Percutaneous Excision: A Viable Alternative to Manage Benign Breast Lesions

• Published in: Canadian Association of Radiologists journal 2011-11, Vol.62 (4), p.265-271
• Main Authors: Slanetz, Priscilla J., MD, MPH, FACR, Wu, Shieh-Pei, MD, Mendel, Jeffrey B., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Benign breast disease; Biopsy; Breast; Breast biopsy; Breast cancer; Breast Diseases - diagnostic imaging; Breast Diseases - surgery; Breast ultrasound; Breasts; Female; Fibroadenoma; Humans; Male; Mammography; Middle Aged; Patient safety; Patient Satisfaction; Radiology; Studies; Treatment Outcome; Tumors; Ultrasonic imaging; Ultrasonography, Interventional; Vacuum; Womens health
• ISSN: 0846-5371; 1488-2361
• DOI: 10.1016/j.carj.2010.05.002

Abstract Objective Benign breast masses, such as fibroadenomas, are common, and their management is variable, depending on symptoms and patient concerns. We undertook this study to determine the safety, efficacy, and patient acceptance of percutaneous excision of benign breast masses by using a hand-held vacuum-assisted device. Methods By using sonographic guidance, percutaneous removal was performed in 40 patients with 42 lesions by using a 9-gauge ( n = 13) or 12-gauge ( n = 29) probe (ATEC; Suros Surgical). Technical success, procedural complications, and patient experience were recorded at the time of excision and at 48 hours. Clinical, imaging, and/or surgical follow-up was obtained for 39 of 42 lesions (93%). Three of 42 lesions (7%) were lost to follow-up. Results Of 42 lesions, maximal diameters ranged from 0.6–4.0 cm (mean 1.6 cm), with lesion volumes between 0.05 and 11.2 mL (mean [SD] 1.4 ± 2.1 mL, median 7 mL). The procedure was well tolerated by all patients, and no residual mass was visible in any case at the conclusion of the procedure. All the patients preferred this approach to open surgical biopsy. After percutaneous excision, surgery was performed on 3 of 42 lesions (7%) for atypia ( n = 2) or malignancy ( n = 1), with a residual mass found only for the malignant case. Of the 26 of 42 lesions (62%) with imaging follow-up, 24 (92%) had no lesion recurrence. Overall, the procedure either completely removed the mass and/or relieved the patient's symptoms of a mass in 36 of 39 lesions (92%) for which clinical, imaging, and/or surgical follow-up was available. Three lesions were lost to follow-up. Conclusion Ultrasound-guided percutaneous excision of benign breast masses is a safe, effective, and well-tolerated minimally invasive procedure for the diagnosis and removal of benign breast masses. It may serve as an alternative to surgical excision for women with a known benign or probably benign breast mass who desire excision but prefer to avoid surgery or who are poor surgical candidates.