Volume 15 Supplement 1

British Society of Breast Radiology Annual Scientific Meeting 2013

Open Access

PB.35: Comparison of large-bore vacuum-assisted biopsy and surgical diagnostic excision biopsy in B3 breast lesions

  • AH Tang1 and
  • ND Forester1
Breast Cancer Research201315(Suppl 1):P35

https://doi.org/10.1186/bcr3535

Published: 8 November 2013

Introduction

B3 lesion management is unclear. Despite varying malignancy risk, diagnostic excision was conventional, revealing malignancy in some and benign features in others. Large-bore vacuum-assisted biopsy (VAB, 7 to 8G) can enhance pathological certainty, providing reassurance of benignity, or identify co-existing malignancy, with many groups moving towards VAB to replace surgical excision biopsy. However, little research has addressed the accuracy of VAB compared with surgical biopsy in this situation.

Methods

From November 2011 to May 2013, we incorporated VAB into the management of all B3 lesions identified by 10/14G biopsy. Excision biopsy was still performed on any lesion initially identified as B3 with atypia, unless upgraded by VAB. The VAB result and surgical excision outcomes were compared.

Results

A total of 181 lesions were identified and considered for VAB. Atypia was present in 102 lesions. Sixty-five of 102 lesions had VAB, with 11 upgraded to malignancy. Of the 54/65 lesions not upgraded by VAB, 25 proceeded to excision biopsy, revealing DCIS in seven. A total 37/102 lesions did not have VAB (fibro-epithelial lesions/technical factors); malignancy was identified in five at excision biopsy. The overall malignancy rate was 23/102 (22.5%). Of VAB/excision biopsy discordant lesions, average tissue obtained at VAB was 2.4 g, compared with 2.9 g in concordant lesions (NS).

Conclusion

VAB can increase preoperative detection of malignancy, but has an associated miss rate. Thirty per cent of the DCIS present in B3 lesions with atypia was missed by second-line VAB. This is important to appreciate as women are placed on surveillance programmes for B3 lesions following VAB, but without completion excision biopsy.

Authors’ Affiliations

(1)
Department of Breast Radiology, Royal Victoria Infirmary

Copyright

© Tang and Forester; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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