[Vacuum-assisted biopsy and wire localization for the diagnosis of non-palpable breast lesions].
OBJECTIVE
To compare the effectiveness and accuracy of the use of vacuum-assisted biopsy (VAB) versus wire localization (WL) in the diagnosis of non-palpable breast lesions (NPBL).


METHODS
Ninety-seven consecutive women with NPBL were randomized into VAB group and WL group. All specimens were identified by mammography. The patients were requested to score the cosmetic appearance of their breast after operation, and a numerical rating scale was used to measure pain on the first postoperative day. Underestimation rates for atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) were recorded if open surgical biopsy revealed DCIS and invasive cancer, respectively. Clear margins were also recorded in the two groups.


RESULTS
VAB and WL located all the NPBL successfully. In the VAB group, the specimen volume was smaller than that of the WL group (2.3 cm(3) vs. 18.4 cm(3), P = 0.03). Underestimation rates of ADH and DCIS in the VAB group were 16.7% and 11.1%, respectively. The diagnostic accordance rate of VAB was 97.9%, the false negative rate was 2.1%, and there was no false positive case. The means of the numerical rating pain scale were different in both groups (1.7 for VAB vs. 2.5 for WL, P = 0.02). When cosmetic results were taken into account, 40 VAB patients had excellent outcomes and 8 good outcomes, compared with 25 excellent and 24 good for the WL group. There were better cosmetic outcomes with the VAB procedure (P < 0.05).


CONCLUSIONS
VAB is highly reliable and may avoid diagnostic open surgery in the majority of patients with benign lesions. However, because of the underestimation of histologic diagnosis and tumor margin involvement, VAB can not be used to completely substitute wire localization.
Su
Kun-Lun
KL
Department of Breast Surgery, Guangxing Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310007, China. sukunlun@yahoo.com.cn
Xu
Hai-Bin
HB
Hu
Zu-Jian
ZJ
He
Jun-Ling
JL
Yang
Ou-Ou
OO
Hu
Wang-Hua
WH
D000328:Adult; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000473:pathology; D003951:Diagnostic Errors; D005260:Female; D018226:Fibroadenoma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D006965:Hyperplasia; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D014618:Vacuum