The Role of Ultrasound-Guided Vaccum-Assisted Breast Biopsy Systems in Management of Breast Lesions

Abstract

Benign lesions of the breast are far more frequent than malignant ones. The incidence of benign breast lesions begins to rise during the second decade of life and peaks in the fourth and fifth decades.

Much concern is given to malignant lesions of the breast because breast cancer is the most common malignancy in women in Western countries. It is the second leading cause of cancer death (lung is first) in women.

Reaching a definite diagnosis via biopsy is necessary. In case the lesion is benign, the patient would be able to avoid unnecessary surgical excision or protracted follow-up(Hatmaker et al., 2006).

Generally any lesion, palpable or non- palpable, which is not definitely benign should be biopsied.

FNA biopsy is a simple, quick and low cost technique. It’s useful in sampling suspicious lymph nodes and for evaluating cystic fluid that is bloody or that comes from an incompletely collapsed or recurrent cyst. For sampling solid breast lesions, the false-negative results were disappointing(Kass et al, 2007). Core needle biopsy (CNB) is more advantageous to FNA biopsy. It provides histological material for morphological as well as cellular assessment. In order to ensure adequate tissue sampling, five to 10 cores are obtained. The biopsy guns typically used for US-CNB range from 12-gauge up to 14-gauge with a throw of 1 to 2.3 cm, accordingly, there’s a high probability of failure of the biopsy procedure in sub-centimetric solid lesions. Furthermore, though the diagnostic accuracy of CNB is high, the severity of the disease is sometimes underestimated(Vlastos and Verkooijen, 2007). This has led to the introduction of the one single large-core radiofrequency biopsy system and four vacuum assisted biopsy systems which are suitable for use under ultrasound guidance(Wilson and Kavia, 2009). Both systems allow single insertion of the needle and directional sampling. Also, a larger amount of tissue is acquired, resulting in more accurate pathology results and providing more accurate characterization of the lesions.

VAM and BLES are accurate techniques which are faster, less invasive, and less expensive than surgery and cause no deformity. They provide an alternative to surgery for the removal of known benign lesions such as fibroadenomas and focal fibrous lesions.

VAM and BLES should not be used for excision of known malignant lesions or borderline lesions associated with a significant risk of breast cancer(Wilson and Kavia, 2009).

Although VAM seems to have many advantages, investigators appear to be concerned about the underestimation rates of (ADH) and (DCIS). Compared to the VAM, the BLES demonstrated statistically significant lower underestimation rates of (DCIS) and (ADH) at biopsy(Al-Harethee et al., 2013).

The minimally invasive Breast Lesion Excision System (Intact Medical) represents a safe and efficacious alternative to the well-established vacuum-assisted breast biopsy technology. BLES has the ability to deliver a sample with intact architecture, enabling accurate histologic diagnosis(Michalopoulos et al., 2012)