Follow-up results after vacuum excision
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KeywordsCore Biopsy Architectural Distortion Papillary Lesion Radial Scar Final Histology
Vacuum-assisted excision biopsy (VAEB) has two current indications: the removal of fibroadenomas at patient request, and the removal of benign lesions of uncertain malignant potential (B3) where the perceived risk of upgrade is low.
As the primary aim of VAEB of fibroadenomas is patient satisfaction, we sent a postal patient satisfaction survey to all 81 women who had undergone VAEB of fibroadenomas in our unit. After two postings we achieved a 59% response rate. The main findings of the survey were that 79% of patients had complete resolution of the palpable abnormality and that 96% would recommend the procedure to others and undergo a further procedure if required. Fifty-four per cent reported no pain during the procedure and only 8% reported pain as greater than 2/10 on a visual analogue scale. Postprocedure pain during the following week, however, was rated at greater than 2/10 in 55%. The commonest complication was bruising.
Our unit offers VAEB to patients with B3 lesions where no atypia is present on core biopsy as an alternative to diagnostic surgical excision. We decided to audit the first 43 such cases to assess the upgrade rate and findings at follow-up imaging to see whether we needed to refine our selection criteria for VAEB. Twenty-five papillary lesions and 18 radial scars were excised under ultrasound control, the majority with an 8 G device. Following VAEB there were no upgrades of radial scars, but two lesions were missed due to difficulty in excising subtle ultrasound abnormalities and required wire localisation. Significant mammographic architectural distortion often remained following VAEB of radial scars. An 8% upgrade of papillary lesions was seen at final histology. A number of patients went on to develop further papillary lesions in the same area at follow-up. Some upgrades of papillary lesions might have been avoided by careful multidisciplinary team discussion of the core biopsies.