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Breast Masses: Removal of All US Evidence during Biopsy by Using a Handheld Vacuum-assisted Device—Initial Experience¹

¹ From the Department of Radiology (D.E.M., B.F.C., S.V.K.), Baystate Comprehensive Breast Center/Regional Cancer Program (R.B.B.), Department of Pathology (R.A.G., M.E.B.), Department of Surgery (J.L.F.), and Division of Hematology and Oncology (G.M.J.), Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199. From the 2001 RSNA scientific assembly. Received April 25, 2002; revision requested June 21; revision received August 16; accepted September 30. Supported by an RSNA Seed Grant and by the Rays of Hope charitable fund. Address correspondence to D.E.M.

PURPOSE: To assess the effects of removal of all ultrasonographic (US) evidence of breast lesions by using a vacuum-assisted biopsy (VAB) device.

MATERIALS AND METHODS: Thirty-four women with breast masses underwent US-guided biopsy with an 11-gauge VAB device, with which removal of all evidence of the lesion was attempted. Histologic findings were compared with results of surgery and follow-up imaging. Patient tolerance and perceptions of the procedure and the ability of the procedure to eliminate a palpable finding were evaluated with questionnaires and findings at follow-up physical examination.

RESULTS: The biopsy protocol was completed in all cases. Twenty-six benign lesions (76%) and eight malignancies (24%) were diagnosed. After VAB, 10 patients (29%) underwent surgery on the basis of histologic findings of invasive carcinoma (n = 7), ductal carcinoma in situ (n = 1), lobular neoplasia (n = 1), or atypical ductal hyperplasia (n = 1). VAB resulted in complete excision of four of 10 lesions: two of eight malignancies and two of two benign lesions. Among 21 patients with benign lesions who underwent 6-month follow-up imaging, eight (38%) had a definite residual mass. At 6-month follow-up examination, VAB was seen to have eliminated the palpable abnormality in seven (88%) of eight patients with initially palpable benign masses. Thirty-two patients (94%) described no or mild pain during biopsy, and 33 patients (97%) rated care as excellent.

CONCLUSION: After removal of all US evidence of breast masses with a VAB device, there was a substantial probability that residual lesion that was not visualized during the procedure would later be found at surgery or follow-up imaging. A palpable mass (1.2 cm in mean diameter) was eliminated in 88% of cases, and patient tolerance and perceptions of the procedure were favorable.

© RSNA, 2003

Index terms: Breast, biopsy, 00.1261, 00.1262 • Breast neoplasms, localization, 00.12985 • Breast neoplasms, therapy, 00.1262 • Breast neoplasms, US, 00.1298, 00.12985 • Ultrasound (US), guidance, 00.12985

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