title: 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.
abstract: OBJECTIVE
  To evaluate the efficacy of a BLES procedure as a primary excisional biopsy rather than a surgical wide local excision for treatment of a high risk or a malignant lesion.
  
  
  METHODS
  41 patients underwent a BLES procedure in order to attempt to remove a small breast lesion using a 15 mm or 20 mm wand from August 2007 to January 2009. The lesions were either proven on prior core biopsy to show high risk or malignant pathology or were considered to be indeterminate or suspicious on ultrasound or mammography. The pathology was reviewed to include the final status of lesion excision. If margin involvement was demonstrated then a formal surgical excision was subsequently recommended. Follow up mammography or ultrasound was performed annually in patients following the final pathological diagnosis.
  
  
  RESULTS
  9 patients had a primary diagnosis of atypia (columnar cell change with atypia or atypical ductal hyperplasia (ADH)), 23 patients had ductal carcinoma in situ (DCIS) and 9 had an invasive carcinoma (IC) at the original BLES pathology. Clear BLES margins of >1 mm were obtained in 3/9 atypia lesions, 15/23 DCIS and 0/9 IC. 12/13 low grade DCIS were completely excised. Subsequent surgical margin excisions were undertaken in 20 patients. After at least 5 years of follow up (mean 66 months), 1 lesion had recurred on imaging.
  
  
  CONCLUSIONS
  A BLES excision has potential as an alternative technique to traditional surgical wide local excision in the management of certain small breast lesions with high risk and low grade malignant potential.
authors.affiliation: Dept of Imaging, Royal Marsden NHS Foundation Trust, United Kingdom. Electronic address: steven.allen@rmh.nhs.uk.
authors.forename: S D
authors.initials: SD
authors.lastname: Allen
authors.affiliation: Dept of Pathology, Royal Marsden NHS Foundation Trust, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Osin
authors.affiliation: Dept of Pathology, Royal Marsden NHS Foundation Trust, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Nerurkar
mesh_terms: D000328:Adult; D001706:Biopsy / Q000295:instrumentation / Q000379:methods; D062005:Biopsy, Large-Core Needle / Q000295:instrumentation / Q000379:methods; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013238:Stereotaxic Techniques / Q000295:instrumentation; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors
keywords: BLES; Breast; INTACT; Radiofrequency; Stereotactic; Ultrasound