European journal of radiology · 2026
Ultrasound-guided vacuum-assisted excision: A minimally invasive solution for managing imaging-histological discordant breast lesions after core needle biopsy.
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Elisa D'Ascoli, Catherine Depretto, Gianmarco Della Pepa, Gabriele Rossini, Claudia De Berardinis, Giovanni Irmici, Caterina Cazzella, Alice Bonanomi, Lisa Corradini, Laura Suman, Monica Marchesini, Eleonora Ancona, Paride Scaperrotta Gianfranco
Аннотация
OBJECTIVE: To evaluate the role of US-guided Vacuum-assisted excision (VAE) in the management of imaging-histological discordant lesions after core needle biopsy (CNB), avoiding unnecessary surgical excision.
MATERIALS AND METHODS: We retrospectively evaluated all patients who underwent US-guided VAE with a 9 G needle between January 2015 and August 2023 for imaging-histological discordance after CNB. We determined the upgrade rate to malignancy (UR) after VAE and delayed false-negative results after surgery or follow-up. We assessed the diagnostic performance of the procedure, technical efficacy (TE), technical success (TS), the occurrence of complications and the correlation between upgrade to malignancy and lesion size, BI-RADS category, morphological characteristics, presence of calcifications and history of breast cancer (χ2 and Mann-Whitney tests).
RESULTS: We collected data from 334 patients (median age 47.5 years, IQR 14). After VAE, 70.6 % (N = 236) of the excised lesions were benign, 20.1 % (N = 67) were B3 lesions and 9.3 % (N = 31) were malignant. The UR to malignancy was 9.3 %. The delayed false negative results were 1.3 %. Accuracy was 98.2 % [95 % CI: 0.95-0.99], SE was 88.6 % [95 % CI: 0.73-0.97], SP was 100 % [95 % CI: 0.98-1], PPV was 100 % [95 % CI: 0.89-1] and NPV was 97.9 % [95 % CI: 0.95-0.99]. TE was 84.4 %; TS was 100 %. No major complications were observed. BIRADS category, morphology, margins, and orientation of the lesion were significantly associated with upgrade to malignancy (p < 0.001).
CONCLUSIONS: VAE reduces the risk of underestimation of associated malignancy in imaging-histological discordant lesions and increases diagnostic accuracy, thus reducing the need for surgery, without compromising the quality of patient care.
MATERIALS AND METHODS: We retrospectively evaluated all patients who underwent US-guided VAE with a 9 G needle between January 2015 and August 2023 for imaging-histological discordance after CNB. We determined the upgrade rate to malignancy (UR) after VAE and delayed false-negative results after surgery or follow-up. We assessed the diagnostic performance of the procedure, technical efficacy (TE), technical success (TS), the occurrence of complications and the correlation between upgrade to malignancy and lesion size, BI-RADS category, morphological characteristics, presence of calcifications and history of breast cancer (χ2 and Mann-Whitney tests).
RESULTS: We collected data from 334 patients (median age 47.5 years, IQR 14). After VAE, 70.6 % (N = 236) of the excised lesions were benign, 20.1 % (N = 67) were B3 lesions and 9.3 % (N = 31) were malignant. The UR to malignancy was 9.3 %. The delayed false negative results were 1.3 %. Accuracy was 98.2 % [95 % CI: 0.95-0.99], SE was 88.6 % [95 % CI: 0.73-0.97], SP was 100 % [95 % CI: 0.98-1], PPV was 100 % [95 % CI: 0.89-1] and NPV was 97.9 % [95 % CI: 0.95-0.99]. TE was 84.4 %; TS was 100 %. No major complications were observed. BIRADS category, morphology, margins, and orientation of the lesion were significantly associated with upgrade to malignancy (p < 0.001).
CONCLUSIONS: VAE reduces the risk of underestimation of associated malignancy in imaging-histological discordant lesions and increases diagnostic accuracy, thus reducing the need for surgery, without compromising the quality of patient care.