Bicchierai Giulia, Pugliese Francesca, Amato Francesco, De Benedetto Diego, Boeri Cecilia, Vanzi Ermanno, Di Naro Federica, Bianchi Simonetta, Cossu Elsa, Miele Vittorio, Nori Jacopo
Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy.
Radiology Department, Ospedale San Giovanni di Dio, Agrigento, Italy.
Radiol Med. 2023 May;128(5):528-536. doi: 10.1007/s11547-023-01626-5. Epub 2023 Apr 8.
In recent years vacuum-assisted excision (VAE) has been described as an alternative treatment for some B3 lesions. This study aims to assess the effectiveness of using VAE to manage selected B3 lesions by quantifying the number of B3 lesions undergoing VAE, the malignant upgrade rate, and the complications encountered.
Our department evaluated all B3 lesions diagnosed between January 2019 and October 2021 and treated them with VAE. The data were collected during the initial biopsy and final histology based on VAE image guidance, also considering initial lesions and complications. The exclusion criteria were: B3 lesion of size > 20 mm, presence of a concomitant malignant lesion, lesion < 5.0 mm distant from the skin, nipple or pectoral muscle, phyllodes tumours or indeterminate B3 lesions. Lesions that upgraded to malignancy underwent surgical excision, while benign lesions performed radiological follow-ups.
From 416 B3 lesions diagnosed, 67 (16.1%) underwent VAE. VAE was performed under X-ray (50/67) or ultrasound guidance (17/67). Five cases (7.5%) upgraded to a malignant lesion, 2 ADH, 2 LIN and one papillary lesion that underwent surgery. No malignancy or new lesions has occurred at the site of the VAE, with an average radiological follow-up of 14.9 months.
VAE could be a safe and effective pathway for managing selected B3 lesions. Lesions initially subjected to CNB with ADH and LN outcome, before undergoing VAE, should perform a VAB for better tissue characterization and management.
近年来，真空辅助切除（VAE）已被描述为某些B3病变的替代治疗方法。本研究旨在通过量化接受VAE的B3病变数量、恶性升级率和所遇到的并发症，评估使用VAE治疗选定B3病变的有效性。
我们科室评估了2019年1月至2021年10月期间诊断出的所有B3病变，并采用VAE进行治疗。基于VAE图像引导，在初次活检和最终组织学检查期间收集数据，同时考虑初始病变和并发症。排除标准为：大小>20mm的B3病变、存在伴随的恶性病变、距离皮肤、乳头或胸肌<5.0mm的病变、叶状肿瘤或不确定的B3病变。升级为恶性的病变接受手术切除，而良性病变进行影像学随访。
在诊断出的416个B3病变中，67个（16.1%）接受了VAE。VAE在X线（50/67）或超声引导下（17/67）进行。5例（7.5%）升级为恶性病变，2例为非典型导管增生（ADH），2例为小叶原位癌（LIN），1例乳头状病变接受了手术。VAE部位未发生恶性病变或新病变，平均影像学随访14.9个月。
VAE可能是治疗选定B3病变的一种安全有效的方法。对于最初在接受VAE之前经粗针穿刺活检（CNB）诊断为ADH和LIN的病变，应进行真空辅助活检（VAB）以获得更好的组织特征和管理。
