Outcomes of ultrasound-guided vacuum-assisted excision of breast lesions: A single-center study

This study aims to present ultrasound-guided vacuum-assisted excision (UGVAE) as an alternative therapeutic approach for benign breast lesions. In addition, it evaluates the procedure’s performance, associated complications, and clinical outcomes. This single-center, retrospective cohort study, approved by the Institutional Review Board, included 67 female patients who underwent UGVAE for breast lesions using 7 – 10 G needles. The study analyzed various parameters, including patient demographics, imaging features, and follow-up findings. Indications for UGVAE included patient preference, pain, palpable lump, nipple discharge, discordant biopsy results, and interval increase in breast imaging-reporting and data system (BI-RADS) 3 lesions. Lesion size, shape, echogenicity, and location were assessed through ultrasound and mammography. UGVAE was performed by two experienced radiologists, and post-procedure complications were documented. Data were analyzed using the Statistical Package for the Social Sciences and descriptive statistical methods. The mean age of the study population was 41.8 ± 14 years, and the mean lesion size was 1.7 ± 0.85 cm. A previous biopsy of the lesion was recorded in 19.4% of cases, and 7.5% of the patients had a history of breast cancer. The indications for UGVAE included patient preference (22.4%), pain (16.4%), palpable lump (14.9%), and an interval increase in BI-RADS 3 lesions (17.9%). Abnormal mammographic findings were reported in 95.1% of cases. Sonographic features predominantly included circumscribed (94%) and oval (73.1%) lesions. Complete excision was achieved in 80.6% of cases, and hematoma occurred in 13.4% of patients as a post-procedure complication. Histopathological results confirmed all lesions as benign, with fibroadenoma being the most common diagnosis (50.7%). Follow-up imaging showed no significant residual lesion in 46.3% of patients. UGVAE is considered a cost-effective, minimally invasive, and safe alternative to surgical excision for benign breast lesions.
- Marchant DJ. Benign breast disease. Obstet Gyn Clin N Am. 2002;29(1):1-20. doi: 10.1016/s0889-8545(03)00048-2
- Stachs A, Stubert J, Reimer T, Hartmann S. Benign breast disease in women. Dtsch Ärzteblatt Int. 2019;116(33-34): 565-574. doi: 10.3238/arztebl.2019.0565
- Pleasant V. Benign breast disease. Clin Obstet Gynecol. 2022;65(3):448-460. doi: 10.1097/grf.0000000000000719
- Malherbe F, Nel D, Molabe H, Cairncross L, Roodt L. Palpable breast lumps: An age-based approach to evaluation and diagnosis. S Afr Fam Pr. 2022;64(1):5571. doi: 10.4102/safp.v64i1.5571
- Miltenburg DM, Speights VO. Benign breast disease. Obstet Gynecol Clin North Am. 2008;35(2):285-300. doi: 10.1016/j.ogc.2008.03.008
- Onstad M, Stuckey A. Benign breast disorders. Obstet Gynecol Clin North Am. 2013;40(3):459-473. doi: 10.1016/j.ogc.2013.05.004
- AlSharif S, Alshamrani KM, Scaranelo A, Khoumais N, Subahi A, Mesurolle B. Unusual male breast lesions. J Clin Imaging Sci. 2021;11:21. doi: 10.25259/jcis_43_2021
- Cant PJ, Madden MV, Coleman MG, Dent DM. Non-operative management of breast masses diagnosed as fibroadenoma. Brit J Surg. 1995;82(6):792-794. doi: 10.1002/bjs.1800820624
- Mann RM, Athanasiou A, Baltzer PA, et al. Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radiol. 2022;32(6):4036-4045. doi: 10.1007/s00330-022-08617-6
- Puglisi F, Fontanella C, Numico G, et al. Follow-up of patients with early breast cancer: Is it time to rewrite the story? Crit Rev Oncol Hematol. 2014;91(2):130-141. doi: 10.1016/j.critrevonc.2014.03.001
- Lakoma A, Kim ES. Minimally invasive surgical management of benign breast lesions. Gland Surg. 2014;3(2):14248-14148. doi: 10.3978/j.issn.2227-684x.2014.04.01
- Wignarajah P, Malata CM, Benson JR. Oncoplastic and reconstructive breast surgery. Front Oncol. 2023;13:1176915. doi: 10.3389/fonc.2023.1176915
- Pfob A, Mehrara BJ, Nelson JA, Wilkins EG, Pusic AL, Sidey- Gibbons C. Towards patient-centered decision-making in breast cancer surgery. Ann Surg. 2023;277(1):e144-e152. doi: 10.1097/sla.0000000000004862
- Lane W, Phillips BT, Offodile AC 2nd. Where advocacy meets patient-centered care-cost considerations in breast reconstruction decision-making. Gland Surg. 2020;10(1):50711-50511. doi: 10.21037/gs.2020.03.21
- Park HL, Kim LS. The Current role of vacuum assisted breast biopsy system in breast disease. J Breast Cancer. 2011;14(1):1-7. doi: 10.4048/jbc.2011.14.1.1
- Rageth CJ, O’Flynn EA, Pinker K, et al. Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2019;174(2):279-296. doi: 10.1007/s10549-018-05071-1
- Yoo HS, Kang WS, Pyo JS, Yoon J. Efficacy and safety of vacuum-assisted excision for benign breast mass lesion: A meta-analysis. Medicina. 2021;57(11):1260. doi: 10.3390/medicina57111260
- O’Flynn EA, Wilson AR, Michell MJ. Image-guided breast biopsy: State-of-the-art. Clin Radiol. 2010;65(4):259-270. doi: 10.1016/j.crad.2010.01.008
- Yao F, Li J, Wan Y, et al. Sonographically guided vacuum-assisted breast biopsy for complete excision of presumed benign breast lesions. J Ultrasound Med. 2012;31(12):1951-1957. doi: 10.7863/jum.2012.31.12.1951
- Huo HP, Wan WB, Wang ZL, Li HF, Li JL. Percutaneous removal of benign breast lesions with an ultrasound-guided vacuum-assisted system: Influence factors in the hematoma formation. Chin Méd Sci J. 2016;31(1):31-36. doi: 10.1016/s1001-9294(16)30019-0
- Tajudeen AW, Botond KS, Maher J, Dalia E, Kasim B, Inga C. Efficacy and safety of ultrasound guided vacuum-assisted excision of fibroadenomas: A systematic review. Open J Radiol. 2017;7(2):95-102. doi: 10.4236/ojrad.2017.72011
- Dixon JM, Dobie V, Lamb J, Walsh JS, Chetty U. Assessment of the acceptability of conservative management of fibroadenoma of the breast. Brit J Surg. 1996;83(2):264-265. doi: 10.1046/j.1365-2168.1996.02105.x
- Heywang-Köbrunner SH, Schreer I, Decker T, Böcker W. Interdisciplinary consensus on the use and technique of vacuum-assisted stereotactic breast biopsy. Eur J Radiol. 2003;47(3):232-236. doi: 10.1016/s0720-048x(02)00196-1
- Verkooijen HM, Peeters PH, Buskens E, et al. Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: A meta-analysis. Br J Cancer. 2000;82(5):1017-1021. doi: 10.1054/bjoc.1999.1036
- Rakha EA, Ellis IO. An overview of assessment of prognostic and predictive factors in breast cancer needle core biopsy specimens. J Clin Pathol. 2007;60(12):1300. doi: 10.1136/jcp.2006.045377
- Bae S, Yoon JH, Moon HJ, Kim MJ, Kim EK. Breast microcalcifications: Diagnostic outcomes according to image-guided biopsy method. Korean J Radiol. 2015;16(5):996-1005. doi: 10.3348/kjr.2015.16.5.996
- Tan X, Xuhong J, Ai X, et al. Effectiveness of ultrasound-guided vacuum-assisted excision for treating benign breast lesions. Cancer Innov. 2025;4(1):e158. doi: 10.1002/cai2.158
- Mathew J, Crawford D, Lwin M, Barwick C, Gash A. Ultrasound-guided, vacuum-assisted excision in the diagnosis and treatment of clinically benign breast lesions. Ann R Coll Surg Engl. 2007;89(5):494-496. doi: 10.1308/003588407x187621
- Soliman AH. Ultrasound-guided vacuum-assisted excision biopsy in breast fibroadenomas: An Egyptian center experience. Egypt J Radiol Nucl Med. 2022;53(1):213. doi: 10.1186/s43055-022-00874-1
- Kim MJ, Park BW, Kim SI, et al. Long-term follow-up results for ultrasound-guided vacuum-assisted removal of benign palpable breast mass. Am J Surg. 2010;199(1):1-7. doi: 10.1016/j.amjsurg.2008.11.037
- Wang ZL, Li JL, Su L, Zhang YF, Tang J. An evaluation of a 10-gauge vacuum-assisted system for ultrasound-guided excision of clinically benign breast lesions. Breast. 2009;18(3):192-196. doi: 10.1016/j.breast.2009.04.001
- Thurley P, Evans A, Hamilton L, James J, Wilson R. Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas. Clin Radiol. 2009;64(4):381-385. doi: 10.1016/j.crad.2008.09.013
- Wang ZL, Liu G, Huang Y, Wan WB, Li JL. Percutaneous excisional biopsy of clinically benign breast lesions with vacuum-assisted system: Comparison of three devices. Eur J Radiol. 2012;81(4):725-730. doi: 10.1016/j.ejrad.2011.01.059
- Lee SH, Kim EK, Kim MJ, Moon HJ, Yoon JH. Vacuum-assisted breast biopsy under ultrasonographic guidance: Analysis of a 10-year experience. Ultrasonography. 2014;33(4):259-266. doi: 10.14366/usg.14020
- Grady I, Gorsuch H, Wilburn-Bailey S. Long-term outcome of benign fibroadenomas treated by ultrasound-guided percutaneous excision. Breast J. 2008;14(3):275-278. doi: 10.1111/j.1524-4741.2008.00574.x
- Chen SC, Yang HR, Hwang TL, Chen MF, Cheung YC, Hsueh S. Intraoperative ultrasonographically guided excisional biopsy or vacuum-assisted core needle biopsy for nonpalpable breast lesions. Ann Surg. 2003;238(5):738-742. doi: 10.1097/01.sla.0000094439.93918.31
- March DE, Coughlin BF, Barham RB, et al. Breast masses: Removal of All US evidence during biopsy by using a handheld vacuum-assisted device-initial experience. Radiology. 2003;227(2):549-555. doi: 10.1148/radiol.2272020476
- Ko EY, Bae YA, Kim MJ, Lee KS, Lee Y, Kim LS. Factors affecting the efficacy of ultrasound-guided vacuum-assisted percutaneous excision for removal of benign breast lesions. J Ultrasound Med. 2008;27(1):65-73. doi: 10.7863/jum.2008.27.1.65
- Bugdayci O, Kaya H, Aribal E. Ultrasound guided therapeutic excisional vacuum assisted biopsy in breast fibroadenomas. J Breast Health. 2017;13(2):74-76. doi: 10.5152/tjbh.2017.3038