Shin Ho Kook MD, Presenter: Nothing to Disclose

Hyon Joo Kwag MD, Abstract Co-Author: Nothing to Disclose

Yoonjung Choi MD, Abstract Co-Author: Nothing to Disclose

Pyeong Kook Kang, Abstract Co-Author: Nothing to Disclose

To determine the role of US-guided vacuum-assisted biopsy (mammotome) for the removal of sonographic evidence of low- and high-risk benign and malignant breast lesions.

Six hundred seventy eight US-guided mammotme biopsies, using 11- (520 cases) and 8-gauge (158 cases) devices, were performed for the removal of sonographic evidence of breast lesions on sonography (BI-RADS category 3 and 4) at our institution between Mar. 2002-Feb. 2007. We retrospectively reviewed histopathologic results of mammotome biopsy lesions and grouped as low- (611 cases) and high-risk (46 cases) benign and malignant (21 cases) lesions. Surgical excision of 7 of 46 high-risk benign lesions (5 ADH, 2 phyllodes tumors) and breast conserving surgery or modified mastectomy of 20 of 21 malignant lesions (10 invasive carcinoma, 10 DCIS) were subsequently performed. We compared the histopathologic results of the mammotome biopsies and the corresponding surgically excised tissue. We also reviewed the results of follow-up US findings of low-risk (306 of 611 cases) and high-risk benign breast lesions (33 of 39 cases).

Of the 27 surgically excised cases, 15 cases (55.6%, 4 of 7 high-risk benign, 11 of 20 malignant) revealed residual lesion on mammotome biopsy site. There was no case of upgrade pathology on surgical specimen. Follow-up sonography (n=306, 6months/1year) of low-risk benign lesions showed negative finding in 231 (75.2%), post-biopsy changes in 56 (17.8%) and residual lesions in 19 (19/306, 5.7%) cases. Follow-up sonography (n=33, 1-4years) of high-risk benign lesions revealed negative finding in 28 (85%), post-biopsy scar in 4 (12%), local recur on biopsy site in 1 (3%) and none of the case show residual lesion.

We suggest the US-guided mammotome biopsy for the removal of sonographic evidence can replace the surgical excision for the low-risk benign lesions and may be not considered open surgical reexcision for high-risk benign lesions. But Surgery is crucial for malignancy confirmed lesions even though the imaging study shows no evidence of residual lesion.

This study may help to establish the guidelines for management of these patients.

Kook, S, Kwag, H, Choi, Y, Kang, P, The Role of US-guided Vacuum-assisted Breast Biopsy for Total Removal of Sonographic Evidence in Low and High-Risk Benign and Malignant Breast Lesions.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5012710.html