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US-Guided Vacuum-Assisted Percutaneous Excision for Management of Benign Papilloma Without Atypia Diagnosed at US-Guided 14-Gauge Core Needle Biopsy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To assess the diagnostic accuracy of ultrasound (US)-guided vacuum-assisted excision (VAE) for the postbiopsy management of benign papilloma without atypia after US-guided 14-gauge core needle biopsy (CNB).

Methods

This was an institutional review board–approved retrospective study, with a waiver of informed consent. After a review of the histologic results and postbiopsy management of US-guided CNB performed from January 2007 through April 2009, 122 benign papillomas without atypia were diagnosed at CNB and excised percutaneously with US-guided VAE. Among them, a total of 67 papillomas having surgical excision (n = 5) or at least 2 years’ US follow-up (n = 62) after VAE were enrolled onto this study. We reviewed the medical records, US findings, and pathologic results obtained before and after VAE. Over the follow-up period, whether any malignancy at the site of the VAE was diagnosed was evaluated.

Results

The pathologic results of 67 VAEs were benign in 63 (94%) and atypical in four (6%). None of 63 benign lesions proved to be malignant after surgical excision (n = 1) or US follow-up (n = 62). Of four atypical lesions, however, one was upgraded to ductal carcinoma-in-situ (25%) after surgical excision. Of 62 benign VAE results having US follow-up, 56 (90.3%) showed no residual lesion at the site of the VAE.

Conclusions

For the postbiopsy management of benign papilloma without atypia after US-guided CNB, US-guided VAE was accurate and could be alternative to surgery. In cases of diagnosis of atypical lesion at VAE, however, surgery should be performed for a definitive diagnosis.

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References

  1. Evers K. To excise or not to excise? Acad Radiol. 2010;17:545–6.

    Article  PubMed  Google Scholar 

  2. Shin HJ, Kim HH, Kim SM, et al. Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: comparison of sonographic features and biopsy methods. AJR Am J Roentgenol. 2008;190:630–6.

    Article  PubMed  Google Scholar 

  3. Kil WH, Cho EY, Kim JH, Nam SJ, Yang JH. Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy? Breast. 2008;17:258–62.

    Article  PubMed  Google Scholar 

  4. Tseng HS, Chen YL, Chen ST, et al. The management of papillary lesion of the breast by core needle biopsy. Eur J Surg Oncol. 2009;35:21–4.

    Article  PubMed  CAS  Google Scholar 

  5. Bode MK, Rissanen T, Apaja-Sarkkinen M. Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors. Acta Radiol. 2009;50:722–9.

    Article  PubMed  CAS  Google Scholar 

  6. Chang JM, Moon WK, Cho N, et al. Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study. Eur Radiol. 2010;20:1093–100.

    Article  PubMed  Google Scholar 

  7. Youk JH, Kim EK, Kwak JY, Son EJ, Park BW, Kim SI. Benign papilloma without atypia diagnosed at US-guided 14-gauge core-needle biopsy: clinical and US features predictive of upgrade to malignancy. Radiology. 2011;258:81–8.

    Article  PubMed  Google Scholar 

  8. American College of Radiology. Breast imaging reporting and data system—mammography. In: American College of Radiology, editor. Breast imaging reporting and data system. 4th ed. Reston: American College of Radiology; 2003.

  9. Bassett LW, Mahoney MC, Apple SK. Interventional breast imaging: current procedures and assessing for concordance with pathology. Radiol Clin North Am. 2007;45:881–94.

    Article  PubMed  Google Scholar 

  10. Tennant SL, Evans A, Hamilton LJ, et al. Vacuum-assisted excision of breast lesions of uncertain malignant potential (B3)—an alternative to surgery in selected cases. Breast. 2008;17:546–9.

    Article  PubMed  CAS  Google Scholar 

  11. Dennis MA, Parker S, Kaske TI, Stavros AT, Camp J. Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy. AJR Am J Roentgenol. 2000;174:1263–8.

    PubMed  CAS  Google Scholar 

  12. Govindarajulu S, Narreddy SR, Shere MH, Ibrahim NB, Sahu AK, Cawthorn SJ. Sonographically guided mammotome excision of ducts in the diagnosis and management of single duct nipple discharge. Eur J Surg Oncol. 2006;32:725–8.

    Article  PubMed  CAS  Google Scholar 

  13. Torres-Tabanera M, Alonso-Bartolome P, Vega-Bolivar A, et al. Percutaneous microductectomy with a directional vacuum-assisted system guided by ultrasonography for the treatment of breast discharge: experience in 63 cases. Acta Radiol. 2008;49:271–6.

    Article  PubMed  CAS  Google Scholar 

  14. Kim MJ, Kim EK, Kwak JY, et al. Nonmalignant papillary lesions of the breast at US-guided directional vacuum-assisted removal: a preliminary report. Eur Radiol. 2008;18:1774–83.

    Article  PubMed  Google Scholar 

  15. Maxwell AJ. Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience. Clin Radiol. 2009;64:801–6.

    Article  PubMed  CAS  Google Scholar 

  16. Wei H, Jiayi F, Qinping Z, et al. Ultrasound-guided vacuum-assisted breast biopsy system for diagnosis and minimally invasive excision of intraductal papilloma without nipple discharge. World J Surg. 2009;33:2579–81.

    Article  PubMed  Google Scholar 

  17. Chang JM, Cho N, Moon WK, Park JS, Chung SY, Jang M. Does ultrasound-guided directional vacuum-assisted removal help eliminate abnormal nipple discharge in patients with benign intraductal single mass? Korean J Radiol. 2009;10:575–80.

    Article  PubMed  Google Scholar 

  18. Liberman L, Drotman M, Morris EA, et al. Imaging-histologic discordance at percutaneous breast biopsy. Cancer. 2000;89:2538–46.

    Article  PubMed  CAS  Google Scholar 

  19. Schueller G, Jaromi S, Ponhold L, et al. US-guided 14-gauge core-needle breast biopsy: results of a validation study in 1352 cases. Radiology. 2008;248:406–13.

    Article  PubMed  Google Scholar 

  20. Youk JH, Kim EK, Kim MJ, Kwak JY, Son EJ. Analysis of false-negative results after US-guided 14-gauge core needle breast biopsy. Eur Radiol. 2010;20:782–9.

    Article  PubMed  Google Scholar 

  21. Youk JH, Kim EK, Kim MJ. Atypical ductal hyperplasia diagnosed at sonographically guided 14-gauge core needle biopsy of breast mass. AJR Am J Roentgenol. 2009;192:1135–41.

    Article  PubMed  Google Scholar 

  22. Youk JH, Kim EK, Kwak JY, Son EJ. Atypical papilloma diagnosed by sonographically guided 14-gauge core needle biopsy of breast mass. AJR Am J Roentgenol. 2010;194:1397–402.

    Article  PubMed  Google Scholar 

  23. Bonaventure T, Cormier B, Lebas P, Bonneau C, Michenet P. Benign papilloma: is US-guided vacuum-assisted breast biopsy an alternative to surgical biopsy?. J Radiol. 2007;88:1165–8.

    Article  PubMed  CAS  Google Scholar 

  24. Kim MJ, Kim SI, Youk JH, et al. The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal. Clin Radiol. 2011;66:530–5.

    Article  PubMed  CAS  Google Scholar 

  25. Chang JM, Han W, Moon WK, et al. Papillary lesions initially diagnosed at ultrasound-guided vacuum-assisted breast biopsy: rate of malignancy based on subsequent surgical excision. Ann Surg Oncol. doi:10.1245/s10434-011-1617-3.

  26. Cusumano P, Polkowski WP, Liu H, Schulz-Wendtland R, Janssens J. Percutaneous tissue acquisition: a treatment for breast cancer? Vacuum-assisted biopsy devices are not indicated for extended tissue removal. Eur J Cancer Prev. 2008;17:323–30.

    Article  PubMed  Google Scholar 

  27. March DE, Coughlin BF, Barham RB, et al. Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device—initial experience. Radiology. 2003;227:549–55.

    Article  PubMed  Google Scholar 

  28. Perez-Fuentes JA, Longobardi IR, Acosta VF, Marin CE, Liberman L. Sonographically guided directional vacuum-assisted breast biopsy: preliminary experience in Venezuela. AJR Am J Roentgenol. 2001;177:1459–63.

    PubMed  CAS  Google Scholar 

  29. Fine RE, Whitworth PW, Kim JA, Harness JK, Boyd BA, Burak WE Jr. Low-risk palpable breast masses removed using a vacuum-assisted hand-held device. Am J Surg. 2003;186:362–7.

    Article  PubMed  Google Scholar 

  30. Alonso-Bartolome P, Vega-Bolivar A, Torres-Tabanera M, et al. 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. 2004;45:390–6.

    Article  PubMed  CAS  Google Scholar 

  31. Tagaya N, Nakagawa A, Ishikawa Y, Oyama T, Kubota K. Experience with ultrasonographically guided vacuum-assisted resection of benign breast tumors. Clin Radiol. 2008;63:396–400.

    Article  PubMed  CAS  Google Scholar 

  32. Grady I, Gorsuch H, Wilburn-Bailey S. Long-term outcome of benign fibroadenomas treated by ultrasound-guided percutaneous excision. Breast J. 2008;14:275–8.

    Article  PubMed  Google Scholar 

  33. Wang ZL, Li JL, Su L, Zhang YF, Tang J. An evaluation of a 10-gauge vacuum-assisted system for ultrasound-guided excision of clinically benign breast lesions. Breast. 2009;18:192–6.

    Article  PubMed  Google Scholar 

  34. Grady I, Gorsuch H, Wilburn-Bailey S. Ultrasound-guided, vacuum-assisted, percutaneous excision of breast lesions: an accurate technique in the diagnosis of atypical ductal hyperplasia. J Am Coll Surg. 2005;201:14–7.

    Article  PubMed  Google Scholar 

  35. Jaffer S, Nagi C, Bleiweiss IJ. Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy. Cancer. 2009;115:2837–43.

    Article  PubMed  Google Scholar 

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Acknowledgment

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2009-0067048).

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea

    Ji Hyun Youk MD, Min Jung Kim MD, Eun Ju Son MD, Jin Young Kwak MD & Eun-Kyung Kim MD

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  1. Ji Hyun Youk MD
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  2. Min Jung Kim MD
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  3. Eun Ju Son MD
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  4. Jin Young Kwak MD
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  5. Eun-Kyung Kim MD
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Correspondence to Eun-Kyung Kim MD.

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Youk, J.H., Kim, M.J., Son, E.J. et al. US-Guided Vacuum-Assisted Percutaneous Excision for Management of Benign Papilloma Without Atypia Diagnosed at US-Guided 14-Gauge Core Needle Biopsy. Ann Surg Oncol 19, 922–928 (2012). https://doi.org/10.1245/s10434-011-2033-4

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  • DOI: https://doi.org/10.1245/s10434-011-2033-4

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