Role of one-pass breast lesion excision system in complete excision of high-risk breast lesions with atypia expressed as clusters of microcalcifications

  • Alexandra ChristouEmail author
  • Vassilis Koutoulidis
  • Dimitra Koulocheri
  • Evangelia Panourgias
  • Afrodite Nonni
  • Constantinos G. Zografos
  • George C. Zografos



To assess the role of the breast lesion excision system (BLES) in complete removal of clusters of microcalcifications found on mammogram proved histologically to be high-risk lesions with cell atypia.

Methods and materials

Three hundred ninety-four consecutive women (mean age 58.5 years, range 39–78 years) with 400 clusters of suspicious microcalcifications underwent stereotactic biopsy using the intact BLES device between January 2014 and January 2016. All cases proved histologically to be high-risk lesions were subsequently assessed for complete removal. The underestimation rate was also assessed.


Thirty-eight out of 400 (9.5%) lesions were high-risk lesions with atypia with mean size 7.63 mm (st. dev. = 4.03 mm) which was within the size that the BLES needle can excise (20 mm). Four (10.5%) papillomas with atypia, 14 (36.8%) cases with flat epithelial atypia (FEA), 10 (26.3%) cases with lobular intraepithelial neoplasia (LIN-LIN 1, LIN 2), 8 (21.2%) with atypical ductal hyperplasia (ADH) and 2 (5.3%) cases with mucocele-like lesions (MLL) with atypia were found. Twenty-nine out of 38 lesions had subsequent surgery. Complete excision was achieved in 23/29 lesions (79.3%). No underestimation was found. Two-year mammographic stability was found in all lesions. Non-parametric statistical analysis showed no other significant predictive factor for complete excision apart from the distance of the lesions from the specimen margins (p = 0.031 Mann-Whitney test).


One-pass BLES intact biopsy technique is a safe method of complete removal of high-risk atypical lesions with high accuracy rates for certain histologies and could be potentially used as an alternative excision method to diagnostic surgery in selected cases.

Key Points

• Breast lesion excision system (BLES) is an image-guided biopsy technique that uses radiofrequency to remove an intact piece of tissue including the target breast neoplasm.

• Breast lesion excision system (BLES) under stereotactic guidance is able to accurately biopsy high-risk breast lesions expressed mammographically as clusters of suspicious microcalcifications.

• BLES under stereotactic guidance is an accurate technique for en bloc excision of selected cases of small clusters of suspicious microcalcifications proved to be high-risk lesions with histopathologically disease-free margins of excision.


Breast neoplasms Image-guided biopsy Margins of excision 



Atypical ductal hyperplasia


Area under the curve


Breast Imaging Reporting and Data System


Breast lesion excision system


Core biopsy




Ductal carcinoma in situ


Flat epithelial atypia




Lobular intraepithelial neoplasia


Lobular intraepithelial neoplasia type 1


Lobular intraepithelial neoplasia type 2


Mucocele-like lesion






Magnetic resonance imaging




Receiver operating characteristic

st. dev.

Standard deviation


Vacuum-assisted biopsy



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is George C Zografos, Professor of Surgery Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Georgios Dimakopoulos kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Alexandra Christou
    • 1
    Email author
  • Vassilis Koutoulidis
    • 2
  • Dimitra Koulocheri
    • 3
  • Evangelia Panourgias
    • 4
  • Afrodite Nonni
    • 5
  • Constantinos G. Zografos
    • 6
  • George C. Zografos
    • 7
  1. 1.Brighton and Sussex University NHS HospitalsBrightonUK
  2. 2.1st Department of Radiology Areteion Hospital, School of MedicineNational and Kapodistrian University of AthensAthensGreece
  3. 3.Department of RadiologyBreast Unit Hippokration HospitalAthensGreece
  4. 4.1st Department of Radiology, School of MedicineNational and Kapodistrian University of Athens Areteion HospitalAthensGreece
  5. 5.1st Department of Pathology, School of MedicineNational and Kapodistrian University of AthensAthensGreece
  6. 6.Nikaia General HospitalAthensGreece
  7. 7.Hippokration Hospital, School of MedicineNational and Kapodistrian University of AthensAthensGreece

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