Practical Challenges of DBT-Guided VABB: Harms and Benefits, from Literature to Clinical Experience.

Vacuum-assisted breast biopsy (VABB) guided by digital breast tomosynthesis (DBT) represents one of the best instruments to obtain a histological diagnosis of suspicious lesions with no ultrasound correlation or those which are visible only on DBT. After a review of the literature, we retrospectively analyzed the DBT-guided VABBs performed from 2019 to 2022 at our department. Descriptive statistics, Pearson's correlation and χ2 test were used to compare distributions of age, breast density (BD) and early performance measures including histopathology. We used kappa statistics to evaluate the agreement between histological assessment and diagnosis. Finally, we compared our experience to the literature to provide indications for clinical practice. We included 85 women aged 41-84 years old. We identified 37 breast cancers (BC), 26 stage 0 and 11 stage IA. 67.5% of BC was diagnosed in women with high BD. The agreement between VABB and surgery was 0.92 (k value, 95% CI: 0.76-1.08). We found a statistically significant inverse correlation between age and BD. The post-procedural clip was correctly positioned in 88.2%. The post-procedural hematoma rate was 14.1%. No infection or hemorrhage were recorded. When executed correctly, DBT-guided VABB represents a safe and minimally invasive technique with high histopathological concordance, for detecting nonpalpable lesions without ultrasound correlation.

Vacuum-assisted biopsy system for breast lesions: a potential therapeutic approach.

Purpose: The primary objective is to optimize the population eligible for Mammotome Minimally Invasive Surgery (MIS) by refining selection criteria. This involves maximizing procedure benefits, minimizing malignancy risk, and reducing the rate of malignant outcomes. Patients and methods: A total of 1158 female patients who came to our hospital from November 2016 to August 2021 for the Mammotome MIS were analyzed retrospectively. Following χ2 tests to screen for risk variables, binary logistic regression analysis was used to determine the independent predictors of malignant lesions. In addition, the correlation between age and lesion diameter was investigated for BI-RADS ultrasound (US) category 4a lesions in order to better understand the relationship between these variables. Results: The malignancy rates of BI-RADS US category 3, category 4a and category 4b patients who underwent the Mammotome MIS were 0.6% (9/1562), 6.4% (37/578) and 8.3% (2/24) respectively. Malignant lesions were more common in patients over the age of 40, have visible blood supply, and BI-RADS category 4 of mammography. In BI-RADS US category 4a lesions, the diameter of malignant tumor was highly correlated with age, and this correlation was strengthened in patients over the age of 40 and with BI-RADS category 4 of mammography. Conclusion: The results of this study demonstrate that the clinical data and imaging results, particularly age, blood supply, and mammography classification, offer valuable insights to optimize patients' surgical options and decrease the incidence of malignant outcomes.

Pathological characteristics of breast nodules after large-volume fat grafting for breast augmentation.

BACKGROUND: The complications of large-volume fat grafting (LVFG) for breast augmentation remain unpredictable and include palpable breast nodules, oil cysts, and calcifications. AIMS: This study was aimed to provide an optimal treatment option for breast nodules after LVFG and evaluate their pathological characteristics. PATIENTS/METHODS: We effectively performed complete resection of breast nodules in 29 patients after LVFG using a minimal skin incision with the vacuum-assisted breast biopsy (VABB) system under ultrasound guidance. And we further carried on histologic examination of excised nodules and evaluated their pathological characteristics. RESULTS: The breast nodules were excised thoroughly with cosmetic effect satisfactorily. Interestingly, subsequent histologic examination showed that type I and VI collagens were strongly expressed in the fibrotic area and type IV collagen were positively expressed around the blood vessel. Furthermore, we found that the type VI collagen+ area appeared around mac2+ macrophages and α-SMA+ myofibroblasts. CONCLUSIONS: The VABB system may be the optimal treatment option for breast nodules after LVFG. And type VI collagens may serve as a biomarker of grafted adipose tissue fibrosis. The relationship between macrophages, fibroblasts, and collagen formation may be therapeutic targets for regulating fibrosis.

Vascular Complications following Vacuum-Assisted Breast Biopsy (VABB): A Case Report and Review of the Literature.

INTRODUCTION: Vacuum-assisted breast biopsy (VABB) has been evaluated as a minimally invasive, safe, and accurate procedure with low complication risks; the most frequent one is the mild/moderate hematoma, which occurs with a low-frequency rate, and the majority of patients who experienced it can be treated successfully with only manual compression and dressing. Although cases of uncontrollable catastrophic bleeding are exceedingly rare, local breast vessel involvement is a concrete risk, even in patients with no bleeding propensity. CASE PRESENTATION: In this article, we aimed to describe a 60 years-old woman who, following VABB, experienced a massive hematoma without external bleeding and was successfully treated with embolization. The woman was called back for a cluster of suspicious microcalcifications identified in the left breast's upper-outer quadrant; however, following histopathological analysis, the few samples collected were negative. She had a silent past medical history, 100% performance status, and no active pharmacotherapy. Approximately 15-30 min after VABB, the patient complained of weakness, pain, and lipothymia. A physical examination revealed a massive hematoma without external bleeding. Clinical data reported PaO 65/40 mmHg and blood chemistry Hb < 10 g/dL. The emergency team was alerted to stabilize the patient, and after that, the breast hemorrhage was controlled by endovascular embolization. Despite this being a rare occurrence, it is important to draw up and follow an appropriate protocol to ensure proper patient management and early treatment. DISCUSSION: This case illustrates the prompt and accurate management of a rare complication following VABB. Due to the very high number of patients undergoing this particular procedure, we aim to point out the concrete risk of vascular injury; other similar cases are described to support our thesis and provide different clinical manifestations of this rare occurrence.

Vacuum-assisted Evacuation (VAEv) of Symptomatic and/or Voluminous Breast Haematomas Following Surgeries and Percutaneous Procedures.

BACKGROUND/AIM: Among postoperative complications in breast surgery, postoperative hematoma is the most common occurrence. While mostly self-limited, in some cases surgical revision is mandatory. Among percutaneous procedures, preliminary studies demonstrated the efficacy of vacuum-assisted breast biopsy (VAB) in evacuating postprocedural breast hematomas. However, no data are available regarding VAB evacuating postoperative breast hematomas. Therefore, the present study aimed to investigate the efficacy of the VAB system in evacuating postoperative and postprocedural hematoma, symptom resolution, and avoidance of surgery. PATIENTS AND METHODS: From January 2016 to January 2020, patients with ≥25 mm symptomatic breast hematomas developed after breast-conserving surgery (BCS) and percutaneous procedures were retrospectively enrolled from a perspective-maintained database. Hematoma maximum diameter, estimated hematoma volume, total procedure time, and visual analog scale (VAS) score before ultrasound (US) vacuum-assisted evacuation (VAEv) were recorded. At one-week VAS score, residual hematoma volume, and complications were recorded. RESULTS: Among 932 BCSs and 618 VAB procedures, a total of 15 late postoperative hematomas were recorded (9 after BCS and 6 after VAB). Preoperative median diameter was 43.00 (35.50-52.50) mm and median volume 12.60 (7.35-18.30) mm3 Regarding VAEv, median time recorded was 25.92 (21.89-36.81) min. At one week, the median hematoma reduction was 83.00% (78.00%-87.5%) with a statistically significant VAS reduction (5.00 vs. 2.00; p>0.001). No surgical treatment was needed and only one case of seroma occurred. CONCLUSION: VAEv represents a promising safe, time and resource-sparing treatment modality for the evacuation of breast hematomas, potentially decreasing the rate of reoperation after surgery.

Freehand 1.5T MR-Guided Vacuum-Assisted Breast Biopsy (MR-VABB): Contribution of Radiomics to the Differentiation of Benign and Malignant Lesions.

Radiomics and artificial intelligence have been increasingly applied in breast MRI. However, the advantages of using radiomics to evaluate lesions amenable to MR-guided vacuum-assisted breast biopsy (MR-VABB) are unclear. This study includes patients scheduled for MR-VABB, corresponding to subjects with MRI-only visible lesions, i.e., with a negative second-look ultrasound. The first acquisition of the multiphase dynamic contrast-enhanced MRI (DCE-MRI) sequence was selected for image segmentation and radiomics analysis. A total of 80 patients with a mean age of 55.8 years ± 11.8 (SD) were included. The dataset was then split into a training set (50 patients) and a validation set (30 patients). Twenty out of the 30 patients with a positive histology for cancer were in the training set, while the remaining 10 patients with a positive histology were included in the test set. Logistic regression on the training set provided seven features with significant p values (<0.05): (1) 'AverageIntensity', (2) 'Autocorrelation', (3) 'Contrast', (4) 'Compactness', (5) 'StandardDeviation', (6) 'MeanAbsoluteDeviation' and (7) 'InterquartileRange'. AUC values of 0.86 (95% C.I. 0.73-0.94) for the training set and 0.73 (95% C.I. 0.54-0.87) for the test set were obtained for the radiomics model. Radiological evaluation of the same lesions scheduled for MR-VABB had AUC values of 0.42 (95% C.I. 0.28-0.57) for the training set and 0.4 (0.23-0.59) for the test set. In this study, a radiomics logistic regression model applied to DCE-MRI images increased the diagnostic accuracy of standard radiological evaluation of MRI suspicious findings in women scheduled for MR-VABB. Confirming this performance in large multicentric trials would imply that using radiomics in the assessment of patients scheduled for MR-VABB has the potential to reduce the number of biopsies, in suspicious breast lesions where MR-VABB is required, with clear advantages for patients and healthcare resources.

Small vascular lesions of the breast diagnosed by magnetic resonance imaging-guided vacuum assisted biopsy: Report of 2 cases.

Vascular lesions of the breast comprise a heterogeneous group that includes a variety of benign, atypical, and malignant lesions. These are a diagnostic challenge given variable clinical, radiological and pathological presentation, especially when they are small and asymptomatic. We present 2 cases of these rare lesions of the breast which were occult to mammographics and ultrasound studies. Both the lesions were detected only on magnetic resonance imaging, most helpful in the diagnosis of these rare tumor. Histopathological examinations following the magnetic resonance guided biopsies, were initially interpreted as negative for breast cancer in both cases. These turned out to be respectively a low grade angiosarcoma and a benign vascular lesion after a new histopathological examination following a larger magnetic resonance guided biopsies performed in light of the radiology-pathology discordance. Although rare, it is important to consider vascular tumours of the breast; radiologists need to be aware such tumors may present non-specific imaging features.

Ultrasound-guided vacuum-assisted breast biopsy in the diagnosis of cancer recurrence at the surgical scar: a report of three cases.

Aim of the study: Ultrasound-guided vacuum-assisted biopsy is being increasingly used in the diagnosis of breast lesions. The advantages of vacuum-assisted biopsy over core needle biopsy include large sample and higher diagnostic accuracy. Indications for ultrasound-guided vacuum-assisted biopsy include suspicious calcifications visible on ultrasound, architectural distortion, and very subtle or insinuating lesions. Case description: We present three patients treated for breast cancer with breast-conserving surgery who developed suspicious findings on mammogram and MRI at or near the surgical scar. The findings were subtle, small, or atypical lesions on ultrasound. Ultrasound-guided vacuum-assisted biopsy was performed, and recurrence was diagnosed. The technique was advantageous due to real-time imaging, ability to control the path of the needle, obtaining multiple cores with a single skin puncture and single pass, supine position, no radiation, and no IV contrast. Conclusions: Ultrasound-guided vacuum-assisted biopsy should be considered in cases involving multiple suspicious findings at or near the surgical scar, with subtle or atypical sonographic correlates. Vacuum-assisted biopsy is indicated; yet ultrasound guidance is more comfortable, no radiation and no contrast.

The Efficacy of Thrombin-Gelatin Matrix in Hemostasis for Large Breast Tumor after Vacuum-Assisted Breast Biopsy.

BACKGROUND: Vacuum-assisted breast biopsy (VABB) for benign breast tumor excision is a developing trend in breast surgery. The most common complication of VABB is hematoma. We assessed the efficiency of the thrombin-gelatin matrix (TGM) for hemostasis after VABB. METHODS: From December 2013 to June 2017, 147 patients with breast tumors > 2 cm in size were treated with a 7-gauge ultrasound-guided EnCor EnSpire® breast biopsy system. After VABB, the TGM was applied using an iron-tube device. After injection, brief external compression for 15 min and postoperative bandage compression for approximately 12 h were applied. The medical records were reviewed and analyzed for hematoma and acute bleeding at 1 and 3 months after VABB. RESULTS: A total of 72 patients received hemostasis via TGM, and 75 patients received hemostasis by compression. The rates of postoperative acute bleeding in the TGM group were significantly lower than those in the non-TGM group (5.5% vs. 22.7%, p = 0.003). Among patients with hematoma, there was no statistically significant difference between the two groups (25% vs. 26.7%, p = 0.85). CONCLUSIONS: This is the first cohort study to apply the TGM hemostatic matrix for post-VABB hemostasis. The TGM hemostatic matrix could be an option for patients with large breast tumors.

Video-Assisted Breast Surgery (VABS) and Vacuum-Assisted Breast Biopsy (VABB) for Fibroadenoma Mammae on Patients' Satisfaction: A Preliminary Study.

OBJECTIVE: This study aimed to compare the patients' satisfaction level after fibroadenoma surgery with Video-Assisted Breast Surgery (VABS) and Vacuum-Assisted Breast Biopsy (VABB) techniques. METHODS: Patients who underwent VABS or VABB for a diagnosis of fibroadenoma mammae at the Oncology Clinic in Solo, Indonesia were included in this study. Clinical and demographic data were obtained from medical records. Direct or telephone interviews were performed and the patients were asked to complete Universitas Sebelas Maret Breast Satisfaction Questionnaire 8 (UNS-BsQ8) questionnaire. RESULTS: A total sample of 16 patients with VABS and 26 patients with VABB were recruited. All the patients were confirmed to have fibroadenoma based on the pathological result. The mean total scores for VABS and VABB were 34.50 ± 2.094 and 31.57 ± 3.081, respectively (P= 0.137). Out of 8 questions, only 3 items had statistically significant differences. VABS had higher mean score than VABB in terms of surgery cost (P = 0.002), pain in surgery site (P = 0.006), and pain in shoulder (P =  0.013). CONCLUSION: There was no significant difference in terms of overall patients' satisfaction level between both groups. However, VABS had a higher mean score than VABB in terms of cost and pain.

Detection rate of breast malignancy of needle localization biopsy of breast microcalcification.

OBJECTIVE: The current study aimed to retrospectively assess the cancer detection rate of needle localization biopsy of breast microcalcifications undetectable on sonography. MATERIALS AND METHODS: Patients who underwent mammography-guided needle localization biopsy of breast microcalcifications undetectable on sonography from January 2005 to December 2017 were included in the study. Patients with incomplete medical records were excluded from the study. Patient mammograms were categorized using the Breast Imaging-Reporting and Data System (BI-RADS) assessment criteria. The percentages of benign and malignant lesions were determined by pathological examination of surgically recovered specimens. Correlation between preoperative imaging assessment and final diagnosis was investigated, and the complications associated with the procedures were recorded. RESULTS: A total of 301 needle-localized biopsies were performed under mammographic guidance. The mean age of the patients was 58.18 ± 7.73 years. The overall ductal carcinoma in situ (DCIS) and cancer detection rate was 23.3%. The proportion of patients with BI-RADS 0 category and undergoing second mammography was higher in the DCIS and cancer group. A total of 227 patients did not undergo second mammography. Of these patients, 70 demonstrated BI-RADS 4 category, 34 were diagnosed with DCIS, and 5 were diagnosed with breast cancer during subsequent follow-up. CONCLUSION: Needle-localized excision of microcalcifications undetectable on sonography has high detection rate for early stage of breast cancer with low risk of associated complications. Regular mammography is a satisfactory follow-up tool for female patients with microcalcifications in the breasts. Additional studies should be performed to compare between needle-localized excision and vacuum-assisted breast biopsy.

The influence of preoperative biopsy on the surgical method in breast cancer patients: a single-center experience of 3,966 cases in China.

BACKGROUND: The National Surgical Adjuvant Breast and Bowel Project (NSABP) B32 trial reported that the detection rate of sentinel lymph nodes by core needle biopsy (CNB) is higher than that by segmental resection. However, there are few reports regarding the detection rate of sentinel lymph nodes by vacuum-assisted breast biopsy (VABB). Therefore, we analyzed the impact of preoperative biopsy methods on the surgical modes of 3,966 patients with breast cancer in our center. METHODS: In total, 3,966 female breast cancer patients [clinical tumor node metastasis (TNM) stage I-III] were enrolled in this study. Preoperative pathological diagnosis methods included fine needle aspiration (FNA) biopsy, CNB, excision biopsy, and VABB. According to the time of diagnosis. The data were analysis by chi square test, variance analysis and the Kaplan-Meier time series in SPSS 22.0. RESULTS: There was a decrease in the number of patients that underwent excision biopsy (7.3% to 2.7%) and intraoperative freezing (89.4% to 28.9%) over time, while CNB exhibited an increasing trend (1.6% to 55.3%). The positive rates of VABB, CNB, excision biopsy, and FNA were 99.5%, 97.1%, 97.9%, and 82.2%, respectively, and the false negative rates were 0%, 1.8%, 0.34%, and 8.9%, respectively. The overall breast-conserving rate was 36.7%, while the breast-conserving rate for VABB was 57.1%. The axillary sentinel lymph node biopsy rate of cN0 patients was 48.3%, and the intraoperative frozen group (36.7%) and excision biopsy group (39.5%) were lower than the CNB (57.1%) and VABB (77.9%) groups. Until December 2019, there were 350 cases with tumor recurrence or metastasis. The methods of biopsy were not correlated to the cumulative survival time. CONCLUSIONS: Changes to the diagnosis and treatment of breast cancer has a profound impact on the method of tumor biopsy. VABB biopsy offers advantages such as accurate diagnosis, a greater volume of tissue taken at one time, minimally invasive and repeatable, and does not affect the surgical approach and prognosis of patients. It will gradually become the primary method of preoperative pathological evaluation of breast cancer.

Complete Removal of the Lesion as a Guidance in the Management of Patients with Breast Ductal Carcinoma In Situ.

Background: Considering highly selected patients with ductal carcinoma in situ (DCIS), active surveillance is a valid alternative to surgery. Our study aimed to show the reliability of post-biopsy complete lesion removal, documented by mammogram, as additional criterion to select these patients. Methods: A total of 2173 vacuum-assisted breast biopsies (VABBs) documented as DCIS were reviewed. Surgery was performed in all cases. We retrospectively collected the reports of post-VABB complete lesion removal and the histological results of the biopsy and surgery. We calculated the rate of upgrade of DCIS identified on VABB upon excision for patients with post-biopsy complete lesion removal and for those showing residual lesion. Results: We observed 2173 cases of DCIS: 408 classified as low-grade, 1262 as intermediate-grade, and 503 as high-grade. The overall upgrading rate to invasive carcinoma was 15.2% (330/2173). The upgrade rate was 8.2% in patients showing mammographically documented complete removal of the lesion and 19% in patients without complete removal. Conclusion: The absence of mammographically documented residual lesion following VABB was found to be associated with a lower upgrading rate of DCIS to invasive carcinoma on surgical excision and should be considered when deciding the proper management DCIS diagnosis.

Advances in Ultrasound-Guided Vacuum-Assisted Biopsy of Breast Microcalcifications.

Microcalcification is one of the significant indications for or can even be the sole mammographic feature of breast cancer, especially occult breast cancer. Biopsy and pathologic examination are the most important methods used to identify the nature of suspicious microcalcifications. Stereotactic vacuum-assisted breast biopsy (S-VAB) is the most commonly used biopsy method for microcalcifications currently because of the high detection rate of mammography for microcalcifications. However, in recent years, several clinical studies have gradually found that ultrasound-guided vacuum-assisted breast biopsy (US-VAB) could be an alternative to S-VAB for microcalcifications to some extent, and has its own advantages of flexibility, real-time performance, comfort and high accessibility compared with mammography. An overview of US-VAB of microcalcifications is provided with respect to success rate, diagnostic accuracy, advantages and limitations. On the basis of numerous studies and clinical experience, US-VAB proved to be a valid alternative to S-VAB, with comparable diagnostic accuracy if the microcalcification foci could be detected by ultrasound. And for patients with ultrasound-invisible microcalcifications who are not suitable for or tolerable of S-VAB, US-VAB combined with mammography localization of microcalcifications can also be considered.

The Vacuum-Assisted Breast Biopsy System is an Effective Strategy for the Treatment of Gynecomastia.

BACKGROUND: Gynecomastia is the most common benign disease in males with an increasing prevalence in recent years. It may cause local pain and psychological disorders. The vacuum-assisted breast biopsy system has been reported to be a novel surgical approach for the treatment of gynecomastia. However, there are little detailed reports comparing the curative effect between traditional surgery and vacuum-assisted breast biopsy for gynecomastia. Besides, there was little study which compared the application of two different systems for the treatment of gynecomastia. Our study aimed to investigate the effectiveness of vacuum-assisted breast biopsy systems for patients with gynecomastia. METHODS: We retrospectively reviewed 83 patients with gynecomastia between January 2015 and December 2019. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. The characteristics of patients as well as the curative effects between the two groups were analyzed. The two vacuum-assisted breast biopsy systems (Mammotome and Encor) were performed for the patients with gynecomastia. The efficacy, safety, complications, and patient satisfactions were recorded during postoperative follow-up periods. RESULTS: Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 ± 1.3 cm vs 0.8 ± 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 ± 2.4 ds vs 3.1 ± 1.6 ds, p < 0.001). Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. There were no statistically significant differences between the two vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. In addition, no serious complications were observed in vacuum-assisted breast biopsy group. All the patients recovered well and were satisfied with the cosmetic outcomes. CONCLUSION: The vacuum-assisted breast biopsy system can be used as a feasible and minimally invasive approach for the treatment of gynecomastia. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Stereotactic breast biopsy: A review & applicability in the Indian context.

Stereotactic biopsy is used for sampling of suspicious non-palpable lesions identified on mammography or digital breast tomosynthesis which are not visible on ultrasound. Stereotactic biopsy is preferable to surgical excision biopsy and helps avoid surgery for benign lesions. Providing tissue diagnosis in patients with early breast cancer may help in formulating a management strategy. Stereotactic biopsy can be carried out using either a dedicated prone table with the patient lying prone or an upright mammographic add-on system with the patient in a sitting or lateral decubitus position. This review focuses on the advantages and disadvantages of both these systems, the indications, contraindications and the complications inherent with this technique. The important pitfalls and their management as well as ways to ensure quality assurance have also been elaborated upon. Data regarding uptake of stereotactic biopsy in other parts of the world have been discussed using evidence from existing registries and databases and attempts made to quantify the need of the technique in the Indian set-up. In the absence of a national breast screening programme and limited resources in India, a hub and spoke model has been proposed as a viable model for healthcare providers for providing stereotactic biopsy.

Role of Magnetic Resonance Imaging in Predicting Residual Breast Cancer After Vacuum-Assisted Breast Biopsy.

PURPOSE: This study aims to evaluate the effectiveness of breast magnetic resonance imaging (MRI) in detecting residual breast cancer in patients after vacuum-assisted breast biopsy (VABB). METHODS: Between 2012 and 2019, 26 patients with breast cancer who underwent VABB were enrolled. Breast MRI was conducted after VABB. Imaging findings were then compared with the histopathological results. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. RESULTS: Residual cancer was confirmed histologically in 8 of the 26 patients after VABB. The overall sensitivity, specificity, PPV, NPV, and accuracy of MRI for diagnosing residual cancer were 79.9%, 73.0%, 87.1%, 61.3%, and 77.8%, respectively. The sensitivity and NPV improved to 100%, when the number of biopsy specimens was larger than five. CONCLUSION: Breast MRI showed high sensitivity and NPV in detecting residual breast tumor after VABB.

Current status of MRI-guided vacuum-assisted breast biopsy in Japan.

In April 2018, the national health insurance coverage of MRI-guided vacuum-assisted breast biopsy (VAB) was instituted with the application of the Japan Breast Cancer Society. Although MRI-guided VAB has been considered as a special procedure for a long time, having an access to this procedure should be recommended for facilities performing breast MRI as in Western countries. From now on, relevant societies should make efforts in data collection and quality control of MRI-guided VAB in Japan. We must avoid the following. To delay the early diagnosis of breast cancer in the judgment of an inaccurate indication, perform unnecessary biopsy due to overestimation of diagnosis, and reduce the success rate of MRI-guided VAB with immature techniques. This review explains the current status of MRI-guided VAB in Japan and shares procedure and biopsy data as a future reference from an experienced facility.

Value of stereotactic 11-gauge vacuum-assisted breast biopsy in non-palpable suspicious calcifications: an eight-year single institution experience with 587 patients.

BACKGROUND: Vacuum-assisted breast biopsy (VABB) has been routinely recommended for stereotactic intervention in cases of isolate mammographically-detected calcifications. Herein we aimed to evaluate and compare the diagnostic consistency and accuracy of calcified and noncalcified specimens obtained from same sites of sampling on mammography-visible calcifications. In addition, we presented the biopsy procedure and retrospectively evaluated the usefulness of VABB as well as the complications of this technique over an eight-year experience in our centre. METHODS: This single-institution observational cohort study included 587 patients referred for stereotactic 11-gauge VABB of 594 mammographically-detected calcifications between January 2010 and December 2018. The rate of histopathological underestimation, the false negative, the diagnostic consistency and accuracy between calcified and noncalcified specimens of VABB were comprehensively evaluated based on the surveillance data and final histopathological result of the surgical specimens. RESULTS: In total, 594 biopsy procedures were performed in 587 patients (mean age 46 years, range, 21-80 years). The average number of biopsy specimens was 14.7 (range, 9-21) per lesion. VABB pathological results revealed 471 (79.3%) benign, 39 (6.6%) high-risk, and 84 (14.1%) malignant cases. The diagnostic inconsistency between calcified and noncalcified specimens was 14.6% (105/123) for high-risk and malignant lesions. Furthermore, calcified specimens exhibited higher diagnostic accuracy of malignant lesion as compared with the noncalcified specimens (97.7% versus 82.6%, respectively). Underestimation rate for high-risk lesions and in situ carcinoma was 5.1% and 54.1%, respectively, along with a false negative rate of 6.25%. In addition, mild complications were reported with high patient tolerance. CONCLUSIONS: Stereotactic 11G-VABB might be preferred for the investigation of non-palpable mammographically-detected calcifications in terms of accuracy and safety profile. The high prevalence of diagnostic discordance between the specimens with and without calcifications revealed a higher value of calcified specimens in diagnosing high-risk and malignant calcifications.

Mammary hamartoma: is ultrasound-guided vacuum-assisted breast biopsy sufficient for its treatment?

BACKGROUND: Mammary hamartomas were mostly benign tumors with rare rate of recurrence and malignant transformation. Ultrasound (US)-guided vacuum-assisted breast biopsy (VABB) has been reported sufficiently safe in treating many breast benign tumors but remained undefined in mammary hamartoma for its usual underdiagnosis in US. Thus, this study aims to evaluate the efficiency of US-guided VABB in treating mammary hamartomas. METHODS: From May 2015 to March 2019, 3,388 lesions of 2,534 patients underwent percutaneous US-guided VABB, among which 31 mammary hamartomas proved by pathology were included in this study. Patients were followed up by US three, six and twelve months later, then at 1-year intervals. Lesions were classified to analyze the possible factors associated with excision rate, bleeding volume and complications. RESULTS: Of the 31 patients, recurrence was seen in 1 case in 1 year after the procedure and complete excision rate was 96.8% (30/31). The bleeding volume ranged from 1 to 15 mL (mean number ± standard deviation, 6.5±3.4 mL) and significant statistical differences were detected in patient age and the largest diameter of lesions. The main complications included pain (22.6%), hematomas (9.7%) and ecchymosis (3.2%). CONCLUSIONS: US-guided VABB ensures an outstanding complete excision rate and provides an alternative solution to treat mammary hamartomas.