Potential role of vacuum-assisted procedures in resecting breast cancers and highlighting selection criteria to support future trials

C N Valadares; H L Couto; A N Soares; P H Toppa; B P Ricardo; S A McIntosh; N Sharma; V Resende

doi:10.3389/fonc.2023.1239574

Potential role of vacuum-assisted procedures in resecting breast cancers and highlighting selection criteria to support future trials

Front Oncol. 2023 Sep 21:13:1239574. doi: 10.3389/fonc.2023.1239574. eCollection 2023.

Authors

C N Valadares^{1

2}, H L Couto^{1

2}, A N Soares³, P H Toppa¹, B P Ricardo¹, S A McIntosh⁴, N Sharma⁵, V Resende¹

Affiliations

¹ Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
² Sociedade Brasileira de Mastologia, Rio de janeiro, Brazil.
³ Faculdade Santa Casa de Belo Horizonte, Minas Gerais, Brazil.
⁴ Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom.
⁵ Breast Unit, Leeds Teaching Hospital NHS Trust, St James Hospital, Leeds, United Kingdom.

Abstract

Purpose: The purpose of this study was to evaluate the role of vacuum-assisted biopsy (VAB) in resecting breast cancers.

Methods: Retrospective database analysis of 116 cancers [both invasive breast cancers (IC) and ductal carcinoma in situ (DCIS)] diagnosed by VAB submitted to standard surgical treatment with complete histological data from VAB and surgery. Excision following VAB was defined as complete resection (CR) if there was no residual tumor in the surgical specimen, minimal residual disease (MRD) if residual tumor ≤ 3 mm, gross residual disease (GRD) if residual tumor > 3 mm, and upgrade from DCIS on VAB to IC. CR and MRD were combined as potentially resected percutaneously (PRP). GRD and those with upgrade to IC were determined not eligible for percutaneous resection (NPR). Factors predictive of PRP were evaluated.

Results: Mean age was 55.6 years (20-91; SD: 12,27). CR was seen in 29 of 116 cases (25%), MRD in 18 of 116 cases (15.5%), GRD in 64 of 116 cases (55.2%), and five of 116 cases (4.3%) were upgraded from DCIS to IC, and those groups combined represented 47 cases of PRP (40.5%) and 69 (59,5%) of NPR. For 77 tumors ≤ 10 mm, 45 (58.5%) were PRP. Multivariate analysis reveals significance for enlarged VAB (EVAB) (p = 0.008, OR: 4.4, 95% CI), low/intermediate nuclear grade (p < 0.001, OR: 12.5, 95% CI) and final tumor size (T) ≤ 10 mm (p = 0.001, OR: 50.1, 95% CI) for PRP.

Conclusions: This study showed that lesions completely excised with VAB that were cancer could have been treated with VAB rather than surgery but tumor selection in terms of subtype and size is important.

Keywords: biopsy; breast; breast cancer; minimally invasive procedure; vacuum assisted biopsy.