Utility of vacuum-assisted breast biopsy puncture (VAB): Mammotome and Suros

Abstract

The increase in the incidence of breast cancer has prompted the development of new interventional and therapeutic techniques, replacing traditional surgical biopsy with image-guided percutaneous biopsy techniques. In 1994, Parker et al developed percutaneous large core breast biopsy –core needle puncture- and, in 2000,   Vacuum Assisted Biopsy (VAB) for the study of non-palpable lesions and microcalcifications seeking to manage lesions of uncertain malignant potential. These techniques were protocolized in the Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) held in 2019, and we consider this conference our main / primary bibliographic reference. The aim of the present work is to compare anatomo-pathological results of punctures obtained by VAB  with the respective surgical specimens and to demonstrate the benefits of this interventional procedure.

We conducted an observational, retrospective, cross-sectional, using non-probabilistic convenience sampling. We selected patients with BIRADS 4-5 mammography results who underwent VAB and were diagnosed with  atypical precursor lesions or early breast carcinoma. The study included surgical specimens obtained between January 2019 and July 2023 at Instituto Oulton in Córdoba, Argentina. The cylinders obtained with 9/11 gauge needle were fixed in 10% formalin, processed using a Leica automatic processor, and cut into 4 micron sections and stained with hematoxylin-eosin. The data were analyzed using descriptive statistics, including  frequency distribution analysis and the calculation of percentages.

Out of a total of 504 AVBs, only 53 were operated on at our institution, resulting in a 100% concordance rate. Histologic underestimation ranged from 18% to 21% varying according to ultrasound or mammographic images of microcalcifications,  distortion, or nodules). This rate aligns with findings reported in other studies, which typically indicate underestimation rates  between 10% and 25%.

We can conclude that  the VAB technique is considered today as the gold standard when faced with the mammographic finding of microcalcifications BIRADS 4-5 given its moderate to high positive predictive value for cancer, according to recommendations and international guidelines: National Inter-Society Consensus on Breast Cancer (2019), SAMAS (2018, American Society of Clinical Oncology (ASCO), American Joint Committee on Cancer (AJCC), and College of American Pathologists (CAP).