assessmentmentioning

confidence: 99%

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

Sanderink¹,

Laarhuis²,

Strobbe³

et al. 2018

European Journal of Cancer

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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.

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Section: Studiesmentioning

confidence: 99%

Section: Studiesmentioning

confidence: 99%

Section: Studiesmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

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

Sanderink¹,

Laarhuis²,

Strobbe³

et al. 2018

European Journal of Cancer

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Minimally invasive breast cancer excision using the breast lesion excision system under ultrasound guidance

Sanderink¹,

Strobbe

Bult

et al. 2020

Breast Cancer Res Treat

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Purpose To assess the feasibility of completely excising small breast cancers using the automated, image-guided, single-pass radiofrequency-based breast lesion excision system (BLES) under ultrasound (US) guidance. Methods From February 2018 to July 2019, 22 patients diagnosed with invasive carcinomas ≤ 15 mm at US and mammography were enrolled in this prospective, multi-center, ethics board-approved study. Patients underwent breast MRI to verify lesion size. BLES-based excision and surgery were performed during the same procedure. Histopathology findings from the BLES procedure and surgery were compared, and total excision findings were assessed. Results Of the 22 patients, ten were excluded due to the lesion being > 15 mm and/or being multifocal at MRI, and one due to scheduling issues. The remaining 11 patients underwent BLES excision. Mean diameter of excised lesions at MRI was 11.8 mm (range 8.0–13.9 mm). BLES revealed ten (90.9%) invasive carcinomas of no special type, and one (9.1%) invasive lobular carcinoma. Histopathological results were identical for the needle biopsy, BLES, and surgical specimens for all lesions. None of the BLES excisions were adequate. Margins were usually compromised on both sides of the specimen, indicating that the excised volume was too small. Margin assessment was good for all BLES specimens. One technical complication occurred (retrieval of an empty BLES basket, specimen retrieved during subsequent surgery). Conclusions BLES allows accurate diagnosis of small invasive breast carcinomas. However, BLES cannot be considered as a therapeutic device for small invasive breast carcinomas due to not achieving adequate excision.

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Vacuum-assisted excision of small breast cancers under ultrasound guidance

Björnström

Niinikoski

Arlan

et al. 2023

European Journal of Radiology

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Margin-free excision of small solid breast carcinomas using the Intact Breast Lesion Excision System®: is it feasible?

Abstract: Our results indicate that it is possible, when using the BLES device, to completely excise small (≤ 10 mm) breast carcinomas that appear radiologically as solid lesions. This subset of patients should be investigated regarding the therapeutic potential of this method.

Cited by 7 publications

References 19 publications

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

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

Minimally invasive breast cancer excision using the breast lesion excision system under ultrasound guidance

Vacuum-assisted excision of small breast cancers under ultrasound guidance

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