|ECR 2015 / C-0632|
|Is excisional biopsy warranted after a diagnosis of flat epitelial atypia (FEA) at vacuum-assisted biopsy?|
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Methods and materials
We reviewed our database of all stereotactically (n=724) and sonographically (n=521) vacuum assisted biopsy procedures performed in our hospital between January 2007 and December 2010. We included in the study 45 lesions (45 patients) biopsied under stereotactic (n=34) and sonographic (n=11) VAB guidance in which FEA was the most advanced lesion at pathologic examination.
All 45 patients underwent surgical excision (n=27) or a minimum of 2 years´ imaging follow-up (n=18).
The patient´s age, personal history of breast cancer, clinical presentation (if the lesion was palpable), mammographic breast composition, type of VAB probe, type of lesion (microcalcifications, mass, distortion, asymmetry), lesion size, BIRADS classification, percentage of lesion removal in case of calcifications, histopathology results if the patient underwent surgery or imaging follow-up if not were recorded.
FEA underestimation were defined as lesions yielding FEA at VAB and carcinoma at excisional surgery (performed immediately after VAB or during the follow-up period due to changes at site of VAB).
Bilateral mammography was performed with a dedicated FFDM unit (Senographe 2000D, GE Healthcare, Milwaukee, USA), with magnification views obtained in all cases of microcalcifications.
Ultrasonography was performed using a high –frequency linear-array 7 -12 Mhz transducer ( MyLab 70XV, Esaote, Biomedica, Genoa, Italy).
All VAB were obtained under stereotactic guidance (Fischer stereotactic table) using the 11G Mammotome® Vacuum Biopsy System (Ethicon Endosurgery, Johnson & Johnson). Specimen radiographs were routinely obtained in case of calcifications and a clip marker was deployed at the site of biopsy in cases of complete or almost complete removal of the lesion. Regular mammogram after each stereotactically guided biopsy was also performed (Fig.1).
VAB performed under sonographic guidance were performed using either 12G (n=4), 11G (n=4), 8G (n=2) and 9G (n=1) probes (Mammotome® system and ATEC® and Suros Surgical Systems) (Fig.2).
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