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Variation in Pathological Appearance Across Repeated Sampling from Probably Benign Breast Lesions.

Athanasios Zouzos1,2, Irma Fredriksson1,3, Theodoros Foukakis1,2

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Vacuum-assisted excision (VAE) shows high diagnostic discrepancies with prior biopsies for breast lesions. Avoiding fine-needle aspiration cytology (FNA) for BI-RADS 3 and 4a lesions is recommended, with VAE as a potential surgical alternative.

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B3 lesionsbreastcore-needle biopsyfine-needle aspirationvacuum-assisted excision

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Area of Science:

  • Breast oncology
  • Diagnostic pathology
  • Minimally invasive procedures

Background:

  • Benign breast lesions can have a 1-40% upgrade rate to malignancy when comparing biopsy to surgical excision.
  • Previous research has explored diagnostic discrepancies between biopsy and surgical outcomes.
  • Vacuum-assisted excision (VAE) is a minimally invasive technique for breast lesion diagnosis and treatment.

Purpose of the Study:

  • To analyze diagnostic discrepancies between initial breast biopsies (cytology and histology) and subsequent vacuum-assisted excision (VAE).
  • To determine the upgrade rate to malignancy based on different biopsy methods prior to VAE.
  • To evaluate the effectiveness of VAE as an alternative to surgical excision for specific breast lesions.

Main Methods:

  • Post hoc analysis of a Swedish randomized trial involving patients undergoing VAE between November 2019 and August 2022.
  • Inclusion of patients with initial biopsy (fine-needle aspiration cytology [FNA] or core-needle biopsy [CNB]) preceding VAE.
  • Collection and comparison of pathology reports from biopsy, VAE, surgical excision, and recurrence, with at least 2 years of clinical and imaging follow-up.

Main Results:

  • Diagnostic discrepancy between FNA and VAE was 38% (27/71), and between CNB and VAE was 29% (37/126).
  • Upgrade rate to cancer was 7% (5/71) for FNA and 5% (6/126) for CNB.
  • The highest upgrade rate to cancer in the CNB group was 25% (3/12) for lesions with prior atypical ductal hyperplasia (ADH).

Conclusions:

  • High upgrade rates were observed between prior CNB (15%) and FNA (24%) and VAE, indicating significant diagnostic discrepancies.
  • Findings suggest avoiding FNA for BI-RADS 3 and 4a breast lesions.
  • Multi-round VAE may serve as a safe and effective alternative to surgery for selected cases, particularly those with ADH on CNB.