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Effectiveness of percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions) as an alternative to open surgical biopsy

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A Correction to this article was published on 05 July 2021

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Abstract

Objectives

Traditionally B3 breast lesions are treated surgically, but overtreatment is a concern, as the majority have a final benign diagnosis. A national screening program introduced vacuum-assisted excision (VAE) for managing B3 lesions in late 2016. This retrospective study aimed to assess the outcomes associated with this approach.

Methods

All B3 lesions diagnosed between 01/2017 and 12/2019 were identified at two centres. Information was obtained on the initial biopsy and final histology, and method of VAE image guidance, needle size and number of cores. Lesions were excluded if there was cancer elsewhere in the breast at the time of diagnosis; the lesion was not suitable for VAE due to position in the breast or had B3 pathology for which open biopsy was still required. The final decision to offer VAE was always made at a multidisciplinary meeting (MDM). Risk difference was used to test the significance at p ≤ .05.

Results

In total, 258 B3 lesions were diagnosed, 105 (40.7%) met the inclusion criteria and underwent VAE. VAE was performed under X-ray (89/105) or ultrasound guidance (16/105), taking an average of 18.5 cores with the 10-G needle or 10.8 cores with the 7-G needle. Nine cases (8.6%) were upgraded to a malignant diagnosis following VAE. Malignancy was found in 15.5% (9/58) of B3 lesions with epithelial atypia, but in none without atypia (0/47) (p = .004). No new lesions or malignancy has occurred at the site of the VAE with an average mammographic follow-up of 2.2 years.

Conclusion

Upgrade to malignancy following VAE was uncommon (8.6%) and associated with atypia in the initial biopsy. VAE is an alternative approach to the management of B3 lesions, reducing open surgical procedures.

Key Points

• Upgrade to malignancy after a vacuum-assisted excision of a B3 breast lesion is uncommon with an 8.6% upgrade rate.

• The risk of a malignant diagnosis after a vacuum-assisted excision was significantly higher for B3 lesions with atypia compared to those without (+15.5% difference, p = .004).

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Change history

Abbreviations

ADH:

Atypical ductal hyperplasia

MDM:

Multidisciplinary team meeting

NHSBSP:

National Health Service Breast Screening Programme

PPV:

Positive predictive value

RIS:

Radiology information system

VAE:

Vacuum-assisted excision

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham City Hospital Hucknall Road, Nottingham, NG51PB, UK

    Elisabetta Giannotti, Jonathan J. James, Rachel Sun & Amanjot Karuppiah

  2. Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham City Hospital Hucknall Road, Nottingham, NG51PB, UK

    Yan Chen

  3. Department of Radiology, King’s Mill Hospital, Mansfield Road, Sutton-In-Ashfield, Mansfield, NG174JL, UK

    Julia Yemm

  4. Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham City Hospital Hucknall Road, Nottingham, NG51PB, UK

    Andrew H. S. Lee

Authors
  1. Elisabetta Giannotti
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Correspondence to Elisabetta Giannotti.

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Guarantor

The scientific guarantor of this publication is Elisabetta Giannotti Elisabetta.giannotti@nuh.nhs.uk

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors Dr. Yan Chen has significant statistical expertise.

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Written informed consent was not required for this study because the study was locally registered as an audit.

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Institutional Review Board approval was not required because this audit was locally registered.

Methodology

• retrospective

• diagnostic or prognostic study

• multicentre study

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The original online version of this article was revised: The spelling of Julia Yemm’s name was incorrect.

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Giannotti, E., James, J.J., Chen, Y. et al. 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, 9540–9547 (2021). https://doi.org/10.1007/s00330-021-08060-z

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  • DOI: https://doi.org/10.1007/s00330-021-08060-z

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