Usefulness of Fine-Needle Aspiration Biopsy before Performing Ultrasound-Guided Vacuum-Assisted Excision

Abstract

Purpose: Ultrasound-guided vacuum-assisted excision (US-VAE) is considered the less invasive method for the histological assessment of breast lesions than surgical excision and also used for removing benign lesions. Some benign lesions require further excision after removing them by US-VAE, because pathologic diagnosis with specimen obtained by US-VAE cannot be confirmative. However, a well-targeted fineneedle aspiration biopsy (FNAB) before US-VAE can provide preoperative diagnosis. The aim of this study is to evaluate the accuracy and safety of FNAB to minimize further excision after performing US-VAE.

Methods: From June 2007 to December 2009, US-VAE was performed on 321 patients with benign breast lesions which diagnosed by FNAB. Clinicopathological data, medical records and imaging studies were reviewed. We estimated the further excision rate after carrying out US-VAE and evaluated effectiveness of FNAB for pathologic diagnosis of breast lesions before performing US-VAE.

Results: Of 321 lesions, 118 (27.1%) were diagnosed as specific benign, 201 patients (57.9%) as other nonspecific benign or negative malignant cell, 2 (0.6%) as atypical ductal hyperplasia (ADH) at FNAB. The pathologic diagnoses after US-VAE were usually specific benign diseases; fibroadenoma (190 cases, 59.2%), fibrocystic change (51 cases, 15.9%), other benign (68 cases, 21.2%). As indeterminate lesions, ADH (5 cases, 1.6%), borderline phyllodes tumor (4 cases, 1.2%) were diagnosed. Of 321, only three patients (0.9%) were underwent further excision for malignancy. They were diagnosed as malignant after taking US-VAE, two lobular carcinoma in situ and one invasive ductal carcinoma.

Conclusion: US-VAE is relatively accurate and effective for removing benign lesion of breast. To reduce the further excision rate, the cytological and pathological confirmation using FNAB should be performed precisely before performing the US-VAE.