Breast Papillary Lesions Diagnosed and Treated using Ultrasound-Guided Vacuum-Assisted Excision

Abstract Background: The management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions. Methods: We retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe. Results: Most patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low. Conclusions: Breast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.

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Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision

10.21203/rs.3.rs-40553/v2 ◽

2020 ◽

Author(s):

Xiaohui Li ◽

Hua Gao ◽

Minling Xu ◽

Yang Wu ◽

Dezong Gao

Keyword(s):

Breast Imaging ◽

Accurate Diagnosis ◽

Atypical Hyperplasia ◽

Breast Lesions ◽

Ultrasound Images ◽

Ultrasound Guided ◽

Linear Probe ◽

Papillary Lesions ◽

Low Rate

Abstract Background The management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions. Methods We retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe. Results Most patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low. Conclusions Breast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.

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Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision

BMC Surgery ◽

10.1186/s12893-020-00869-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiaohui Li ◽

Hua Gao ◽

Minling Xu ◽

Yang Wu ◽

Dezong Gao

Keyword(s):

Breast Imaging ◽

Accurate Diagnosis ◽

Atypical Hyperplasia ◽

Breast Lesions ◽

Ultrasound Images ◽

Ultrasound Guided ◽

Biopsy Needle ◽

Linear Probe ◽

Papillary Lesions

Abstract Background The management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions. Methods We retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe. Results Most patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low. Conclusions Breast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.

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Radiologic and Pathologic Correlation for Lactating Adenomas

Journal of Breast Imaging ◽

10.1093/jbi/wbaa108 ◽

2021 ◽

Vol 3 (2) ◽

pp. 208-214

Author(s):

Hoiwan Cheung ◽

Elizabeth U Parker ◽

Mark R Kilgore ◽

John R Scheel

Keyword(s):

Breast Imaging ◽

Short Interval ◽

Malignant Potential ◽

Postpartum Women ◽

Breast Lesions ◽

Lactating Women ◽

Neoplastic Processes ◽

Imaging Characteristics ◽

Benign Breast Lesions

Abstract Lactating adenomas are benign breast lesions that occur in pregnant, lactating, and postpartum women. These lesions have no associated malignant potential; their origin is disputed with no consensus on whether they represent hyperplastic or neoplastic processes. On ultrasound, lactating adenomas are classically described as solid, circumscribed, parallel masses with iso/hypoechoic internal echotexture and posterior enhancement. Histologically, lactating adenomas appear as circumscribed nodules of tightly packed lobular acini with extensive lactational change during pregnancy or the postpartum period. Masses in pregnant and lactating women with probably benign imaging characteristics—oval, circumscribed, parallel, iso/hypoechoic—can be managed with short interval follow-up (BI-RADS 3) rather than biopsy. However, lactating adenomas can also demonstrate characteristics that overlap with pregnancy-associated breast cancer, such as margins that are not circumscribed, prompting biopsy to exclude pregnancy-associated carcinoma. Breast imaging radiologists must be aware of the variable appearances of lactating adenomas to appropriately manage pregnant and lactating women presenting with palpable lumps.

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Diagnosis of Papillary Breast Lesions on Core Needle Biopsy: Upgrade Rates and Interobserver Variability

International Journal of Surgical Pathology ◽

10.1177/1066896919854543 ◽

2019 ◽

Vol 27 (7) ◽

pp. 736-743 ◽

Cited By ~ 1

Author(s):

Lianqun Qiu ◽

Daniel D. Mais ◽

Marlo Nicolas ◽

Jennifer Nanyes ◽

Kenneth Kist ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Imaging ◽

Interobserver Variability ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Breast Lesions ◽

Ductal Hyperplasia ◽

Papillary Lesions

The histologic distinction between papillary breast lesions remains challenging, especially with core biopsy (CB) specimens. A retrospective review of the clinical, imaging, and histologic findings was performed for patients with papillary breast lesions on CB from 2013 to 2017. The interpretation accuracy was expressed as upgrade rate relative to the excision diagnosis. Diagnostic reproducibility with and without immunohistochemistry was analyzed as interobserver variability among 3 board-certified pathologists. Among 57 papillary lesions with biopsies and excisions available for review, the upgrade rates were 0% for benign papilloma, 30% for papilloma with atypical ductal hyperplasia, and 25% for papilloma with ductal carcinoma in situ, resulting in an overall upgrade rate of 11.1%. There were no statistical differences between patients in an upgrade group and others, when comparing the patient age, clinical presentation, BI-RADS (Breast Imaging Reporting and Database System) category, location, and histologic grade. The overall interobserver variability of the 60 consecutive core biopsies of papillary breast lesions by morphology alone was in the “substantial” agreement range (κ = 0.79, 86% agreement), with an excellent κ score of 0.88 for papilloma (92% agreement). “Substantial” and “fair” κ values were seen for papilloma with atypical ductal hyperplasia/ductal carcinoma in situ (0.74, 84% agreement) and invasive carcinoma (0.40, 60% agreement). Use of immunohistochemical stains improved the κ values into “excellent” range (0.92, 94% agreement). Our study favors a conservative approach in the management of benign papillomas, at least in cases of good radiologic-pathologic concordance. Papillary breast lesions with atypia/malignancy show lower diagnostic reproducibility on CB, and utility of immunohistochemistry is recommended in challenging cases.

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Consultant Radiographer-led Ultrasound-guided Vacuum Assisted Excision Biopsy

Ultrasound ◽

10.1179/174313408x321012 ◽

2008 ◽

Vol 16 (4) ◽

pp. 234-237 ◽

Cited By ~ 2

Author(s):

Sarah Lawson

Keyword(s):

Current Evidence ◽

Excision Biopsy ◽

Evidence Based ◽

Breast Lesions ◽

Ultrasound Guided ◽

Appropriate Treatment ◽

Working Practices ◽

Cost Efficient

The recent introduction of ultrasound-guided vacuum assisted biopsy (VAB) has led to an increase in the non-operative diagnosis of indeterminate breast lesions. Local working practices have evolved in line with current evidence-based research for ultrasound-guided vacuum assisted excision biopsy of a selected group of these indeterminate lesions. Due to service demands and role extension within the professions allied to health, opportunities have arisen to train radiographers with proven expert practice in breast ultrasound in interventional procedures. Departmental policy has been established to support such suitably experienced radiographers to train and undertake this procedure. Aims have been to provide an effective, acceptable, cost-efficient service which can be accessed as an alternative to surgery. This paper demonstrates how with audited training, competence can be established. Discussion of initial experience suggests that once long-term effective follow up is reported, excision VAB could become established as an appropriate treatment for some patients with initial B3 core biopsy histology.

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Hemostasis using re-radiofrequency ablation for hepatic tract bleeding after ultrasound-guided percutaneous radiofrequency ablation of hepatic tumors

British Journal of Radiology ◽

10.1259/bjr.20210353 ◽

2021 ◽

pp. 20210353

Author(s):

Kyoung Doo Song ◽

Min Woo Lee ◽

Hyunchul Rhim ◽

Tae Wook Kang

Keyword(s):

Radiofrequency Ablation ◽

Medical Center ◽

Transarterial Embolization ◽

Ultrasound Images ◽

Hepatic Tumors ◽

Ultrasound Guided ◽

Additional Measure ◽

External Compression ◽

Needle Tract

Objective: To evaluate the hemostatic efficacy of re-radiofrequency ablation (re-RFA) for hepatic tract bleeding after ultrasound-guided RFA of hepatic tumors. Methods: A total of 4679 percutaneous ultrasound-guided RFA procedures were performed for hepatic tumors at Samsung Medical Center between January 2012 and December 2020. We identified patients who had hepatic tract bleeding after RFA by reviewing radiologic reports and ultrasound images and investigated the measures taken to control the bleeding and their outcomes. We also identified patients who had a significant peritoneal hematoma on immediate post-RFA CT or underwent transarterial embolization to control hepatic bleeding after RFA of hepatic tumors. Results: In total, 91 patients with tract bleeding after RFA were identified. As initial measures to control the bleeding, external compression, re-RFA, and observation were performed in 71 (78%), 17 (19%), and 3 (3%) patients, respectively. Hemostasis using re-RFA was attempted to control tract bleeding in 40 patients as an initial measure or an additional measure after other initial efforts. In all 40 patients, the bleeding stopped after re-RFA on Doppler ultrasound, and there was no active bleeding on the immediate follow-up CT. During the study period, in the years when re-RFA was performed frequently, the number of transarterial embolizations to control tract bleeding and significant peritoneal hematoma formation tended to be low. Conclusion: Hemostasis using re-RFA of the needle tract is effective in controlling tract bleeding after ultrasound-guided RFA of hepatic tumors. Advances in knowledge: Re-RFA is a simple, safe, and effective method to control tract bleeding.

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Surgical Follow-Up and Clinical Presentation of 142 Breast Papillary Lesions Diagnosed by Ultrasound-Guided Core-Needle Biopsy

Annals of Surgical Oncology ◽

10.1245/s10434-007-9780-2 ◽

2008 ◽

Vol 15 (4) ◽

pp. 1040-1047 ◽

Cited By ~ 89

Author(s):

Monica Rizzo ◽

Mary Jo Lund ◽

Gabriela Oprea ◽

Matthew Schniederjan ◽

William C Wood ◽

...

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Clinical Presentation ◽

Ultrasound Guided ◽

Core Needle ◽

Papillary Lesions

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Primary breast MALT lymphoma: a case report

Mastology ◽

10.29289/2594539420210034 ◽

2021 ◽

Vol 31 ◽

Author(s):

Pedro Toscano Paffer ◽

Ana Luiza Serra Coimbra ◽

Gustavo Fonseca de Albuquerque Souza ◽

Lucas Nunes Viana da Costa ◽

Matheus Toscano Paffer ◽

...

Keyword(s):

Risk Factors ◽

Malt Lymphoma ◽

Breast Imaging ◽

Left Breast ◽

Medical Clinic ◽

Ultrasound Guided ◽

Specialist Physician ◽

History Of ◽

Immunohistochemical Studies

A 42-year-old woman, with no history of autoimmune diseases or risk factors for cancer, sought a private medical clinic for undergoing breast imaging tests, noticing the presence of a solid nodule with indistinct margins — BI-RADS 4 — in the left breast. An ultrasound-guided core biopsy was performed and complemented by histopathological and immunohistochemical studies, confirming the diagnosis of primary small B-cell MALT lymphoma. After treatment with radiotherapy, the patient evolved with remission, maintaining annual follow-up with a specialist physician. The importance of routine screening for pathologies that affect the breasts is highlighted, aiming at their early diagnosis. In addition, radiotherapy has good prognostic results at the expense of surgical treatment.

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