Vacuum-assisted core biopsy of B3 lesions showing atypia on needle core biopsy: a worthwhile exercise?

Introduction

There has been increasing interest in the use of vacuum-assisted core biopsy (VACB) over the past two decades. There remains some uncertainty about its role in the presence of cytological or architectural atypia on needle core biopsy (NCB). We have recently been offering VACB for selected B3 cases with atypia. MDT discussion, where technical suitability and potential value of VACB is debated, is used to select appropriate cases.

Methods

A retrospective case review of all B3 lesions diagnosed at NCB between 1 March 2008 and 1 March 2010.

Results

A total of 166 B3 lesions were diagnosed: 123 underwent surgical biopsy, of which 30 were malignant (eight invasive, 22 non invasive), 10 had LCIS and 83 were benign. Forty-three B3 lesions underwent VACB: 18/43 lesions had shown atypia at NCB and following VACB, seven were upgraded to DCIS, three were downgraded to B2, six remained as B3 with atypia (5/6 had surgery - three malignant, two benign). VACB failed in two cases. Twenty-five out of 43 cases had shown no atypia at NCB. One out of 25 was upgraded to B4 on VACB, but no malignancy was seen at surgery. Twenty-four out of 25 cases were downgraded to B2.

Conclusions

Our results show a potential benefit of this technique in selected cases. We were able to upgrade 39% of B3 lesions with atypia, thereby allowing immediate definitive surgery. We were able to avoid surgical excision in 3/18 (17%) of B3 lesions with atypia.