A Single Centre Feasibility Study of Vacuum Assisted Breast Biopsy Excision as a Non-Surgical Alternative for Selected Women With Borderline Breast Lesions.

introductionBased on opinion-based clinical guidelines, VAB Ex has been introduced into clinical practice in the UK, Europe, and New Zealand for subsets of borderline breast lesions (BBL) but to date has little uptake in Australia.

aimsIn the setting of a large Australian teaching hospital, our aims were to determine if VAB Ex is a feasible and effective alternative to surgical breast biopsy (SBB) for women with BBL and is acceptable to our patient population.

methodsFollowing ethics approval, this is a prospective pilot of VAB Ex as an alternative to SBB for establishing the definitive diagnosis in women whose prior needle biopsies showed a specific range of BBL and a low risk of malignant upgrade. Surgeons at our centre identified potentially eligible candidates, and radiologists determined technical suitability. Eligible women were offered the choice of VAB Ex and surgical breast biopsy, and their decision was recorded. Radiologists performed VAB Ex at the medical imaging department. Following histologic evaluation, MDT review determined the next steps in patient care.

resultsA total of 31 women with 33 lesions (2 women each had 2 lesions) were eligible for VAB Ex. They all accepted the offer of VAB Ex instead of SBB. The mean patient age was 57.8 years. (range 35-85 years). Image guidance for VAB Ex was by ultrasound in 31 lesions any by stereotaxis in 2, all using 7G needles. Successful lesion removal was achieved in 100% cases. No adverse events requiring medical intervention were encountered. The mean specimen weight was 1.7 g, range (0.47-6.6 g). The mean lesion extent on VAB Ex was 6 mm (range 3-15 mm). Intraductal papilloma was the most common diagnosis (18 cases), radial scar (6), fibrocystic change (4), DCIS (3), adenomyoepithelioma (1) and granulomatous mastitis (1). Among 28 of 31 (90.3%) women had benign VAB Ex findings and did not require surgery. The three patients with DCIS on VAB Ex had breast conserving surgery, confirming DCIS and a 4.5 mm tubular carcinoma in one case. Patient feedback indicated little experience of pain or discomfort and return to usual duties within 24 h. A cost analysis found saving of AUS $2849.67 per patient.

conclusionAustralian women prefer VAB Ex to SBB and Australian breast surgeons are key supporters of this patient-centred innovation. Overall, 90% of our patients with low-risk BBL had benign results and did not require surgical biopsy. VAB Ex provides cost-effective care.