Background: This paper reports the results obtained by the Senology Unit of the Surgery Department of Luigi Sacco Hospital in Milan from November 2005 to October 2009 in order to evaluate VABB efficacy for the diagnosis of non-palpable breast lesions. Materials and Methods: During a period of 48 months, 616 VAAB were performed (563 under stereotactic guidance and 53 under US guidance). 502 patients underwent a VABB after the detection of suspect mammary micro-calcifications, while in 61 patients a parenchymal distortions or mammary nodules were detected. The radiological classification of the lesions was: 4 BIRADS 2 (0.6%), 191 BIRADS 3 (31%), 353 BIRADS 4 (57.3%) and 33 BIRADS 5 (5.4%). The extension of the lesions varies from 0.3 to 9 cm (average 1.42 cm). We used an 11 G needle in 606 procedures (98.4%) and an 8 G needle in 10 patients (1.6%). At the end of the VABB, we placed a radiopaque marker in 384 patients. From October 2007 a cylindrical capsule made of anallergic and hyperechogenic collagen was associated with the placement of the marker. This clip, linked with a collagen capsule, allowed precise pre-operative localisation of the lesion with an ultrasound scan. Moreover, after performing resection, the removed breast tissue underwent radiography to verify the inclusion of the clip inside the glandular parenchyma. Results: Breast tissue removed with VABB allowed an histological diagnosis in 606 cases (98.4%). The detail was: 273 (44.3%) malignant lesions (B5), 7 (1.1%) lesions suspected of being malignant (B4), 65 (10.6%) lesions of uncertain behaviour (B3), and 261 (42.4%) benign lesions (B2). Only 10 VABB (1.6%) removed an inadequate quantity of breast tissue (B1). A precocious complication, consisting of a post-bioptic haematoma developed in 15 patients (2.4%). 124 patients with a VABB positive for neoplasia or highly suspect underwent a surgical breast resection in our Hospital. We then compared the match between the histological examination (obtained with VABB) and the result of the histological examination of the surgical resection. In 119 cases (96%) the two data matched. Conclusions: Our results confirm how VAAB is an easily reproducible, non-invasive, comfortable and cheap technique for the diagnosis of non-palpable breast lesions. It allows surgical procedures for the diagnosis of lesions that are often benign (42.4% in our case study) to be avoided. Moreover, if the lesion is a cancer this procedure allows a precise localisation of the original lesion. This is the most important factor for successful excision of a non-palpable malignant mammary lesion: it allows the goal of oncologically correct surgical radicality to be reached, obtaining at the same time a fulfilling aesthetic result, thanks to the noninvasive character of the operation and the conservation of mammary parenchyma.

Vacuum-assisted breast biopsy(VABB) for the diagnosis of nonpalpable breast lesions: results of 600 procedures / R. Amadori, A.P. Fontana, A. Sartani, A. Norsa, D. Bossi, A. Gambaro, R. Bianco, D. Foschi, F. Corsi. - In: EUROPEAN JOURNAL OF SURGICAL ONCOLOGY. - ISSN 0748-7983. - 36:10(2010 Jan), pp. 1018-1018. [10.1016/j.ejso.2010.06.034]

Vacuum-assisted breast biopsy(VABB) for the diagnosis of nonpalpable breast lesions: results of 600 procedures

A.P. Fontana
Secondo
;
A. Sartani;A. Norsa;D. Foschi
Penultimo
;
F. Corsi
Ultimo
2010

Abstract

Background: This paper reports the results obtained by the Senology Unit of the Surgery Department of Luigi Sacco Hospital in Milan from November 2005 to October 2009 in order to evaluate VABB efficacy for the diagnosis of non-palpable breast lesions. Materials and Methods: During a period of 48 months, 616 VAAB were performed (563 under stereotactic guidance and 53 under US guidance). 502 patients underwent a VABB after the detection of suspect mammary micro-calcifications, while in 61 patients a parenchymal distortions or mammary nodules were detected. The radiological classification of the lesions was: 4 BIRADS 2 (0.6%), 191 BIRADS 3 (31%), 353 BIRADS 4 (57.3%) and 33 BIRADS 5 (5.4%). The extension of the lesions varies from 0.3 to 9 cm (average 1.42 cm). We used an 11 G needle in 606 procedures (98.4%) and an 8 G needle in 10 patients (1.6%). At the end of the VABB, we placed a radiopaque marker in 384 patients. From October 2007 a cylindrical capsule made of anallergic and hyperechogenic collagen was associated with the placement of the marker. This clip, linked with a collagen capsule, allowed precise pre-operative localisation of the lesion with an ultrasound scan. Moreover, after performing resection, the removed breast tissue underwent radiography to verify the inclusion of the clip inside the glandular parenchyma. Results: Breast tissue removed with VABB allowed an histological diagnosis in 606 cases (98.4%). The detail was: 273 (44.3%) malignant lesions (B5), 7 (1.1%) lesions suspected of being malignant (B4), 65 (10.6%) lesions of uncertain behaviour (B3), and 261 (42.4%) benign lesions (B2). Only 10 VABB (1.6%) removed an inadequate quantity of breast tissue (B1). A precocious complication, consisting of a post-bioptic haematoma developed in 15 patients (2.4%). 124 patients with a VABB positive for neoplasia or highly suspect underwent a surgical breast resection in our Hospital. We then compared the match between the histological examination (obtained with VABB) and the result of the histological examination of the surgical resection. In 119 cases (96%) the two data matched. Conclusions: Our results confirm how VAAB is an easily reproducible, non-invasive, comfortable and cheap technique for the diagnosis of non-palpable breast lesions. It allows surgical procedures for the diagnosis of lesions that are often benign (42.4% in our case study) to be avoided. Moreover, if the lesion is a cancer this procedure allows a precise localisation of the original lesion. This is the most important factor for successful excision of a non-palpable malignant mammary lesion: it allows the goal of oncologically correct surgical radicality to be reached, obtaining at the same time a fulfilling aesthetic result, thanks to the noninvasive character of the operation and the conservation of mammary parenchyma.
breast, surgery
Settore MED/18 - Chirurgia Generale
Settore MED/08 - Anatomia Patologica
Settore MED/36 - Diagnostica per Immagini e Radioterapia
gen-2010
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/269251
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