Page 108 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology UGVAE of breast lesions

1. Introduction infiltrative pattern rather than forming distinct masses.
Accurate diagnosis of these lesions requires larger tissue
Benign breast masses are common clinical findings, samples, making VAB the preferred method. Furthermore,
especially among women of reproductive age and VAB is well-suited for sampling lesions situated near
encompass a variety of non-cancerous conditions such delicate anatomical areas, including the thoracic wall or
as fibroadenomas (FA), cysts, and fibrocystic changes. nipple, as its design avoids the use of a forward-moving
1,2
These masses often present as palpable lumps or areas of needle, thereby improving both accuracy and safety.
18
thickening and are typically discovered during routine breast Hematoma is the primary complication associated with
examinations or imaging studies such as mammography
or ultrasound. The management of benign breast masses minimally invasive procedures, posing a challenge to the
3,4
varies depending on factors such as the mass’s size, location, use of ultrasound-guided vacuum-assisted systems for
19
symptoms, and any associated risks, including patient age benign breast masses. However, the exact mechanism by
which vacuum-assisted systems contribute to hematoma
and family history. While many benign masses require
2,5
only monitoring and conservative management, others formation remains unclear and lacks a definitive
20
may necessitate diagnostic procedures, like a biopsy, for explanation.
further evaluation or interventions such as aspiration or Conventionally, benign breast lesions, such as FA,
surgical excision, particularly if they are symptomatic, are diagnosed using a triple assessment approach,
growing, or causing cosmetic concerns. 6,7 which includes clinical evaluation, imaging (ultrasound,
For benign breast masses, the need for follow-up mammography, or magnetic resonance imaging), and
examinations can significantly impact patients both pathological examination through core biopsy or,
emotionally and financially, often leading to poor historically, fine needle aspiration cytology. When a lesion
compliance with recommended monitoring protocols. is confirmed to be a simple FA, management options
1,8
Regular imaging studies or clinical re-evaluations are typically include reassurance without further intervention
crucial for tracking any changes in the mass over time, but for most patients, periodic follow-up with imaging, or
the frequency and duration of follow-up can create anxiety, surgical excision in cases involving older patients (over
21
particularly when patients perceive the risk of malignancy 35 years), lesions larger than 3 cm, or complex FA.
22
as uncertain. 4,9,10 Furthermore, surgical excision, though Research by Dixon et al. demonstrated that conservative
occasionally necessary for symptomatic or progressively management is a safe and widely accepted approach for
22
enlarging masses, is a costly procedure that may not be patients under 40 years of age. With advancements in
covered by all insurance plans. It can also leave permanent ultrasound technology, current guidelines for managing
scars on the breast, potentially affecting the patient’s body breast symptoms suggest that, in patients younger than
image and quality of life. 11,12 As a result, many patients may 25 years, biopsy is generally unnecessary if imaging reveals
be reluctant to undergo excision or adhere to prolonged a solid lesion with benign characteristics, such as an
follow-up schedules, highlighting the need for a patient- ellipsoid shape, a wider-than-tall orientation, well-defined
centered approach that balances clinical necessity with smooth margins, fewer than four gentle lobulations, and a
consideration for psychological, esthetic, and financial homogeneous internal structure. 21
factors. 13,14 Introduced in 1995, ultrasound-guided vacuum-
Vacuum-assisted excisional biopsy (VAB) is a assisted breast biopsy (UGVAB) has emerged as an effective
specialized technique that utilizes large-bore needles, technique for sampling non-palpable lesions identified
23
typically 8G or 11G, to extract larger tissue samples through mammography. While core needle biopsy is
24
compared to fine-needle aspiration or core needle biopsy. recognized for its precision and sensitivity, its limited
This capability significantly reduces the rate of negative ability to capture the invasive characteristics of certain
biopsies and minimizes discordance between the biopsy lesions, due to the small sample size, can hinder accurate
material and surgical specimens. In 2002, the United diagnosis. UGVAB addresses this limitation by obtaining
25
15
States Food and Drug Administration authorized VAB larger tissue samples, thereby enhancing diagnostic
for excising benign breast lesions. While VAB allows for accuracy and distinguishing benign from malignant
the removal of substantial tissue volumes, open surgical breast lesions. Furthermore, ultrasound-guided vacuum-
26
excision remains the preferred approach for large, palpable assisted excision (UGVAE), a related technique, is now
16
masses. Consequently, the indications and effectiveness widely used not only for the biopsy of breast lesions but
of VAB remain topics of debate. VAB is particularly also for treating benign breast conditions, solidifying
17
advantageous in diagnosing challenging cases, such as its role as a versatile and valuable tool in breast disease
invasive lobular carcinomas, which often grow in an management. 15,27-29

Volume 9 Issue 2 (2025) 100 doi: 10.36922/ejmo.8436