Evaluation of the initial efficacy in the removal of benign breast lesions by vacuum - Assisted biopsy in radiology center of bach mai hospital

Diagnostic indications: – Biopsy small lesion (<5mm) – ultrasound visible – Biopsy suspicious grouped microcalcification • Therapeutic indications: – Remove symptomatic BIRADS 3-lesion, probably benign, woman are not willing to follow-up – Remove intraductal papilloma which cause nipple discharge

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Evaluation of the initial efficacy in the removal of benign breast lesions by vacuum-assisted biopsy in radiology center of Bach Mai hospital Dr. Lê Nguyệt Minh Radiology center of Bach Mai hospital hinhanhykhoa.com Introduction • Benign breast lesions is one of the common diseases: – America: 1 million women diagnosed benign breast lesions/ year – Thailand: 73% benign breast lesions / study of 2532 patients biopsied. • Pain, discomfort in breast is sensitive  reduce the quality of life  Treatment? Vacuum- assisted breast biopsy (VABB) Aim • to evaluate the initial efficacy in the removal of benign breast lesions by vacuum-assisted biopsy hinhanhykhoa.com Excision surgery leave a scar Vacuum- assisted breast biopsy (VABB) • 11G ~ 7G • Using Vacuum and Rotating cutter • One insertion and Serial sampling • Enough specimen for Pathology • Excision of Benign Tumor hinhanhykhoa.com After VABB Vacuum Assisted Breast Biopsy 1995 1996 Fred Burbank, Mark Retchard 1998 Zannis 2002 FDA Total lesionremoval High asthetic Meta analysis of efficacy and safety between Mammotome vacuum-assisted breast biopsy and open excision for benign breast tumor Boni Ding, Daojin Chen, Xiaorong Li, Hongyan Zhang, Yujun Zhao Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha 410013, China Correspondence to: Yujun Zhao. Organ Transplantation Center, Third Xiangya Hospital, Central South University, Changsha 410013, China. Gland Surgery 2013;2(2):69-79 hinhanhykhoa.com Indication of VABB • Diagnostic indications: – Biopsy small lesion (<5mm) – ultrasound visible – Biopsy suspicious grouped microcalcification • Therapeutic indications: – Remove symptomatic BIRADS 3-lesion, probably benign, woman are not willing to follow-up – Remove intraductal papilloma which cause nipple discharge Intraindications • Absolute intraindications: – Allergy to local anethesia – Severe systematic disease – Coagulation disorder – Local inflamation – Patient is too nervous, can not corporate • Relative intraindication: – Cancer in other location Subjects and method • Prospective cohort study – From January to June 2018 – 21 woman with 31 lesions – Data and pre-, during , post procedure images stored in PACS – Assess complications post procedure. Results • Characteristics of subjects – Mean of age 37,5± 11,7 8. Oluwole S.F. và Freeman H.P. (1979). Analysis of benign breast lesions in blacks. Am J Surg, 137(6), 786–789. 9. 9. Park H.-L., Kwak J.-Y., Lee S.-H. và cộng sự. (2005). Excision of Benign Breast Disease by Ultrasound-Guided Vacuum Assisted Biopsy Device (Mammotome). Ann Surg Treat Res, 68(2), 96–101. Symptoms Number of lesion Percentage % Pain 30 96,8 Pain related menstrual period 19 63,3 Mass papable 27 87,1 Result • Result of pathology Pathoanatomy Number of lesions Percent % Fibroadenoma 17 54,8 Fibrocystic breast disease 08 25,8 abscess 01 03,2 Sclerosing adenosis 01 03,2 Papiloma intra tubular 01 03,2 others 03 09,7 Tổng 31 100 Result Time of biopsy (min) Amount of samples Lidocain 2% pha 1:5 (ml) Size on ultrasound (mm) Mean ± SD 12,3 ± 8,3 10,8 ± 6,7 10,6 ± 4,1 11,7 ±5,4 Mode 10,0 8,0 10,0 Minimum 5 3 5 5 Maximum 48 31 20 22 Total 383 335 328 31 11. Clinical application of mammotome minimally invasive biopsy system for excision of 560 benign breast lumps--《Lingnan Modern Clinics in Surgery》2007年05期. , accessed: 04/06/2018. Results • There is a proportional correlation between the size of the lesions and other factors such as the amount of anesthetics used, the volume of the hematoma after the biopsy, the time of wound removal and the size of the biopsy needle Correlation between the volume of lesion R P Size of biopsy needle Test Mann-Whitney U = 84 0,185 Volume of hematoma 0,467 0,008 Amount of anesthetic 0,674 0,000 The time of biopsy 0,659 0,000 hinhanhykhoa.com Results Complications after biopsy Number of lesions Percentage % p Residual 0 0 Ecchymosis no 27 87,1 0,000 yes 4 12,9 Postprocedure pain No 2 6,5 0,02 Low 20 64,5 Medium 9 29,0 Heavy 0 0 15. Li S., Wu J., Chen K. và cộng sự. (2013). Clinical outcomes of 1,578 Chinese patients with breast benign diseases after ultrasound-guided vacuum-assisted excision: recurrence and the risk factors. Am J Surg, 205(1), 39–44. Results Complications after biopsy • The distance from the lesion to the skin surface is inversely proportional to the size of the post-biopsy hematoma (p= 0,04). • Post-biopsy pain. Pain N Distance from the lesion to the nipple Standard deviation Non 2 25,0 21,2 Low 20 21,4 5,7 Medium 9 13,9 13,6 Total 31 19,5 9,9 16. Liu S., Zou J.-L., Zhou F.-L. và cộng sự. (2017). [Efficacy of ultrasound-guided vacuum-assisted Mammotome excision for management of benign breast diseases: analysis of 1267 cases]. Nan Fang Yi Ke Da Xue Xue Bao, 37(8), 1121–1125. Conclusion • Vacuum-assisted breast biopsy is an effective and safe method for removal benign breast lesions. This method is also highly aesthetic. The anapathology results based on this method are reliable, especially for small lesions. 24 Thanks for your listen!

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