Criteria for Excision of Suspicious Calcifications Using the Breast Lesion Excision System (BLES)

Alexandra Christou (1), Vassilis Koutoulidis (2), Dimitra Koulocheri (3), Afrodite Nonni (4), Constantinos George Zografos (5), Georgios Constantinos Zografos (6)
(1) Brighton and Sussex University NHS Hospitals, Brighton, UK, United Kingdom,
(2) Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece, Greece,
(3) Department of Radiology, Breast Unit Hippokration Hospital, Athens, Greece, Greece,
(4) Department of Pathology, National and Kapodistrian University of Athens, Greece, Greece,
(5) Department of Surgery, Nikaia General Hospital, Athens, Greece, Greece,
(6) Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Greece, Greece

Abstract

Background: The aim of the study was to retrospectively evaluate possible imaging and histopathology criteria that can be used in a clinical basis to assess the success of excision of suspicious calcifications using the breast lesion excision system (BLES).
Methods: We investigated 400 BLES stereotactic biopsies of suspicious calcifications with the mean size of 15.38 mm (st. dev.= 13.579 mm, range 3-78 mm) using a 20 mm probe performed in our department between January 2014 and 2016. The mean age of our population was 58.5 years old (range 39-78 years). The pathology results of BLES specimens were compared with the final surgical results to assess excision success rates. Possible imaging and histopathology criteria for removal were statistically analyzed (mammographic size, disease free margins, grade, comedo phenotype, molecular type).
Results: The results showed that 90/400 (22.5%) biopsies were cancers (80% DCIS) and 38/400 were lesions with cell atypia (9.5%) of which 29/38 had subsequent surgery and were included in the study. Excision was achieved in 31/90 cancers (34.4%) and in 23/29 lesions with cell atypia (76.3%). The imaging and histopathology criteria for BLES excision that could be potentially clinically assessed were the initial mammographic size (p<0.001), the distance of the lesion from the specimen margins (p<0.001), the presence of comedo necrosis (p=0.014) and the grade of the cancers (p=0.021). The underestimation rate was 15.5%.
Conclusion: the mammographic size, grade, comedo presence and disease-free margins, were the main criteria for BLES success rate of excision of suspicious calcifications.

Full text article

Generated from XML file

References

Al-Harethee W, Theodoropoulos G, Filippakis GM, Papapanagiotou I, Matiatou M, Georgiou G, et al. Complications of percutaneous stereotactic vacuum assisted breast biopsy system utilizing radio frequency. European journal of radiology. 2013;82(4):623-6.

Killebrew LK, Oneson RH. Comparison of the diagnostic accuracy of a vacuum?assisted percutaneous intact specimen sampling device to a vacuum?assisted core needle sampling device for breast biopsy: initial experience. The breast journal. 2006;12(4):302-8.

Sie A, Bryan DC, Gaines V, Killebrew LK, Kim CH, Morrison CC, et al. Multicenter evaluation of the breast lesion excision system, a percutaneous, vacuum?assisted, intact?specimen breast biopsy device. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2006; 107(5):945-9.

Wilson R, Kavia S. Comparison of large-core vacuum-assisted breast biopsy and excision systems. Minimally Invasive Breast Biopsies. 2009:23-41.

Seror J-Y, Lesieur B, Scheuer-Niro B, Zerat L, Rouzier R, Uzan S. Predictive factors for complete excision and underestimation of one-pass en bloc excision of non-palpable breast lesions with the Intact® breast lesion excision system. European journal of radiology. 2012;81(4):719-24.

Whitworth PW, Simpson JF, Poller WR, Schonholz SM, Turner JF, Phillips RF, et al. Definitive diagnosis for high-risk breast lesions without open surgical excision: the Intact Percutaneous Excision Trial (IPET). Annals of surgical oncology. 2011;18(11):3047-52.

Medjhoul A, Canale S, Mathieu MC, Uzan C, Garbay JR, Dromain C, et al. Breast lesion excision sample (BLES biopsy) combining stereotactic biopsy and radiofrequency: is it a safe and accurate procedure in case of BIRADS 4 and 5 breast lesions? The breast journal. 2013;19(6):590-4.

Milos R-I, Bernathova M, Baltzer PA, Pinker-Domenig K, Kapetas P, Rudas M, et al. The breast lesion excision system (BLES) under stereotactic guidance cannot be used as a therapeutic tool in the excision of small areas of microcalcifications in the breast. European journal of radiology. 2017;93:252-7.

Sanderink WB, Laarhuis BI, Strobbe LJ, Sechopoulos I, Bult P, Karssemeijer N, et al. A systematic review on the use of the breast lesion excision system in breast disease. Insights into imaging. 2019;10(1):1-12.

Scaperrotta G, Ferranti C, Capalbo E, Paolini B, Marchesini M, Suman L, et al. Performance and role of the breast lesion excision system (BLES) in small clusters of suspicious microcalcifications. European journal of radiology. 2016;85(1):143-9.

Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. International Journal of Radiation Oncology* Biology* Physics. 2014;88(3):553-64.

Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Practical radiation oncology. 2016;6(5): 287-95.

[Available from: http://intactmedical.com/ medical.html.

Christou A, Koutoulidis V, Koulocheri D, Nonni A, Zografos CG, Zografos GC. Predictive factors for breast lesion excision system (BLES) accuracy and safety in stereotactic biopsy of suspicious calcifications. The breast journal. 2020;26(3):391-8.

Christou A, Koutoulidis V, Koulocheri D, Panourgias E, Nonni A, Zografos CG, et al. Performance of breast lesion excision system (BLES) in complete removal of papillomas presented mammographically as groups of calcifications. Clinical imaging. 2019;58:50-8.

Wiley EL, Diaz LK, Badve S, Morrow M. Effect of time interval on residual disease in breast cancer. The American journal of surgical pathology. 2003;27(2):194-8.

Chan KC, Knox WF, Sinha G, Gandhi A, Barr L, Baildam AD, et al. Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ. Cancer. 2001;91(1):9-16.

Rodriguez N, Diaz LK, Wiley EL. Predictors of residual disease in repeat excisions for lumpectomies with margins less than 0.1 cm. Clinical breast cancer. 2005;6(2):169-72.

Chagpar AB, Martin II RC, Hagendoorn LJ, Chao C, McMasters KM. Lumpectomy margins are affected by tumor size and histologic subtype but not by biopsy technique. The American journal of surgery. 2004;188(4):399-402.

Sahoo S, Recant WM, Jaskowiak N, Tong L, Heimann R. Defining negative margins in DCIS patients treated with breast conservation therapy: The University of Chicago experience. The breast journal. 2005;11(4):242-7.

Schwartz GF, Patchefsky AS, Finklestein SD, Sohn SH, Prestipino A, Feig SA, et al. Nonpalpable in situ ductal carcinoma of the breast: predictors of multicentricity and microinvasion and implications for treatment. Archives of Surgery. 1989;124(1):29-32.

Allen S, Osin P, Nerurkar A. The radiological excision of high risk and malignant lesions using the INTACT breast lesion excision system. A case series with an imaging follow up of at least 5 years. European Journal of Surgical Oncology (EJSO). 2014;40(7):824-9.

Christou A, Koutoulidis V, Koulocheri D, Panourgias E, Nonni A, Zografos CG, et al. Role of one-pass breast lesion excision system in complete excision of high-risk breast lesions with atypia expressed as clusters of microcalcifications. European radiology. 2019;29(6): 3149-58.

Authors

Alexandra Christou
alexandrachristou@gmail.com (Primary Contact)
Vassilis Koutoulidis
Dimitra Koulocheri
Afrodite Nonni
Constantinos George Zografos
Georgios Constantinos Zografos
1.
Christou A, Koutoulidis V, Koulocheri D, Nonni A, Zografos CG, Zografos GC. Criteria for Excision of Suspicious Calcifications Using the Breast Lesion Excision System (BLES). Arch Breast Cancer [Internet]. 2021 Apr. 15 [cited 2024 Dec. 10];:100-8. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/350

Article Details