Implementation of vacuum-assisted excision as a management option for benign and high-risk breast lesions.

Autor:	van de Voort EM; Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands.; Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands., Struik GM; Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands.; Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands.; Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg, Netherlands., Birnie E; Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands.; Department of Genetics, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, Netherlands., Sinke RH; Department of Pathology, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands., Verver D; Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands.; Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands., van Streun SP; Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands., Macco M; Department of Radiology, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands., Verhoef C; Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands., Klem TM; Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands.
Jazyk:	angličtina
Zdroj:	The British journal of radiology [Br J Radiol] 2023 Jul; Vol. 96 (1147), pp. 20220776. Date of Electronic Publication: 2023 May 12.
DOI:	10.1259/bjr.20220776
Abstrakt:	Objective: Previous studies have shown that vacuum-assisted excision (VAE) is a safe and effective alternative for surgical excision (SE) of benign breast lesions. However, the use of VAE in high-risk lesions is controversial and guidelines are ambiguous. This study describes the impact of the implementation of VAE in terms of management and outcomes compared to a cohort before implementation. Methods: A single centre retrospective study with two cohorts: 'before' and 'after' implementation of VAE was performed. All patients with a benign or high-risk lesion treated by VAE or SE between 2016 and 2019 were included. Excision, complication, and upgrade rates were compared between both cohorts. Cox regression was used for the evaluation of recurrences and re-excisions. Results: The overall excision rate of all benign and high-risk lesions was comparable in both cohorts (17% vs 16%, p = 0.700). After implementation, benign lesions were significantly more often managed by VAE (101/151, 67%, p < 0.001). Re-excision, recurrence, and complication rates were low and comparable between cohorts (4.3% vs 3.9%, p > 0.999; 3.0 vs 2.0%, p = 0.683; 3.4 vs 6.6%, p = 0.289, respectively). Conclusion: SE could safely be replaced by VAE in 58% of patients treated for a benign or high-risk lesion. With this shift in management, the use of operating rooms and general anaesthesia can safely be omitted in this patient group. Further research on high-risk lesions is warranted since our data are exploratory. Advances in Knowledge: This study provides supportive data for the use of VAE as a management option for both benign (up to 5 cm) and high-risk lesions. Outcomes on re-excision, recurrence should be confirmed in prospective studies especially in high-risk lesions.
Databáze:	MEDLINE
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