Improved evaluation of patients with small clusters of microcalcifications on mammograms: Implementation of vacuum assisted excision with "cavity margins shaving" technique.

RATIONALE AND

OBJECTIVES

The purpose of our study is to assess the diagnostic performance and treatment effectiveness of vacuum assisted excision (VAE) under digital breast tomosynthesis (DBT) guidance with "cavity margins shaving" technique to ensure total lesion removal in patients with ≤ 15 mm clusters of microcalcifications.

MATERIALS AND

METHODS

Patients with a single cluster of microcalcifications (BI-RADS > 3) < 15 mm who underwent DBT-guided VAE were enrolled. The "cavity margins shaving" technique was used: 12 focus samples (FS) and 12 cleaning samples (CS) were taken and the histopathologic assessment of the FS and CS was performed separately. The presence of residual disease within the CS was assessed. The surgical excision results were compared according to the CS status.

RESULTS

A total of 72 patients were included, with 12 benign (16.7%), 45 B3 (62.5%) and 15 malignant (20.8%) lesions. Among the 13 ductal carcinomas in situ (DCIS) and 17 atypical ductal hyperplasia (ADH) cases without residual disease within the CS (21/30, 70%), in 2 cases residual pathology was detected in the subsequent surgery, without any case of upgrade. Comparing the presence of malignant disease (residual DCIS or upgrade of ADH) at surgical excision according to the CS status, the rates were 1/5 (20.0 %) and 4/5 (80.0 %) respectively for negative and positive CS (P = 0.007). The NPV of the absence of residual lesion in the CS was 95.24 % (95 %CI: 76.39 %-99.20 %).

CONCLUSION

VAE with cavity margins shaving technique could represent a valuable alternative to surgical excision in selected patients (such as those with ADH or low-grade DCIS) who met the radiologic and histologic criteria.