Ali Riza Sever MD, Abstract Co-Author: Nothing to Disclose

Philippa Mills MD, Presenter: Nothing to Disclose

David Fish, Abstract Co-Author: Nothing to Disclose

Sue Ellen Jones, Abstract Co-Author: Nothing to Disclose

Peter A Jones MD, Abstract Co-Author: Nothing to Disclose

To evaluate the effectiveness of image-guided removal of breast lesions with uncertain malignant potential using vacuum-assisted biopsy devices and assess the completeness and local recurrence rates of these lesions.

The UK Breast Screening Program Pathology sub group has defined a category of uncertain malignant potential lesions which may provide benign histology on core biopsy but are known to show heterogeneity or to have an increased risk of associated malignancy. Papillomas and radial scars are among this group and surgical excision is recommended. However with the advent of large-core vacuum-assisted devices,image guided complete removal of this group of lesions is possible. Between August 2001 and December 2007, 36 breast lesions were removed using vacuum-assisted biopsy devices. Complete removal was aimed in each case. Three different biopsy systems were used having different needle sizes varying 12-8 Gauge, being 11-Gauge needle in most cases (29). Follow-up was performed 4-60 months after removal. Lesion size, type, biopsy guidance, symptom disappearance, and local recurrence were evaluated. The need for further surgery was also assessed.

None of the 36 cases required any further surgery. There were 23 (64%) papillomas measuring 4-22 mm. Stereotactic excision was performed in 3 patients (2 following ductogram) and remaining excisions were done under US control using hand-held device. Presenting symptom was nipple discharge in 9 cases, and recurrence was noted in 2 patients (8.7%). Remaining cases revealed no residual lesion or discharge. 13 (36%) lesions were radial scars measuring 6-15 mm. 5 lesions were removed under stereotactic guidance. Follow-up imaging revealed no residual lesions or recurrences.

Image guided percutaneous removal of papillomas and radial scars is a safe practice and can be offered as an alternate to surgery. Papillomas can recur if removal is incomplete.

To prove the efficacy of percutaneous removal of papillomas and radial scars using vacuum-assisted devices which can replace a surgery.

Sever, A, Mills, P, Fish, D, Jones, S, Jones, P, Vacuum-assisted Percutaneous Removal of Breast Lesions: Papillomas and Radial Scars.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6017424.html