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Ultrasound-guided vacuum-assisted breast biopsy: Use at the European Institute of Oncology in 2010.

ABSTRACT: Vacuum-assisted breast biopsy (VABB), which plays a fundamental role in the preoperative assessment of microcalcifications, can also be used (with ultrasound guidance) to obtain histology samples of breast lesions that are visible on ultrasonography. It is particularly useful when the lesion diameter is less than 1 cm. This technique has been used in our institute since 1998, and in this report we analyze our experience with it in 2010. This analysis shows that VABB is a safe, effective procedure that can markedly reduce the need for surgical biopsy.

SUBMITTER: Abbate F

PROVIDER: S-EPMC3558107 | biostudies-other | 2011 Dec

REPOSITORIES: biostudies-other

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Ultrasound-guided vacuum-assisted breast biopsy: Use at the European Institute of Oncology in 2010.

Abbate F F Cassano E E Menna S S Viale G G

Journal of ultrasound 20111021 4

Vacuum-assisted breast biopsy (VABB), which plays a fundamental role in the preoperative assessment of microcalcifications, can also be used (with ultrasound guidance) to obtain histology samples of breast lesions that are visible on ultrasonography. It is particularly useful when the lesion diameter is less than 1 cm. This technique has been used in our institute since 1998, and in this report we analyze our experience with it in 2010. This analysis shows that VABB is a safe, effective procedur ...[more]

PMID: 23397003

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Project description:ImportanceTargeted magnetic resonance (MR)/ultrasound fusion prostate biopsy has been shown to detect prostate cancer. The implications of targeted biopsy alone vs standard extended-sextant biopsy or the 2 modalities combined are not well understood.ObjectiveTo assess targeted vs standard biopsy and the 2 approaches combined for the diagnosis of intermediate- to high-risk prostate cancer.Design, setting, and participantsProspective cohort study of 1003 men undergoing both targeted and standard biopsy concurrently from 2007 through 2014 at the National Cancer Institute in the United States. Patients were referred for elevated level of prostate-specific antigen (PSA) or abnormal digital rectal examination results, often with prior negative biopsy results. Risk categorization was compared among targeted and standard biopsy and, when available, whole-gland pathology after prostatectomy as the "gold standard."InterventionsPatients underwent multiparametric prostate magnetic resonance imaging to identify regions of prostate cancer suspicion followed by targeted MR/ultrasound fusion biopsy and concurrent standard biopsy.Main outcomes and measuresThe primary objective was to compare targeted and standard biopsy approaches for detection of high-risk prostate cancer (Gleason score ≥ 4 + 3); secondary end points focused on detection of low-risk prostate cancer (Gleason score 3 + 3 or low-volume 3 + 4) and the biopsy ability to predict whole-gland pathology at prostatectomy.ResultsTargeted MR/ultrasound fusion biopsy diagnosed 461 prostate cancer cases, and standard biopsy diagnosed 469 cases. There was exact agreement between targeted and standard biopsy in 690 men (69%) undergoing biopsy. Targeted biopsy diagnosed 30% more high-risk cancers vs standard biopsy (173 vs 122 cases, P < .001) and 17% fewer low-risk cancers (213 vs 258 cases, P < .001). When standard biopsy cores were combined with the targeted approach, an additional 103 cases (22%) of mostly low-risk prostate cancer were diagnosed (83% low risk, 12% intermediate risk, and 5% high risk). The predictive ability of targeted biopsy for differentiating low-risk from intermediate- and high-risk disease in 170 men with whole-gland pathology after prostatectomy was greater than that of standard biopsy or the 2 approaches combined (area under the curve, 0.73, 0.59, and 0.67, respectively; P < .05 for all comparisons).Conclusions and relevanceAmong men undergoing biopsy for suspected prostate cancer, targeted MR/ultrasound fusion biopsy, compared with standard extended-sextant ultrasound-guided biopsy, was associated with increased detection of high-risk prostate cancer and decreased detection of low-risk prostate cancer. Future studies will be needed to assess the ultimate clinical implications of targeted biopsy.Trial registrationclinicaltrials.gov Identifier: NCT00102544.

Project description:The problem of unnecessary axillary clearance in many patients with early breast cancer was certainly a major issue at IEO when we started working with Prof. Umberto Veronesi in 1994. At that time, axillary dissection in EBC was offered to all patients and this procedure was often hotly debated during our multidisciplinary breast cancer meetings. The question as to whether we could avoid axillary dissection by using PET scans or other nuclear medicine methods was frequently asked by Veronesi. This eventually prompted us to investigate whether, as for melanoma patients, the sentinel node biopsy (SNB) approach could reliably be applied to breast cancer. In December 1995, we proposed a new lymphoscintigraphy protocol to detect the SN in early breast cancer patients to our Ethic Committee, and it was approved. The pilot study was published in 1997 and after only 6 years, the first randomised trial comparing SNB and axillary clearance in breast cancer patients was published. During the pilot study, we optimised the lymphoscintigraphy technique by comparing different radiotracers and different injection modalities. Following the observation that the majority of the radiocolloids injected into the tumour did not migrate to lymph nodes, a new method called ROLL or Radio-guided Occult Lesion Localisation was developed for the localisation of non-palpable breast lesions. This technique was introduced into clinical practice at the European Institute of Oncology in 1996. Several studies showed that the ROLL procedure enabled the surgeon to remove non-palpable breast lesions easily and accurately, overcoming some disadvantages of other methods such as wire-guided localisation (WGL). In addition to SNB and ROLL, other protocols such as the IART (intraoperative avidination for radionuclide therapy)-ARTHE (avidinated radiotherapy) procedure were developed at the IEO Nuclear Medicine Division during the period 1994-2013. I remember that time as the most professionally productive of my career and it would not have been possible without the help, suggestions and encouragement given to me by Umberto Veronesi.

Dataset Information

Ultrasound-guided vacuum-assisted breast biopsy: Use at the European Institute of Oncology in 2010.

Publications

Ultrasound-guided vacuum-assisted breast biopsy: Use at the European Institute of Oncology in 2010.

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