Minimally invasive breast cancer excision using the breast lesion excision system under ultrasound guidance

Abstract Purpose To assess the feasibility of completely excising small breast cancers using the automated, image-guided, single-pass radiofrequency-based breast lesion excision system (BLES) under ultrasound (US) guidance. Methods From February 2018 to July 2019, 22 patients diagnosed with invasive carcinomas ≤ 15 mm at US and mammography were enrolled in this prospective, multi-center, ethics board-approved study. Patients underwent breast MRI to verify lesion size. BLES-based excision and surgery were performed during the same procedure. Histopathology findings from the BLES procedure and surgery were compared, and total excision findings were assessed. Results Of the 22 patients, ten were excluded due to the lesion being > 15 mm and/or being multifocal at MRI, and one due to scheduling issues. The remaining 11 patients underwent BLES excision. Mean diameter of excised lesions at MRI was 11.8 mm (range 8.0–13.9 mm). BLES revealed ten (90.9%) invasive carcinomas of no special type, and one (9.1%) invasive lobular carcinoma. Histopathological results were identical for the needle biopsy, BLES, and surgical specimens for all lesions. None of the BLES excisions were adequate. Margins were usually compromised on both sides of the specimen, indicating that the excised volume was too small. Margin assessment was good for all BLES specimens. One technical complication occurred (retrieval of an empty BLES basket, specimen retrieved during subsequent surgery). Conclusions BLES allows accurate diagnosis of small invasive breast carcinomas. However, BLES cannot be considered as a therapeutic device for small invasive breast carcinomas due to not achieving adequate excision.

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Invasive breast carcinomas with peritumoural PASH-like stroma show lower level of CD68(+) tumour associated macrophages than those of invasive carcinomas without peritumoral PASH-Like Stroma (PASH: Pseudoangiomatous Stromal Hyperplasia)

10.26226/morressier.596dfd55d462b802923870d5 ◽

2017 ◽

Author(s):

Canan Kelten Talu

Keyword(s):

Breast Carcinomas ◽

Pseudoangiomatous Stromal Hyperplasia ◽

Invasive Breast Carcinomas ◽

Invasive Carcinomas

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Comparative analysis of MRI vs mammography in evaluation of size, number of lesions and nodal status of breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.600 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 600-600

Author(s):

S. Saha ◽

S. Chitneni ◽

R. Sehgal ◽

M. Arora ◽

B. Desouza ◽

...

Keyword(s):

Gold Standard ◽

Breast Lesion ◽

Breast Mri ◽

Lesion Size ◽

Contralateral Breast ◽

T2 Lesions ◽

Size Number ◽

Stage Classification ◽

The Mean ◽

Neo Adjuvant Chemotherapy

600 Background: Breast MRI is thought to be better in evaluating patients (pts) with BrCa. Our study was to compare MRI vs mam to predict leisons and LNS in BrCa. Methods: A retrospective study of 100 consecutive pts with pathologically proven BrCa was done. All had preoperative MRI and mam. Findings were compared to the final pathologic size, used as gold standard. MRI and was done at same center and single surgeon did all surgeries. Results: Of 100 pts,MRI reported 124 lesions. MRI reported size in 107 and mam reported size in 63 lesions. In MRI detected sizes 8% had same size as pathological size, 66% were overestimated by a mean of 0.64cm and 26% were underestimated by a mean of 0.48cm. For mam lesions, 10% had same size, 34% were overestimated by a mean of 1.10cm, 57% were underestimated by a mean of 0.78 cm. Total of 25 additional lesions were found in 23 pts in same and 6 leisons in 6 pts in contralateral breast by MRI. MRI also detected enlarged axillary and intramammary LN in 15% pts, 40% were true positives(+ve) and 60% were false +ve. One pt had metastatic LN in the contralateral axilla detected by MRI and confirmed by lymphoscintogram and pathology. 3% pts had neo-adjuvant chemotherapy Conclusion: In our study mam underestimated the breast lesion size in pts significantly more than MRI, but MRI overestimated BrCa lesion size in more number of pts. The mean difference in size on MRI when compared to the pathological size is less than 1 cm, while mam overestimated by a mean of greater than 1cm. This might be particularly important for T1 and T2 lesions, where size is the most important criterion for the T-stage classification. The identification of additional lesions and enlarged LN on MRI further validates the utility of MRI. [Table: see text] No significant financial relationships to disclose.

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Molecular Phenotypes of Unifocal, Multifocal, and Diffuse Invasive Breast Carcinomas

Pathology Research International ◽

10.4061/2011/480960 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Tibor Tot ◽

Gyula Pekár ◽

Syster Hofmeyer ◽

Maria Gere ◽

Miklós Tarján ◽

...

Keyword(s):

Lymph Node ◽

Growth Factor Receptor ◽

Receptor Expression ◽

Lymph Node Status ◽

Her2 Overexpression ◽

Breast Carcinomas ◽

Invasive Component ◽

Invasive Breast Carcinomas ◽

Molecular Phenotypes ◽

Invasive Carcinomas

We analyzed the subgross distribution of the invasive component in 875 consecutive cases of breast carcinomas using large-format histology sections and compared the immunophenotype (estrogen and progesterone receptor expression, HER2 overexpression and expression of basal-like markers, CK5/6, CK14, and epidermal growth factor receptor) in unifocal, multifocal, and diffuse tumors. Histology grade and lymph node status were also analyzed. Unifocal invasive carcinomas comprised 58.6% (513/875), multifocal invasive carcinomas 36.5% (319/875), and diffuse invasive carcinomas 4.9% (43/875) of the cases. The proportion of lymph node-positive cases was significantly higher in multifocal and diffuse carcinomas compared to unifocal cancers, but no other statistically significant differences could be verified between these tumor categories. Histological multifocality and diffuse distribution of the invasive tumor component seem to be negative morphologic prognostic parameters in breast carcinomas, independent of the molecular phenotype.

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Proliferative Lesions and Breast Cancer Histopathology

10.1093/med/9780190270261.003.0004 ◽

2018 ◽

Author(s):

Sophia K. Apple ◽

Lawrence W. Bassett

Keyword(s):

Breast Cancer ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Lobular Carcinoma ◽

Phyllodes Tumor ◽

Breast Cancers ◽

Cancer Subtypes ◽

Radiologic Findings ◽

Invasive Carcinomas

Breast in situ lesions and invasive carcinomas are a heterogeneous group of tumors comprising many different morphological and biological subtypes. The majority of invasive breast cancers thought to arise in the terminal ductal lobular unit (TDLU). As multidisciplinary diagnosis and detection of early breast carcinomas is the gold standard, an understanding of histopathology in correlation with radiologic findings is critical. This chapter reviews the histopathology of high-risk proliferative lesions, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), and invasive breast carcinoma. Tumor progression and some of the frequently seen invasive breast cancer subtypes are described. Histopathology of other malignancies arising from mesenchymal origin, including phyllodes tumor, is also described.

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Relation between Lightscanning and the Histologic and Mammographic Appearance of Malignant Breast Tumors

Acta Radiologica ◽

10.1177/028418519203300113 ◽

1992 ◽

Vol 33 (1) ◽

pp. 63-68 ◽

Cited By ~ 3

Author(s):

O. Jarlman ◽

G. Balldin ◽

I. Andersson ◽

M. Löfgren ◽

A. S. Larsson ◽

...

Keyword(s):

Real Time ◽

Breast Tumors ◽

Scar Tissue ◽

Breast Cancers ◽

Breast Carcinomas ◽

Histologic Appearance ◽

Malignant Breast ◽

The Difference ◽

Invasive Carcinomas

The relation between real-time transillumination (lightscanning) and the histologic appearance of 243 breast carcinomas was evaluated. Lightscanning mainly failed in identifying ductal and lobular carcinomas in situ. The result of lightscanning was also poor regarding small, invasive carcinomas. The absorption patterns in elastosis and scar tissue associated with carcinoma played no important role in the ability of lightscanning to identify a cancer. The relation between the lightscanning and mammographic appearance of 85 breast cancers from the same material was also evaluated. Lightscanning performed poorly in identifying tumors characterized by calcifications as compared to tumors with other mammographic appearances. However, the difference was not significant.

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Evaluation of atypical hyperplasia after percutaneous vacuum-assisted biopsy of suspicious calcifications

Mastology ◽

10.29289/259453942020v30s1038 ◽

2020 ◽

Vol 30 (Suppl 1) ◽

Author(s):

Vera Lucia Nunes Aguillar ◽

Giselle Guedes Netto de Mello ◽

Tatiana de Melo Cardoso Tucunduva ◽

Marcia Mayumi Aracava ◽

Elisandra Cristina Oliveira

Keyword(s):

Lobular Carcinoma ◽

Lesion Size ◽

Wide Excision ◽

Flat Epithelial Atypia ◽

Low Grade ◽

Ductal Hyperplasia ◽

Significant Difference ◽

Invasive Carcinomas ◽

Needle Diameter

Introduction: Atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and flat epithelial atypia (FEA) are part of a heterogeneous group of lesions with uncertain malignant potential and varying rates of malignancy after wide excision. They represent a clinical challenge, given the lack of well-defined approach recommendations. Objective: To determine the local rate of "upgrade" to malignancy (invasive carcinoma or in situ) after wide excision of ADH, ALH, LCIS (classic lobular neoplasia) diagnosed by percutaneous vacuum-assisted biopsy performed only in suspicious calcifications, as well as analyze radiological and histopathological parameters that can be associated with a higher risk of "upgrade". Material and Methods: This is a retrospective analysis of 117 patients diagnosed with ADH, LCIS, and FEA after percutaneous vacuum-assisted biopsy of suspicious calcifications, from 2015 to 2018. We evaluated radiological parameters – lesion size, morphology of the calcifications, diameter of the needle, and presence of residual calcifications – and histopathological parameters – extension of atypia (focal or multifocal) and association with other atypias. Results: Among the 106 patients included, 77 (73%) underwent surgery, with a rate of "upgrade" to malignancy of 19.5% (10 ductal carcinomas in situ, of which 30% had high grade) and 5 had invasive carcinomas (4 ductal and 1 tubular, all with low grade). In the subgroup analysis, the rate of "upgrade" was 31% for ADH, 14.7% for FEA, and 7.7% for LCIS. Needle diameter (9Gx11G) (p=0.48), presence of residual calcifications (less than 90% of the cluster removed) (p=0.73), and mean cluster extension (calculated based on the original mammography) (p=0.66) showed no statistically significant correlation with an increase in the rate of "upgrade". Amorphous calcifications predominated (60%), followed by fine pleomorphic ones, with rates of "upgrade" of 11% and 35%, respectively. Regarding histological parameters, we found no statistically significant difference between groups with focal (up to 2 foci) and multifocal atypia or association with other atypias. Conclusion: Our rate of "upgrade" to malignancy was similar to that of the published literature, and we found no statistically significant radiological or histological criteria for a greater risk of "upgrade".

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Features of tumoural and non-tumoural areas in invasive breast carcinomas including PASH (pseudoangiomatous stromal hyperplasia) areas within the tumour

10.26226/morressier.5b4709836f4cb30010951a84 ◽

2018 ◽

Author(s):

Canan Kelten Talu

Keyword(s):

Breast Carcinomas ◽

Pseudoangiomatous Stromal Hyperplasia ◽

Invasive Breast Carcinomas

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Surgery for Good Prognosis Breast Cancers

Current Breast Cancer Reports ◽

10.1007/s12609-021-00414-2 ◽

2021 ◽

Author(s):

Stuart A. McIntosh

Keyword(s):

Surgical Treatment ◽

Minimally Invasive ◽

Good Prognosis ◽

Surgical Approaches ◽

Breast Cancers ◽

Randomised Trials ◽

High Quality ◽

High Quality Evidence ◽

Small Breast ◽

Quality Evidence

Abstract Purpose of Review The introduction of mammographic screening programmes has resulted increasing numbers of women with small breast cancers with biologically favourable characteristics. Many of these cancers may represent overdiagnosis, with a resulting treatment burden for women and healthcare costs for providers. Here, current surgical approaches to the treatment of such tumours are reviewed, together with alternative approaches to their management. Recent Findings The surgical treatment of small, screen-detected breast cancers with biologically favourable characteristics has been extrapolated from the management of symptomatic breast cancers. There is no prospective randomised evidence for conventional open surgery compared with other approaches in this setting. A number of minimally invasive techniques, most notable vacuum-assisted excision, have been described for the management of these tumours, but at present, there is a lack of high-quality evidence to support their routine use. There are currently ongoing randomised trials evaluating risk-adapted surgical and minimally invasive approaches to the management of good prognosis disease. Summary It is possible that the surgical treatment of good prognosis screen-detected breast cancers may be de-escalated. However, high-quality evidence from ongoing prospective randomised trials will be required in order to change clinical practice.

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