Percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions): a preliminary single-centre Italian experience

La radiologia medica - Tập 128 - Trang 528-536 - 2023
Giulia Bicchierai1, Francesca Pugliese1, Francesco Amato2, Diego De Benedetto1, Cecilia Boeri1, Ermanno Vanzi1, Federica Di Naro1, Simonetta Bianchi3, Elsa Cossu4, Vittorio Miele5, Jacopo Nori1
1Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, FlorenceFlorence, Italy
2Radiology Department, Ospedale San Giovanni di Dio, Agrigento, Italy
3Division of Pathological Anatomy, University of Florence, Florence, Italy
4Diagnostic and Interventional Imaging, University Hospital Policlinico Tor Vergata, Rome, Italy
5Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

Tóm tắt

In recent years vacuum-assisted excision (VAE) has been described as an alternative treatment for some B3 lesions. This study aims to assess the effectiveness of using VAE to manage selected B3 lesions by quantifying the number of B3 lesions undergoing VAE, the malignant upgrade rate, and the complications encountered. Our department evaluated all B3 lesions diagnosed between January 2019 and October 2021 and treated them with VAE. The data were collected during the initial biopsy and final histology based on VAE image guidance, also considering initial lesions and complications. The exclusion criteria were: B3 lesion of size > 20 mm, presence of a concomitant malignant lesion, lesion < 5.0 mm distant from the skin, nipple or pectoral muscle, phyllodes tumours or indeterminate B3 lesions. Lesions that upgraded to malignancy underwent surgical excision, while benign lesions performed radiological follow-ups. From 416 B3 lesions diagnosed, 67 (16.1%) underwent VAE. VAE was performed under X-ray (50/67) or ultrasound guidance (17/67). Five cases (7.5%) upgraded to a malignant lesion, 2 ADH, 2 LIN and one papillary lesion that underwent surgery. No malignancy or new lesions has occurred at the site of the VAE, with an average radiological follow-up of 14.9 months. VAE could be a safe and effective pathway for managing selected B3 lesions. Lesions initially subjected to CNB with ADH and LN outcome, before undergoing VAE, should perform a VAB for better tissue characterization and management.

Tài liệu tham khảo

Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L (2008) European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition–summary document. Ann Oncol 19(4):614–622. https://doi.org/10.1093/annonc/mdm481

Rageth CJ, Olynn EAM, Pinker K et al (2019) Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat 174(2):279–296. https://doi.org/10.1007/s10549-018-05071-1

Pinder SE, Shaaban A, Deb R, Desai A, Gandhi A, Lee AHS, Pain S, Wilkinson L, Sharma N (2018) NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol 73(8):682–692. https://doi.org/10.1016/j.crad.2018.04.004

Forester ND, Lowes S, Mitchell E, Twiddy M (2019) High risk (B3) breast lesions: What is the incidence of malignancy for individual lesion subtypes? A systematic review and meta-analysis. Eur J Surg Oncol 45(4):519–527. https://doi.org/10.1016/j.ejso.2018.12.008

Giannotti E, James JJ, Chen Y, Sun R, Karuppiah A, Yemm J, Lee AHS (2021) Effectiveness of percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions) as an alternative to open surgical biopsy. Eur Radiol 31(12):9540–9547. https://doi.org/10.1007/s00330-021-08060-z

Panzironi G, Moffa G, Galati F, Pediconi F (2022) Ultrasound-guided 8-Gauge vacuum-assisted excision for selected B3 breast lesions: a preliminary experience. Radiol Med 127(1):57–64. https://doi.org/10.1007/s11547-021-01429-6

Sharma N, Cornford E, Cheung S, Price H, Kearins O (2021) The impact of vacuum-assisted excision in the management of indeterminate B3 lesions in the NHS Breast Screening Programme in England. Clin Radiol 76(6):470.e23-470.e29. https://doi.org/10.1016/j.crad.2021.01.021

Lucioni M, Rossi C, Lomoro P et al (2021) Positive predictive value for malignancy of uncertain malignant potential (B3) breast lesions diagnosed on vacuum-assisted biopsy (VAB): is surgical excision still recommended? Eur Radiol 31(2):920–927. https://doi.org/10.1007/s00330-020-07161-5

McMahon MA, Haigh I, Chen Y, Millican-Slater RA, Sharma N (2020) Role of vacuum assisted excision in minimising overtreatment of ductal atypias. Eur J Radiol. 131:109258. https://doi.org/10.1016/j.ejrad.2020.109258

American College of Radiology (2013) ACR BI- RADS® Atlas breast imaging reporting and data system. Reston, VA: American College of Radiology

Bicchierai G, Tonelli P, Piacenti A, De Benedetto D, Boeri C, Vanzi E, Bianchi S, Cirone D, Kaur Gill M, Miele V, Nori J (2020) Evaluation of contrast-enhanced digital mammography (CEDM) in the preoperative staging of breast cancer: Large-scale single-center experience. Breast J 26(7):1276–1283. https://doi.org/10.1111/tbj.13766

Mariscotti G, Durando M, Ruggirello I et al (2020) Lesions of uncertain malignant potential of the breast (B3) on vacuum-assisted biopsy for microcalcifications: predictors of malignancy. Eur J Radiol 130:109194. https://doi.org/10.1016/j.ejrad.2020.109194

Rageth CJ, O’Flynn EA, Comstock C et al (2016) First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat 159(2):203–213. https://doi.org/10.1007/s10549-016-3935-4

Yoo HS, Kang WS, Pyo JS, Yoon J (2021) Efficacy and safety of vacuum-assisted excision for benign breast mass lesion: a meta-analysis. Medicina (Kaunas) 57(11):1260. https://doi.org/10.3390/medicina57111260

Salazar JP, Miranda I, de Torres J, Rus MN, Espinosa-Bravo M, Esgueva A, Salvador R, Rubio IT (2019) Percutaneous ultrasound-guided vacuum-assisted excision of benign breast lesions: a learning curve to assess outcomes. Br J Radiol 92(1094):20180626. https://doi.org/10.1259/bjr.20180626

Buğdaycı O, Kaya H, Arıbal E (2017) Ultrasound guided therapeutic excisional vacuum assisted biopsy in breast fibroadenomas. J Breast Health 13(2):74–76. https://doi.org/10.5152/tjbh.2017.3038

Tennant SL, Evans A, Hamilton LJ, James J, Lee AH, Hodi Z, Ellis IO, Rakha EA, Wilson AR (2008) Vacuum-assisted excision of breast lesions of uncertain malignant potential (B3) - an alternative to surgery in selected cases. Breast 17(6):546–549. https://doi.org/10.1016/j.breast.2008.08.005

Perretta T, Lamacchia F, Ferrari D et al (2020) Evaluation of ultrasound-guided 8-gauge vacuum-assisted excision system for the removal of US-detectable breast lesions. Anticancer Res 40(3):1719–1729. https://doi.org/10.21873/anticanres.14125

Lee SH, Kim EK, Kim MJ, Moon HJ, Yoon JH (2014) Vacuum-assisted breast biopsy under ultrasonographic guidance: analysis of a 10-year experience. Ultrasonography 33(4):259–266. https://doi.org/10.14366/usg.14020

Strachan C, Horgan K, Millican-Slater RA, Shaaban AM, Sharma N (2016) Outcome of a new patient pathway for managing B3 breast lesions by vacuum-assisted biopsy: time to change current UK practice? J Clin Pathol 69(3):248–254. https://doi.org/10.1136/jclinpath-2015-203018

Gruppo Italiano Screening Mammografico (GISMA) (2016) Documento di consenso sulle procedure diagnostiche preoperatorie nelle lesioni mammarie. https://www.gisma.it/wp-content/uploads/2022/05/percorso-diagnostico-preoperatorio-GISMA-B3.pdf. Accessed July 2016. Accessed 20 October 2022

Schiaffino S, Calabrese M, Melani EF, Trimboli RM, Cozzi A, Carbonaro LA, Di Leo G, Sardanelli F (2020) Upgrade rate of percutaneously diagnosed pure atypical ductal hyperplasia: systematic review and meta-analysis of 6458 lesions. Radiology 294(1):76–86. https://doi.org/10.1148/radiol.2019190748

Bodian CA, Perzin KH, Lattes R (1996) Lobular neoplasia. Long term risk of breast cancer and relation to other factors. Cancer 78(5):1024–34

Mayer S, Kayser G, Rücker G, Bögner D, Hirschfeld M, Hug C, Stickeler E, Gitsch G, Erbes T (2017) Absence of epithelial atypia in B3-lesions of the breast is associated with decreased risk for malignancy. Breast 31:144–149. https://doi.org/10.1016/j.breast.2016.11.007

Catanzariti F, Avendano D, Cicero G, Garza-Montemayor M, Sofia C, VenanziRullo E, Ascenti G, Pinker-Domenig K, Marino MA (2021) High-risk lesions of the breast: concurrent diagnostic tools and management recommendations. Insights Imaging 12(1):63. https://doi.org/10.1186/s13244-021-01005-6

Houssami N, Ciatto S, Bilous M, Vezzosi V, Bianchi S (2007) Borderline breast core needle histology: predictive values for malignancy in lesions of uncertain malignant potential (B3). Br J Cancer 96(8):1253–1257. https://doi.org/10.1038/sj.bjc.6603714.PMID:17438578;PMCID:PMC2360144

Bianchi S, Caini S, Renne G, VANCB Study Group et al (2011) Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy. Breast 20(3):264–270. https://doi.org/10.1016/j.breast.2010.12.003

O’Flynn EA, Wilson AR, Michell MJ (2010) Image-guided breast biopsy: state-of-the-art. Clin Radiol 65(4):259–270. https://doi.org/10.1016/j.crad.2010.01.008

Sharma N, Wilkinson LS, Pinder SE (2017) The B3 conundrum-the radiologists’ perspective. Br J Radiol 90(1071):20160595. https://doi.org/10.1259/bjr.20160595

Sohn V, Arthurs Z, Herbert G, Keylock J, Perry J, Eckert M, Fellabaum D, Smith D, Brown T (2007) Atypical ductal hyperplasia: improved accuracy with the 11-gauge vacuum-assisted versus the 14-gauge core biopsy needle. Ann Surg Oncol 14(9):2497–2501. https://doi.org/10.1245/s10434-007-9454-0

Van de Voort EM, Struik GM, van Streun SP, Verhoef C, Uyl-de Groot CA, Klem TM (2022) Hospital costs and cosmetic outcome of benign and high-risk breast lesions managed by vacuum-assisted excision versus surgical excision. Br J Radiol 95(1136):20220117. https://doi.org/10.1259/bjr.20220117

Alonso-Bartolomé P, Vega-Bolívar A, Torres-Tabanera M, Ortega E, Acebal-Blanco M, Garijo-Ayensa F, Rodrigo I, Muñoz-Cacho P (2004) Sonographically guided 11-G directional vacuum-assisted breast biopsy as an alternative to surgical excision: utility and cost study in probably benign lesions. Acta Radiol 45(4):390–396. https://doi.org/10.1080/02841850410005633

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La radiologia medica

Tập 128

528-536

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