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Minimally Invasive Intact Excision of High-Risk Breast Lesions and Small Breast Cancers: The Intact Percutaneous Excision (IPEX) Registry

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

Abstract

Background

Aiming to minimize overtreatment of high-risk breast lesions (HRLs), including atypical ductal hyperplasia, and small breast cancers, including ductal carcinoma in situ (DCIS), we investigated a minimally invasive (MI) approach to definitive diagnosis and management of these conditions.

Methods

In the prospective Intact Percutaneous Excision registry study, women aged 31–86 years had removal of small invasive cancers, DCIS, or HRLs using image-guided 12–20 mm radiofrequency basket capture (MI excision). Second-pass 20 mm basket capture obtained shaved margins in cancer patients. Standard imaging (specimen, breast) and histologic criteria were applied. Patient data were registered in an Institutional Review Board approved, Health Insurance Portability and Accountability Act-compliant registry.

Results

Of 282 registered patients, 124 had DCIS (n = 52) or invasive cancer (n = 72) and 160 had HRLs. Among cancer patients, 101 (81%) had clear histologic margins [average lesion size was 11 mm for both invasive cancers (4–20 mm) and DCIS (1.5–20 mm)]; 29 patients had re-excision (six despite clear margins). Among 160 HRLs, two were upgraded to DCIS and had MI excision. Two other HRL patients had subsequent standard surgical excision (no cancer found).

Conclusion

For diminutive HRLs, DCIS, and invasive cancers, MI excision can achieve the same procedure goals as standard surgical excision. Because MI excision removes less tissue with small incisions, it may reduce the discomfort and expense associated with standard treatment.

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Authors and Affiliations

  1. Nashville Breast Center, Nashville, TN, USA

    Pat Whitworth MD

  2. Baystate Noble Hospital, Westfield, MA, USA

    Steven Schonholz MD

  3. Metro Surgical Associates, Atlanta, GA, USA

    Rogsbert Phillips MD & Yara Robertson MD

  4. Chesapeake Regional Medical Center, Chesapeake, VA, USA

    Antonio Ruiz MD

  5. Birmingham Breast Care, Birmingham, AL, USA

    Susan Winchester MD

  6. Emory Healthcare, Atlanta, GA, USA

    Cathy Graham MD

  7. University of South Alabama, Mobile, AL, USA

    Jean Simpson MD

  8. Targeted Medical Education, Allentown, PA, USA

    Chloe Wernecke BA

Authors
  1. Pat Whitworth MD
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  2. Steven Schonholz MD
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  3. Rogsbert Phillips MD
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  4. Yara Robertson MD
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  6. Susan Winchester MD
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  8. Jean Simpson MD
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  9. Chloe Wernecke BA
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Corresponding author

Correspondence to Pat Whitworth MD.

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Disclosures

This work was supported by an unrestricted research grant from Intact Medical Corporation, Framingham, MA, USA.

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Whitworth, P., Schonholz, S., Phillips, R. et al. Minimally Invasive Intact Excision of High-Risk Breast Lesions and Small Breast Cancers: The Intact Percutaneous Excision (IPEX) Registry. Ann Surg Oncol 26, 954–960 (2019). https://doi.org/10.1245/s10434-019-07212-2

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  • DOI: https://doi.org/10.1245/s10434-019-07212-2

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