Definitive diagnosis for high-risk breast lesions without open surgical excision: the Intact Percutaneous Excision...

Area of Science:

• Breast imaging and pathology
• Minimally invasive breast procedures
• Oncology and surgical pathology

Background:

• Open surgical excision (OSE) is standard for high-risk breast lesions (HRL) found via biopsy.
• Intact percutaneous excision (IPEX) is evaluated for definitive HRL diagnosis, especially atypical ductal hyperplasia (ADH).
• The study aims to identify criteria for <2% upgrade risk to carcinoma, enabling imaging surveillance.

Purpose of the Study:

• To assess the efficacy of intact percutaneous excision (IPEX) for definitive diagnosis of high-risk breast lesions (HRL).
• To establish criteria for identifying patients with atypical ductal hyperplasia (ADH) who can avoid open surgical excision (OSE).
• To determine the upgrade risk to carcinoma for HRL diagnosed with IPEX.

Main Methods:

• A prospective trial involving 1,170 patients across 25 institutions used vacuum- and radiofrequency-assisted IPEX.
• Atypical ductal hyperplasia (ADH) patients were categorized into a potential surgical avoidance population (PSAP) based on lesion removal and centering.
• IPEX findings were compared with subsequent open surgical excision (OSE) pathology.

Main Results:

• IPEX diagnosed 191 carcinomas and 83 HRL (including 32 ADH) in 1,170 patients.
• No non-ADH HRL (n=51) were upgraded to carcinoma after IPEX.
• No ADH lesions meeting PSAP criteria (n=10) upgraded to carcinoma; 3 of 22 non-PSAP ADH lesions did upgrade.

Conclusions:

• IPEX, coupled with clear histologic and radiologic criteria, is a viable management option for image-detected HRL, including ADH.
• This approach allows for imaging surveillance in select cases, potentially reducing the need for open surgical excision.
• IPEX provides definitive diagnosis for HRL, enabling appropriate patient management pathways.