Ultrasound‐guided 7‐gauge vacuum‐assisted core biopsy: Could it be sufficient for the diagnosis and treatment of intraductal papilloma?

Abstract

The aim of this study was to evaluate whether ultrasound‐guided 7‐gauge vacuum‐assisted core biopsy is sufficient for the diagnosis and treatment of intraductal papilloma and to evaluate the lesion characteristics and histologic features affecting the excision rate of papilloma with vacuum‐assisted core biopsy. Between March 2008 and October 2016, 2816 patients underwent US‐guided, 7‐gauge vacuum‐assisted core biopsy (VACB). In them, 101 (3.6%) were demonstrated to have intraductal papilloma by pathology. The accurate diagnostic rate and excision rate of intraductal papilloma after vacuum‐assisted core biopsy were evaluated by open surgical biopsy or follow‐up US. The lesion characteristics and histologic features were analyzed to identify factors affecting the excision rate of papilloma after VACB. Of the 101 intraductal papillomas, 83 (82.2%) cases were benign papilloma. Two cases were intraductal papilloma accompanied by invasive carcinoma. Sixteen (15.8%) cases were with signs of atypical hyperplasia. In them, one intraductal papilloma accompanied by severe atypical hyperplasia underwent further surgery, and it was demonstrated to have intraductal papilloma accompanied by invasive carcinoma. The accurate diagnostic rate of intraductal papillomas by 7‐gauge VACB was 99.0% (100/101). There was no recurrence or malignant transformation in 85.1% (86/101) intraductal papillomas after 7‐gauge vacuum‐assisted core biopsy. Intraductal papilloma with largest diameter <1 cm, with clear margin, without branch involvement or calcification had a significantly higher excision rate. Seven‐gauge VACB is an effective method for the diagnosis of intraductal papilloma of the breast. If histopathological examination confirms a benign character of the lesion, surgery may be avoided but regular follow‐up is recommended. If histopathological examination confirms a papilloma with moderate to severe atypical hyperplasia, it was strongly recommended for surgical excision. Lesion characteristics and histologic features could affect the excision rate of intraductal papillomas with VACB.

Benign breast papilloma: Is surgical excision necessary?

“…Several other similar studies with upgrade rates ranging from 2% to 3% concurred with these findings . A study by Wang et al published in 2019 looked at the suitability of vacuum‐assisted excision as both a diagnostic and therapeutic tool in the management of these lesions. This group looked at 101 findings of intraductal papilloma on 7‐gauge VAE.…”

Management of papillary lesions of the breast diagnosed by core biopsy: Need for an evidence‐based standard of care

“…Another investigator found no malignancy or atypia at excision following diagnosis of papilloma with an 8 gauge or 11 gauge vacuum‐assisted core biopsy . These latter two studies support the conclusion by Wang et al in this issue of The Breast Journal that use of a 7 gauge breast needle and a greater number of samples might eliminate the need for a subsequent excisional biopsy for a benign papilloma found at core biopsy . Nevertheless, the study by Wang et al reported a 10% rate of hematoma, which may be compared to a 4.8% rate of hematoma reported by Kibil following biopsy with a 10 or 11 gauge needle …”

“…Some studies such as Carder et al, Kibil, et al, Wang, et al in this issue of the Breast Journal, Yamaguchi, et al, Mosier, et al, and Youk, et al suggest that the entire papilloma be completely removed and managed by core biopsy if the lesion is very small or if a relatively large amount of tissue is removed.…”

Efficacy and Safety of Vacuum-Assisted Excision for Benign Breast Mass Lesion: A Meta-Analysis

“…Two studies included benign phyllodes tumors [31,32]. The indications of 16 studies vary from BI-RADS 1-4b [11,[16][17][18][19][20][22][23][24]28,[30][31][32][33][34]37]. Perez-Fuentes et al include eight patients with BI-RADS 5 [13] Hahn et al included two patients with BI-RADS 5 [23] Jiang et al included 48 patients with BI-RADS 5 in cases where patients desired biopsy [30].…”

“…Perez-Fuentes et al include eight patients with BI-RADS 5 [13] Hahn et al included two patients with BI-RADS 5 [23] Jiang et al included 48 patients with BI-RADS 5 in cases where patients desired biopsy [30]. Sixteen studies were conducted in Asian countries [14,[18][19][20]22,24,25,[27][28][29][30][31][32]34,36,37].…”