Evaluation of the initial efficacy in the removal of benign breast lesions by vacuum - Assisted biopsy in radiology center of Bach Mai hospital

Evaluation of the initial efficacy in the removal of 
benign breast lesions by vacuum-assisted biopsy 
in radiology center of Bach Mai hospital
Dr. Lê Nguyệt Minh
Radiology center of Bach Mai hospital
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Introduction
• Benign breast lesions is one of the 
common diseases:
– America: 1 million women diagnosed benign 
breast lesions/ year
– Thailand: 73% benign breast lesions / study of 
2532 patients biopsied. 
• Pain, discomfort in breast is sensitive 
 reduce the quality of life
 Treatment? Vacuum- assisted breast 
biopsy (VABB)
Aim
• to evaluate the initial efficacy in the
removal of benign breast lesions by
vacuum-assisted biopsy
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Excision surgery 
 leave a scar
Vacuum- assisted breast biopsy
(VABB)
• 11G ~ 7G
• Using Vacuum and Rotating cutter
• One insertion and Serial sampling
• Enough specimen for Pathology
• Excision of Benign Tumor
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After VABB
Vacuum Assisted Breast Biopsy
1995 1996
Fred Burbank, 
Mark Retchard
1998
Zannis
2002
FDA
Total lesionremoval
High asthetic
Meta analysis of efficacy and safety between Mammotome vacuum-assisted 
breast biopsy and open excision for benign breast tumor 
Boni Ding, Daojin Chen, Xiaorong Li, Hongyan Zhang, Yujun Zhao 
Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha 410013, China Correspondence to: Yujun Zhao. Organ 
Transplantation Center, Third Xiangya Hospital, Central South University, Changsha 410013, China. 
Gland Surgery 2013;2(2):69-79
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Indication of VABB
• Diagnostic indications:
– Biopsy small lesion (<5mm) – ultrasound visible
– Biopsy suspicious grouped microcalcification 
• Therapeutic indications:
– Remove symptomatic BIRADS 3-lesion, 
probably benign, woman are not willing to 
follow-up
– Remove intraductal papilloma which cause 
nipple discharge
Intraindications
• Absolute intraindications:
– Allergy to local anethesia
– Severe systematic disease 
– Coagulation disorder
– Local inflamation
– Patient is too nervous, can not corporate
• Relative intraindication:
– Cancer in other location
Subjects and method
• Prospective cohort study
– From January to June 2018
– 21 woman with 31 lesions
– Data and pre-, during , post procedure images
stored in PACS
– Assess complications post procedure.
Results
• Characteristics of subjects
– Mean of age 37,5± 11,7
8. Oluwole S.F. và Freeman H.P. (1979). Analysis of benign breast lesions in blacks. Am J Surg, 137(6), 786–789.
9. 9. Park H.-L., Kwak J.-Y., Lee S.-H. và cộng sự. (2005). Excision of Benign Breast Disease by Ultrasound-Guided Vacuum 
Assisted Biopsy Device (Mammotome). Ann Surg Treat Res, 68(2), 96–101.
Symptoms Number of 
lesion
Percentage %
Pain 30 96,8
Pain related menstrual 
period
19 63,3
Mass papable 27 87,1
Result
• Result of pathology
Pathoanatomy Number of lesions Percent %
Fibroadenoma 17 54,8
Fibrocystic breast 
disease
08 25,8
abscess 01 03,2
Sclerosing adenosis 01 03,2
Papiloma intra 
tubular
01 03,2
others 03 09,7
Tổng 31 100
Result
Time of
biopsy (min)
Amount of 
samples
Lidocain 2% 
pha 1:5 (ml)
Size on 
ultrasound
(mm)
Mean ± SD 12,3 ± 8,3 10,8 ± 6,7 10,6 ± 4,1 11,7 ±5,4
Mode 10,0 8,0 10,0
Minimum 5 3 5 5
Maximum 48 31 20 22
Total 383 335 328 31
11. Clinical application of mammotome minimally invasive biopsy system for excision of 560 benign breast lumps--《Lingnan
Modern Clinics in Surgery》2007年05期. , accessed: 
04/06/2018.
Results
• There is a proportional correlation between the size of the 
lesions and other factors such as the amount of anesthetics 
used, the volume of the hematoma after the biopsy, the time 
of wound removal and the size of the biopsy needle
Correlation between
the volume of lesion
R P
Size of biopsy needle Test Mann-Whitney U = 84 0,185
Volume of hematoma 0,467 0,008
Amount of anesthetic 0,674 0,000
The time of biopsy 0,659 0,000
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Results
Complications after biopsy
Number of
lesions
Percentage %
p
Residual 0 0
Ecchymosis no 27 87,1 0,000
yes 4 12,9
Postprocedure
pain
No 2 6,5 0,02
Low 20 64,5
Medium 9 29,0
Heavy 0 0
15. Li S., Wu J., Chen K. và cộng sự. (2013). Clinical outcomes of 1,578 Chinese patients with breast benign diseases after 
ultrasound-guided vacuum-assisted excision: recurrence and the risk factors. Am J Surg, 205(1), 39–44.
Results
Complications after biopsy
• The distance from the lesion to the skin surface is inversely 
proportional to the size of the post-biopsy hematoma (p= 0,04).
• Post-biopsy pain. 
Pain N Distance from the 
lesion to the nipple
Standard
deviation
Non 2 25,0 21,2
Low 20 21,4 5,7
Medium 9 13,9 13,6
Total 31 19,5 9,9
16. Liu S., Zou J.-L., Zhou F.-L. và cộng sự. (2017). [Efficacy of ultrasound-guided vacuum-assisted Mammotome excision for 
management of benign breast diseases: analysis of 1267 cases]. Nan Fang Yi Ke Da Xue Xue Bao, 37(8), 1121–1125.
Conclusion
• Vacuum-assisted breast biopsy is an effective 
and safe method for removal benign breast 
lesions. This method is also highly aesthetic. The 
anapathology results based on this method are 
reliable, especially for small lesions.
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