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Role of vacuum assisted excision in minimising overtreatment of ductal atypias.
Eur J Radiol. 2020 Oct; 131:109258.EJ

Abstract

PURPOSE

B3 lesions are indeterminate lesions of uncertain malignant potential. They include lesions with and without epithelial atypia. Those with atypia include atypical intraductal epithelial proliferation (AIDEP)/atypical ductal hyperplasia (ADH) and flat epithelial atypia (FEA). They are traditionally managed with surgery. Vacuum assisted excision (VAE) allows larger samples to be obtained using a vacuum assisted biopsy (VAB) device, which equates to a surgical biopsy. We propose that VAE and mammographic surveillance is a safe alternative to surgery in managing the ductal atypias; (AIDEP/ADH and FEA).

METHOD

Retrospective analysis of prospectively collected data on B3 lesions (April 2009 - March 2016) from consecutive breast screening patients diagnosed with AIDEP/ADH or FEA on initial diagnostic core biopsy. Mammographic abnormality, breast density, size, management pathway and upgrade to cancer and types of cancer were also collected during the treatment pathway and 5 year surveillance period (April 2009 - April 2019).

RESULTS

273 cases of ductal atypia were identified. 187/273 (68.5 %) cases were managed with VAE only as no upgrade to malignancy and then 5 year mammographic surveillance. 34/273 (12.5 %) cases had a VAE diagnosing malignancy. 24/273 (8.8 %) cases had a VAE and then a surgical biopsy due to radiological or pathological concern, 8/24 upgraded to malignancy. 22/273 (8%) cases had a surgical diagnostic biopsy, 9/22 (41 %) cases were upgraded to malignancy. In total 51/273 (19 %) cases were diagnosed with cancer on the new pathway (13 invasive (all ER positive and Her2 negative) and 38 non-invasive, (34 ductal carcinoma in situ (DCIS) and 4 cases of lobular carcinoma in situ (LCIS)). While 17/273 (6.2 %) cases developed malignancy (12 invasive (all HER2 negative) and 4 DCIS and 1 LCIS) during the 5 year surveillance period.

CONCLUSIONS

VAE is a safe alternative to surgery in managing ductal atypias. 187/273 (68.5 %) women avoided surgery. While 34/51 cancers (66.7 %) were diagnosed preoperatively using VAE, allowing the women to have a single therapeutic procedure.

Authors+Show Affiliations

Department of Breast Radiology, Leeds Teaching Hospitals NHS Trust, United Kingdom.Department of Breast Radiology, Leeds Teaching Hospitals NHS Trust, United Kingdom.Division of Cancer and Stem Cell, School of Medicine at University of Nottingham, United Kingdom.Department of Pathology, Leeds Teaching Hospitals NHS Trust, United Kingdom.Department of Breast Radiology, Leeds Teaching Hospitals NHS Trust, United Kingdom. Electronic address: nisha.sharma2@nhs.net.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32919262

Citation

McMahon, M A., et al. "Role of Vacuum Assisted Excision in Minimising Overtreatment of Ductal Atypias." European Journal of Radiology, vol. 131, 2020, p. 109258.
McMahon MA, Haigh I, Chen Y, et al. Role of vacuum assisted excision in minimising overtreatment of ductal atypias. Eur J Radiol. 2020;131:109258.
McMahon, M. A., Haigh, I., Chen, Y., Millican-Slater, R. A., & Sharma, N. (2020). Role of vacuum assisted excision in minimising overtreatment of ductal atypias. European Journal of Radiology, 131, 109258. https://doi.org/10.1016/j.ejrad.2020.109258
McMahon MA, et al. Role of Vacuum Assisted Excision in Minimising Overtreatment of Ductal Atypias. Eur J Radiol. 2020;131:109258. PubMed PMID: 32919262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of vacuum assisted excision in minimising overtreatment of ductal atypias. AU - McMahon,M A, AU - Haigh,I, AU - Chen,Y, AU - Millican-Slater,R A, AU - Sharma,N, Y1 - 2020/09/01/ PY - 2020/06/24/received PY - 2020/08/23/revised PY - 2020/08/25/accepted PY - 2020/9/13/pubmed PY - 2021/3/24/medline PY - 2020/9/12/entrez KW - AIDEP KW - Breast cancer KW - Ductal atypia KW - FEA KW - Surveillance mammography KW - Vacuum assisted-biopsy KW - Vacuumassisted-excision SP - 109258 EP - 109258 JF - European journal of radiology JO - Eur J Radiol VL - 131 N2 - PURPOSE: B3 lesions are indeterminate lesions of uncertain malignant potential. They include lesions with and without epithelial atypia. Those with atypia include atypical intraductal epithelial proliferation (AIDEP)/atypical ductal hyperplasia (ADH) and flat epithelial atypia (FEA). They are traditionally managed with surgery. Vacuum assisted excision (VAE) allows larger samples to be obtained using a vacuum assisted biopsy (VAB) device, which equates to a surgical biopsy. We propose that VAE and mammographic surveillance is a safe alternative to surgery in managing the ductal atypias; (AIDEP/ADH and FEA). METHOD: Retrospective analysis of prospectively collected data on B3 lesions (April 2009 - March 2016) from consecutive breast screening patients diagnosed with AIDEP/ADH or FEA on initial diagnostic core biopsy. Mammographic abnormality, breast density, size, management pathway and upgrade to cancer and types of cancer were also collected during the treatment pathway and 5 year surveillance period (April 2009 - April 2019). RESULTS: 273 cases of ductal atypia were identified. 187/273 (68.5 %) cases were managed with VAE only as no upgrade to malignancy and then 5 year mammographic surveillance. 34/273 (12.5 %) cases had a VAE diagnosing malignancy. 24/273 (8.8 %) cases had a VAE and then a surgical biopsy due to radiological or pathological concern, 8/24 upgraded to malignancy. 22/273 (8%) cases had a surgical diagnostic biopsy, 9/22 (41 %) cases were upgraded to malignancy. In total 51/273 (19 %) cases were diagnosed with cancer on the new pathway (13 invasive (all ER positive and Her2 negative) and 38 non-invasive, (34 ductal carcinoma in situ (DCIS) and 4 cases of lobular carcinoma in situ (LCIS)). While 17/273 (6.2 %) cases developed malignancy (12 invasive (all HER2 negative) and 4 DCIS and 1 LCIS) during the 5 year surveillance period. CONCLUSIONS: VAE is a safe alternative to surgery in managing ductal atypias. 187/273 (68.5 %) women avoided surgery. While 34/51 cancers (66.7 %) were diagnosed preoperatively using VAE, allowing the women to have a single therapeutic procedure. SN - 1872-7727 UR - https://www.unboundmedicine.com/medline/citation/32919262/Role_of_vacuum_assisted_excision_in_minimising_overtreatment_of_ductal_atypias_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0720-048X(20)30447-2 DB - PRIME DP - Unbound Medicine ER -