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The Evolving Role of Vacuum Assisted Biopsy of the Breast: A Progression from Fine-Needle Aspiration Biopsy

  • Ian C. BennettEmail author
  • Apoorva Saboo
Scientific Review

Abstract

Background

The management of breast disease has been greatly facilitated by the technology of needle biopsy interventions, and over the past 30 years, this has evolved from the use of fine-needle aspiration biopsy (FNAB) to the current methodology of vacuum assisted biopsy (VAB).

Methods

This article provides an historical review of the application of needle interventions of the breast in the diagnosis and management of breast conditions, and discusses current indications for the use of vacuum assisted biopsies and vacuum assisted excisions.

Results

Whilst FNAB continues to have a limited role in breast disease diagnosis, the necessity of achieving an histological diagnosis has preferentially seen the development and wider application of automated core needle biopsies (CNB) and VAB in the assessment and management of breast lesions. The advantages of CNB and VAB include the ability to distinguish in situ and invasive disease pre-operatively, and the ability to achieve prior knowledge of immunohistochemical tumour markers particularly in the setting of neoadjuvant drug treatments.

Conclusion

Due to its ability to obtain larger tissue samples, VAB does have diagnostic advantages over CNB and indications for the utilization of VAB are discussed. VAB additionally has an expanding role as a tool for breast lesion excision.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Richard J Santen MD (2017) Benign breast disease in women; Endotext: www.endotext.org
  2. 2.
    Ying-Hua Yu, Liang Chi, Yuan Xi-Zi (2010) Diagnostic value of vacuum-assisted breast biopsy for breast carcinoma: a meta-analysis and systematic review. Breast Cancer Res Treat 120:469–479CrossRefGoogle Scholar
  3. 3.
    Franzen S (1968) Zajicek j. Acta Radiol 7:241Google Scholar
  4. 4.
    Lundgren CI, Zedenius J, Skoog L (2008) Fine-Needle aspiration biopsy of benign thyroid nodules: an evidence–based review. World J Surg 32:1247–1252.  https://doi.org/10.1007/s00268-008-9578-9 CrossRefGoogle Scholar
  5. 5.
    Furnival CM, Hughes HE, Hocking MA, Reid MMW, Blumgart LH (1975) Aspiration cytology in breast cancer: its relevance to diagnosis. Lancet 2(7932):446–449CrossRefGoogle Scholar
  6. 6.
    Dixon JM, Anderson TJ, Lamb J, Nixon SJ, Forrest APM (1984) Fine needle aspiration cytology in relationship to clinical examination and mammography in the diagnosis of a solid breast mass. Br J Surg 71:593–596CrossRefGoogle Scholar
  7. 7.
    Kharkwal S, Sameer AM (2014) Triple test in carcinoma breast. J Clin Diagn Res 8(10):NC09–NC11.  https://doi.org/10.7860/jcdr/2014/9237.4971 Google Scholar
  8. 8.
    Giard RW, Hermans J (1992) The value of aspiration cytologic examination of the breast. A statistical review of the medical literature. Cancer 69:2104–2110CrossRefGoogle Scholar
  9. 9.
    He Q, Fan X, Yuan T et al (2007) Eleven years of experience reveals that fine-needle aspiration cytology is still a useful method for preoperative diagnosis of breast carcinoma. Breast 16:303–306CrossRefGoogle Scholar
  10. 10.
    Willems SM, van Deurzen CHM, van Diest P (2012) Diagnosis of breast lesions: fine-needle aspiration cytology or core needle biopsy? A review. J Clin Pathol 65:287–292CrossRefGoogle Scholar
  11. 11.
    Barrows GH, Anderson TJ, Lamb JL et al (1986) Fine-needle aspiration of breast cancer. Relationship of clinical factors to cytology results in 689 primary malignancies. Cancer 58:1493–1498CrossRefGoogle Scholar
  12. 12.
    American College of Radiology BI-RADS Reporting Classification. http://www.acr.org/Quality-Safety/RAD
  13. 13.
    Gornstein B, Jacobs T, Bedard Y et al (2004) Interobserver agreement of a probabilistic approach to reporting breast fine-needle aspirations on ThinPrep. Diagn Cytopathol 30:389–395CrossRefGoogle Scholar
  14. 14.
    Cote JF, Klijanieko J, Meunier M et al (1998) Stereotactic fine-needle aspiration cytology of nonpalpable breast lesions: institute Curie’s experience of 243 histologically correlated lesions. Cancer 84:77–83CrossRefGoogle Scholar
  15. 15.
    Lieske B, Ravichandran D, Wright D (2006) Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma. Br J Cancer 95:62–66CrossRefGoogle Scholar
  16. 16.
    Collins LC, Connolly JL, Page DL et al (2004) Diagnostic agreement in the evaluation of image-guided breast core needle biopsies: results from a randomized clinical trial. Am J Surg Pathol 28:126–131CrossRefGoogle Scholar
  17. 17.
    Sauer T, Garred O, Lomo J et al (2006) Assessing invasion criteria in fine needle aspirates from breast carcinoma diagnosed as DICS or invasive carcinoma: can we identify an invasive component in addition to DCIS? Acta Cytol 50:263–270CrossRefGoogle Scholar
  18. 18.
    Di LC, Puglisi F, Rimondi G et al (1996) Large core biopsy for diagnostic and prognostic evaluation of invasive breast carcinomas. Eur J Cancer 32A:1693–1700Google Scholar
  19. 19.
    Badoual C, Maruani A, Ghorra C et al (2005) Pathological prognostic factors of invasive breast carcinoma in ultrasound-guided large core biopsies—correlation with subsequent surgical excisions. Breast 14:22–27CrossRefGoogle Scholar
  20. 20.
    Rakha EA, Ellis IO (2007) An overview of assessment of prognostic and predictive factors in breast cancer needle core biopsy specimens. J Clin Pathol 60:1300–1306CrossRefGoogle Scholar
  21. 21.
    Konofaos P, Kontzoglou K, Georgoulakis J et al (2006) The role of ThinPrep cytology in the evaluation of estrogen and progesterone receptor content of breast tumors. Surg Oncol 15:257–266CrossRefGoogle Scholar
  22. 22.
    Britton PD, Flower CD, Freeman AH, Sinnatamby R, Warren R, Goddard MJ, Wight DG, Bobrow L (1997) Changing to core biopsy in an NHS breast screening unit. Clin Radiol 52(10):764–767CrossRefGoogle Scholar
  23. 23.
    Gordon PB, Goldenberg SL, Chan NH (1993) Solid breast lesions: diagnosis with US-guided fine-needle aspiration biopsy. Radiology 189:573–580CrossRefGoogle Scholar
  24. 24.
    Berner A, Davidson B, Sigstad E et al (2003) Fine-needle aspiration cytology vs. core biopsy in the diagnosis of breast lesions. Diagn Cytopathol 29:344–348CrossRefGoogle Scholar
  25. 25.
    Clarke D, Sudhakaran N, Gateley CA (2001) Replace fine needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer. Ann R Coll Surg Engl 83:110–112Google Scholar
  26. 26.
    Poole GH, Willsher PC, Pinder SE et al (1996) Diagnosis of breast cancer with core-biopsy and fine needle aspiration cytology. Aust NZ J Surg 66:592–594CrossRefGoogle Scholar
  27. 27.
    BreastScreen Australia National Accreditation Standards October 2015. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bsa-nas-comm
  28. 28.
    BreastScreen Queensland Open Biopsy Data Report; BSQ Surgery Quality Group Meeting 27 May 2016. Report to meetingGoogle Scholar
  29. 29.
    Ferzli GS, Hurwitz JB, Puza T, Vorst-Bilotti SV (1997) Advanced breast biopsy instrumentation: a critique. J Am Coll Surg 185(2):145–151CrossRefGoogle Scholar
  30. 30.
    Smathers RL (2000) Advanced breast biopsy instrumentation device percentages of lesion and surrounding tissue removed. Am J Roentgenol 175(3):801–803CrossRefGoogle Scholar
  31. 31.
    Burbank F (1997) Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy. Radiology 202(3):843–847CrossRefGoogle Scholar
  32. 32.
    Duchesne N, Parker SH, Lechner MC, Gittleman MA, Kusnick CA, Elvecrog EE, Kaske TI, Gizienski TA (2007) Multicenter evaluation of a new ultrasound-guided biopsy device: improved ergonomics, sampling and rebiopsy rates. Breast J. 13(1):36–43CrossRefGoogle Scholar
  33. 33.
    Parker SH, Klaus AJ, McWey PJ, Schilling KJ, Cupples TE, Duchesne N, Guenin MA, Harness JK (2001) Sonographically guided directional vacuum-assisted breast biopsy using a handheld device. AJR Am J Roentgenol 177(2):405–408CrossRefGoogle Scholar
  34. 34.
    Zannis VJ, Aliano KM (1998) The evolving practice pattern of the breast surgeon with disappearance of open biopsy for nonpalpable lesions. Am J Surg 176:525–528CrossRefGoogle Scholar
  35. 35.
    Krug B, Hellmich M, Ulhaas A, Krämer S, Rhiem K, Zarghooni V, Püsken M, Schwabe H, Grinstein O, Markiefka B, Maintz D (2016) Vacuum-assisted breast biopsies (VAB) carried out on an open 1.0T MR imager: influence of patient and target characteristics on the procedural and clinical results. Eur J Radiol. 85(6):1157–1166CrossRefGoogle Scholar
  36. 36.
    Imschweiler T, Haueisen H, Kampmann G, Rageth L, Seifert B, Rageth C, Freiwald B, Kubik-Huch RA (2014) MRI-guided vacuum-assisted breast biopsy: comparison with stereotactically guided and ultrasound-guided techniques. Eur Radiol 24(1):128–135CrossRefGoogle Scholar
  37. 37.
    Wang ZL, Liu G, Li JL, Su L, Liu XJ, Wang W, Tang J (2011) Breast lesions with imaging-histologic discordance during 16-gauge core needle biopsy system: would vacuum-assisted removal get significantly more definitive histologic diagnosis than vacuum-assisted biopsy? Breast J 17(5):456–461CrossRefGoogle Scholar
  38. 38.
    Cassano E, Urban LABD, Pizzamiglio M, Abbate F, Maisonneuve P, Renne G et al (2007) Ultrasound-guided vacuumassisted core breast biopsy: experience with 406 cases. Breast Cancer Res Treat 102:103–110CrossRefGoogle Scholar
  39. 39.
    Suh YJ, Kim MJ, Kim E-K, Moon HJ, Kwak JY, Koo HR, Yoon JH (2012) Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 8- or 11-gauge vacuum-assisted biopsy. Br J Radiol 85:e349–e356CrossRefGoogle Scholar
  40. 40.
    Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR et al (2011) Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology 260(10):119–128CrossRefGoogle Scholar
  41. 41.
    Strachan C, Horgan K, Millican-Slater RA et al (2016) Outcome of a new patient pathway for managing B3 breast lesions by vacuum-assisted biopsy: time to change current UK practice? J Clin Pathol 69(3):248–254CrossRefGoogle Scholar
  42. 42.
    Londero V, Zuiani C, Linda A, Battigelli L, Brondani G, Bazzocchi M (2011) Borderline breast lesions: comparison of malignancy underestimation rates with 14-gauge core needle biopsy versus 11-gauge vacuum-assisted device. Eur Radiol 21:1200–1206CrossRefGoogle Scholar
  43. 43.
    Mátrai Z, Gulyás G, Kunos C, Sávolt A, Farkas E, Szollár A, Kásler M (2014) Minimally invasive breast surgery. Orv Hetil 155(5):162–169CrossRefGoogle Scholar
  44. 44.
    Park HL, Hong J (2014) Vacuum-assisted breast biopsy for breast cancer. Gland Surg 3(2):120–127Google Scholar
  45. 45.
    Hahn M, Krainick-Strobel U, Toellner T, Gissler J, Kluge S, Krapfl E, Peisker U, Duda V, Degenhardt F, Sinn HP, Wallwiener D, Gruber IV (2012) Interdisciplinary consensus recommendations for the use of vacuum-assisted breast biopsy under sonographic guidance: first update 2012. Minimally Invasive Breast Intervention Study Group (AG MiMi) of the German Society of Senology (DGS); Study Group for Breast Ultrasonography of the German Society for Ultrasound in Medicine (DEGUM). Ultraschall Med. 33(4):366–371CrossRefGoogle Scholar
  46. 46.
    March DE, Coughlin BF, Barham RB et al (2003) Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device–initial experience. Radiology 227:549–555CrossRefGoogle Scholar
  47. 47.
    Sperber F, Blank A, Metser U et al (2003) Diagnosis and treatment of breast fibroadenomas by ultrasound-guided vacuum-assisted biopsy. Arch Surg 138:796–800CrossRefGoogle Scholar
  48. 48.
    Johnson AT, Henry-Tillman RS, Smith LF et al (2002) Percutaneous excisional breast biopsy. Am J Surg 184:550–554 (discussion 554) CrossRefGoogle Scholar
  49. 49.
    Fine RE, Boyd BA, Whitworth PW, Kim JA, Harness JK, Burak WE (2002) Percutaneous removal of benign breast masses using a vacuum-assisted handheld device with ultrasound guidance. Am J Surg 184:332–336CrossRefGoogle Scholar
  50. 50.
    Povoski SP, Jimenez RE (2007) A comprehensive evaluation of the 8-gauge vacuum-assisted Mammotome(R) system for ultrasound-guided diagnostic biopsy and selective excision of breast lesions. World J Surg Oncol 5:83CrossRefGoogle Scholar
  51. 51.
    Lee SH, Kim EK, Kim MJ, Moon HJ, Yoon JH (2014) Vacuum-assisted breast biopsy under ultrasonographic guidance: analysis of a 10-year experience. Ultrasonography 33(4):259–266CrossRefGoogle Scholar
  52. 52.
    Dennis MA, Parker S, Kaske T et al (2000) Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy. Am J Roentgenol 174:1263–1268CrossRefGoogle Scholar
  53. 53.
    Tennant SL, Evans A, Hamilton LJ et al (2008) Vacuum-assisted excision of breast lesions of uncertain malignant potential (B3)—an alternative to surgery in selected cases. Breast 17:546–549CrossRefGoogle Scholar
  54. 54.
    Rakha EA, Lee AH, Jenkins JA, Murphy AE, Hamilton L et al (2011) Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Int J Cancer 129(6):1417–1424CrossRefGoogle Scholar
  55. 55.
    Alonso-Bartolomé P, Vega-Bolıvar A, Torres-Tabanera M, Ortega E, Acebal-Blanco M et al (2004) Sonographically guided 11-G directional vacuum-assisted breast biopsy as an alternative to surgical excision: utility and cost study in probably benign lesions. Acta Radiol 45:390–396CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Breast and Endocrine Surgical Unit, Princess Alexandra HospitalUniversity of QueenslandWoolloongabba, BrisbaneAustralia

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