Outcome of a new patient pathway for managing B3 breast lesions by vacuum-assisted biopsy: time to change current UK practice?

Journal of Clinical Pathology - Tập 69 Số 3 - Trang 248-254 - 2016
CL Strachan1, Kieran Horgan2, Rebecca Millican‐Slater3, Abeer M. Shaaban4, Nisha Sharma5
1Department of Breast Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
2Department of Breast Surgery, St James's University Hospital, Leeds, UK
3Department of Cellular Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
4Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham and the University of Birmingham, Leeds, UK
5Department of Breast Radiology, St James's University Hospital, Leeds, UK

Tóm tắt

AimsB3 lesions of the breast represent a difficult management dilemma. The umbrella term ‘B3’ incorporates lesions with little associated malignancy risk as well as lesions with significant risk of concurrent neoplasia. Diagnosis of B3 lesions in screening populations is largely made on needle core biopsy, which provides little tissue to adequately diagnose pathologically diverse lesions. The advent of vacuum-assisted biopsy (VAB) provides the multidisciplinary team with a more representative pathology sample to direct management.MethodsIn this unit, in 2009, a pathway to guide management of B3 lesions detected on needle core biopsy in screening patients was implemented to assess whether VAB was a safe and viable alternative to surgery in selected cases.Here we present the 5-year follow-up results of this pathway.Results398 patients with B3 lesions were suitable for this pathway, of which 321 went on to have second-line VAB. 24% of these patients subsequently required surgery for malignancy or ongoing concerns, and thus 245 avoided surgery being subsequently referred for 5-year mammographic surveillance or back to screening. Median follow-up was 3 years (IQR 2), and no cancers were detected at the original B3 site during follow-up.ConclusionsWe have demonstrated here that with large volume tissue sampling for indeterminate lesions of the breast surgery can be safely avoided in selected B3 lesions with and without atypia.

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Tài liệu tham khảo

A Joint Document Incorporating the Third Edition of the NHS Breast Screening Programme's Guidelines for Pathology Reporting in Breast Cancer Screening and the Second Edition of The Royal College of Pathologists’ Minimum Dataset for Breast Cancer Histopathology: NHSBSP Publication No 58 January 2005<nhsbsp58.pdf>.

10.1016/j.humpath.2009.09.005

10.1097/PAS.0b013e31819d0a4d

10.1038/modpathol.2011.73

10.1016/j.breast.2004.06.004

10.1016/j.crad.2011.09.002

10.1038/bjc.2013.177

10.1016/j.clon.2014.09.015

10.1016/j.anndiagpath.2013.05.003

10.1002/ijc.25801

10.1002/cncr.22435

10.1016/j.breast.2010.12.003

10.1111/j.1365-2559.2008.03158.x

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Journal of Clinical Pathology

Tập 69 Số 3

248-254

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