Download PDF
Ultraschall Med 2012; 33(4): 366-371
DOI: 10.1055/s-0032-1312831
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Interdisciplinary Consensus Recommendations for the use of Vacuum-Assisted Breast Biopsy under Sonographic Guidance: First update 2012

Konsensusempfehlung zu Anwendung und Indikationen der Vakuumbiopsie der Brust unter Ultraschallsicht: erste Aktualisierung 2012
M. Hahn
1   Department of Obstetrics and Gynaecology, University Hospital Tuebingen
,
U. Krainick-Strobel
2   Mammography Screening Center Tuebingen
,
T. Toellner
3   Private Practice at Clinic Dr. Hancken, Stade
,
J. Gissler
4   Vivantes – Centre of Breast Diseases Berlin
,
S. Kluge
4   Vivantes – Centre of Breast Diseases Berlin
,
E. Krapfl
5   Department of Obstetrics and Gynaecology, Asklepios Clinic, Langen
,
U. Peisker
6   Hermann-Joseph-Hospital, Erkelenz
,
V. Duda
7   Senological Diagnostic Unit, University Hospital Marburg
,
F. Degenhardt
8   Department of Obstetrics and Gynecology, Franziskus Hospital, Bielefeld
,
H. P. Sinn
9   Institute of Pathology, University Hospital Heidelberg
,
D. Wallwiener
1   Department of Obstetrics and Gynaecology, University Hospital Tuebingen
,
I. V. Gruber
1   Department of Obstetrics and Gynaecology, University Hospital Tuebingen
,
In cooperation with the Minimally Invasive Breast Intervention Study Group (AG MiMi) of the German Society of Senology (DGS), and the Study Group for Breast Ultrasonography of the German Society for Ultrasound in Medicine (DEGUM) › Author Affiliations
Further Information

Publication History

19 January 2012

27 March 2012

Publication Date:
21 June 2012 (online)

Also available at
    Permissions and Reprints

Abstract

Purpose: The vacuum biopsy of the breast under sonographic guidance (VB) was introduced in Germany in the year 2000 and the first consensus recommendations were published by Krainick-Strobel et al. in 2005. Since then, many clinical studies on this technique have been published. The purpose of this publication is to update the consensus recommendations from 2005 regarding the latest literature.

Materials and Methods: The consensus statements were the result of two preliminary meetings after the review of the latest literature by members of the Minimally Invasive Breast Intervention Study Group from the German Society of Senology. The final consensus text was review by all members of the working group. The statements listed under results obtained complete acceptance (consensus 100 %).

Results: The consensus recommendations describe the indications, investigator qualifications, technical requirements, documentation, quality assurance and follow-up intervals regarding the latest literature.

Conclusion: The VB is a safe method for extracting breast tissue for histological workup. The technique allows the resection of breast tissue up to 8 cm3. Besides the diagnostic indications, the method qualifies for a therapeutic resection of symptomatic benign lesions (e. g. fibroadenomas). The technique should be used in specialized breast centers working in a multidisciplinary setup. This paper is an expert’s recommendation for the use of VB under sonographic guidance. It is not formulated as a nationwide guideline.

Zusammenfassung

Ziel: Die Vakuumbiopsie der Brust unter sonografischer Bildgebung (VB) wurde flächendeckend in Deutschland ab dem Jahr 2000 eingesetzt. Die erste Konsensusempfehlung von Krainick-Strobel et al. erschien 2005. Seitdem ist die Literatur zu diesem Thema deutlich erweitert worden. Ziel dieser Publikation ist die Aktualisierung der Konsensusempfehlung von 2005 unter Beachtung der neuesten Literatur.

Material und Methoden: Nach Durchsicht der Literatur fand die Konsensusfindung im Rahmen von 2 Arbeitstreffen von Mitgliedern der Arbeitsgemeinschaft Minimalinvasive Mammainterventionen der Deutschen Gesellschaft für Senologie statt. Der fertige Konsensustext wurde allen Mitgliedern der Arbeitsgruppe vorgelegt. Die unter Ergebnisse genannten Punkte wurden einstimmig (Konsensus 100 %) verabschiedet.

Ergebnisse: Diese Konsensusempfehlung beschreibt die Indikationen, die Anforderungen an den Untersucher, die technischen Voraussetzungen, die Dokumentation, die Qualitätssicherung und die Kontrollintervalle unter Beachtung der aktuellen Datenlage.

Schlussfolgerung: Die VB stellt eine sichere Methode zur Histologiegewinnung bei Brusttumoren dar. Sie ermöglicht die Resektion von Gewebsvolumina bis 8 cm3. Neben den diagnostischen Indikationen eignet sich die Methode auch zur therapeutischen Exstirpation von symptomatischen, benignen Befunden (z. B. Fibroadenome). Die Technik sollte in spezialisierten, interdisziplinär arbeitenden Brustzentren durchgeführt werden. Diese Empfehlung ist als Expertenempfehlung zu verstehen und erhebt nicht den Anspruch einer Leitlinie.

Key words

breast - vacuum-assisted biopsy - ultrasound - consensus recommendations
 

  • References

  • 1 Scheler P, Pollow B, Hahn M et al. Hand-held ultrasound-guided vacuum biopsy of mammary lesions – first experiences. Zentralbl Gynakol 2000; 122: 472-475
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Krainick-Strobel U, Hahn M, Duda V et al. Konsensusempfehlung zu Anwendung und Indikationen der Vakuumbiopsie der Brust unter Ultraschallsicht. Senologie 2005; 2: 73-76
    PubMedGoogle Scholar
  • 3 Albert US. Stufe-3-Leitlinie Brustkrebs-Früherkennung in Deutschland. 1. Aktualisierung 2008. München – Wien – New York: W. Zuckschwerdt Verlag; 2008
    Google Scholar
  • 4 Hahn M, Krainick U, Peisker U et al. Is a Handheld Mammotome® Suitable for the Complete Removal of Benign Breast Lesions?. Geburtsh Frauenheilk 2004; 64: 719-722
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Hahn M, Okamgba S, Scheler P et al. Vacuum-assisted breast biopsy: a comparison of 11-gauge and 8-gauge needles in benign breast disease. World J Surg Oncol 2008; 6: 51
    CrossrefPubMedGoogle Scholar
  • 6 Slanetz PJ, Wu SP, Mendel JB. Percutaneous Excision: A Viable Alternative to Manage Benign Breast Lesions. Can Assoc Radiol J 2011; 62: 265-271
    CrossrefPubMedGoogle Scholar
  • 7 Kim MJ, Kim EK, Lee JY et al. Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings. Eur Radiol 2007; 17: 2376-2383
    CrossrefPubMedGoogle Scholar
  • 8 Bruening W, Fontanarosa J, Tipton K et al. Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med 2010; 152: 238-246
    CrossrefPubMedGoogle Scholar
  • 9 Abbate F, Bacigalupo L, Latronico A et al. Ultrasound-guided vacuum assisted breast biopsy in the assessment of C3 breast lesions by ultrasound-guided fine needle aspiration cytology: results and costs in comparison with surgery. Breast 2009; 18: 73-77
    CrossrefPubMedGoogle Scholar
  • 10 Cassano E, Urban LA, Pizzamiglio M et al. Ultrasound-guided vacuum-assisted core breast biopsy: experience with 406 cases. Breast Cancer Res Treat 2007; 102: 103-110
    CrossrefPubMedGoogle Scholar
  • 11 Carpentier E, Maruani A, Michenet P et al. Can US-guided vacuum-assisted biopsies be an alternative to diagnostic surgery in cases of non-diagnostic core needle biopsy?. J Radiol 2005; 86: 475-480
    CrossrefPubMedGoogle Scholar
  • 12 Bonifacino A, Petrocelli V, Pisani T et al. Accuracy rates of US-guided vacuum-assisted breast biopsy. Anticancer Res 2005; 25: 2465-2470
    PubMedGoogle Scholar
  • 13 Parker SH, Klaus AJ, McWey PJ et al. Sonographically guided directional vacuum-assisted breast biopsy using a handheld device. Am J Roentgenol 2001; 177: 405-408
    CrossrefPubMedGoogle Scholar
  • 14 Li JL, Wang ZL, Su L et al. Breast lesions with ultrasound imaging-histologic discordance at 16-gauge core needle biopsy: can re-biopsy with 10-gauge vacuum-assisted system get definitive diagnosis?. Breast 2010; 19: 446-449
    CrossrefPubMedGoogle Scholar
  • 15 Nakano S, Sakamoto H, Ohtsuka M et al. Evaluation and indications of ultrasound-guided vacuum-assisted core needle breast biopsy. Breast Cancer 2007; 14: 292-296
    CrossrefPubMedGoogle Scholar
  • 16 Cho N, Moon WK, Cha JH et al. Sonographically guided core biopsy of the breast: comparison of 14-gauge automated gun and 11-gauge directional vacuum-assisted biopsy methods. Korean J Radiol 2005; 6: 102-109
    CrossrefPubMedGoogle Scholar
  • 17 Philpotts LE, Hooley RJ, Lee CH. Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast. Am J Roentgenol 2003; 180: 347-351
    CrossrefPubMedGoogle Scholar
  • 18 Wang ZL, Liu G, Li JL et al. Breast Lesions with Imaging-Histologic Discordance During 16-Gauge Core Needle Biopsy System: would Vacuum-Assisted Removal get Significantly More Definitive Histologic Diagnosis Than Vacuum-Assisted Biopsy?. Breast J 2011; 17: 456-461
    CrossrefPubMedGoogle Scholar
  • 19 Plantade R, Hammou JC, Gerard F et al. Ultrasound-guided vacuum-assisted biopsy: review of 382 cases. J Radiol 2005; 86: 1003-1015
    CrossrefPubMedGoogle Scholar
  • 20 Duchesne N, Parker SH, Lechner MC et al. Multicenter evaluation of a new ultrasound-guided biopsy device: Improved ergonomics, sampling and rebiopsy rates. Breast J 2007; 13: 36-43
    CrossrefPubMedGoogle Scholar
  • 21 Parker SH, Klaus AJ. Performing a breast biopsy with a directional, vacuum-assisted biopsy instrument. Radiographics 1997; 17: 1233-1252
    PubMedGoogle Scholar
  • 22 Kim MJ, Kim SI, Youk JH et al. The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal. Clin Radiol 2010; 66: 530-535
    PubMedGoogle Scholar
  • 23 Perez-Fuentes JA, Longobardi IR, Acosta VF et al. Sonographically guided directional vacuum-assisted breast biopsy: preliminary experience in Venezuela. Am J Roentgenol 2001; 177: 1459-1463
    CrossrefPubMedGoogle Scholar
  • 24 Sperber F, Blank A, Metser U et al. Diagnosis and treatment of breast fibroadenomas by ultrasound-guided vacuum-assisted biopsy. Arch Surg 2003; 138: 796-800
    CrossrefPubMedGoogle Scholar
  • 25 Povoski SP. The utilization of an ultrasound-guided 8-gauge vacuum-assisted breast biopsy system as an innovative approach to accomplishing complete eradication of multiple bilateral breast fibroadenomas. World J Surg Oncol 2007; 5: 124
    CrossrefPubMedGoogle Scholar
  • 26 Krainick-Strobel U, Huber B, Majer I et al. Complete extirpation of benign breast lesions with an ultrasound-guided vacuum biopsy system. Ultrasound Obstet Gynecol 2007; 29: 342-346
    CrossrefPubMedGoogle Scholar
  • 27 Ko EY, Bae YA, Kim MJ et al. Factors affecting the efficacy of ultrasound-guided vacuum-assisted percutaneous excision for removal of benign breast lesions. J Ultrasound Med 2008; 27: 65-73
    PubMedGoogle Scholar
  • 28 Luo HJ, Chen X, Tu G et al. Therapeutic Application of Ultrasound-Guided 8-Gauge Mammotome System in Presumed Benign Breast Lesions. Breast J 2011; 17: 490-497
    CrossrefPubMedGoogle Scholar
  • 29 Yom CK, Moon BI, Choe KJ et al. Long-term results after excision of breast mass using a vacuum-assisted biopsy device. ANZ J Surg 2009; 79: 794-798
    CrossrefPubMedGoogle Scholar
  • 30 Thurley P, Evans A, Hamilton L et al. Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas. Clin Radiol 2009; 64: 381-385
    CrossrefPubMedGoogle Scholar
  • 31 Bonaventure T, Cormier B, Lebas P et al. Benign papilloma: is US-guided vacuum-assisted breast biopsy an alternative to surgical biopsy?. J Radiol 2007; 88: 1165-1168
    CrossrefPubMedGoogle Scholar
  • 32 Dennis MA, Parker S, Kaske TI et al. Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy. Am J Roentgenol 2000; 174: 1263-1268
    CrossrefPubMedGoogle Scholar
  • 33 Wei H, Jiayi F, Qinping Z et al. Ultrasound-guided vacuum-assisted breast biopsy system for diagnosis and minimally invasive excision of intraductal papilloma without nipple discharge. World J Surg 2009; 33: 2579-2581
    CrossrefPubMedGoogle Scholar
  • 34 Youk JH, Kim MJ, Son EJ et al. US-Guided Vacuum-Assisted Percutaneous Excision for Management of Benign Papilloma Without Atypia Diagnosed at US-Guided 14-Gauge Core Needle Biopsy. Ann Surg Oncol 2012; 19: 922-928
    CrossrefPubMedGoogle Scholar
  • 35 Chang JM, Han W, Moon WK et al. Papillary Lesions Initially Diagnosed at Ultrasound-guided Vacuum-assisted Breast Biopsy: Rate of Malignancy Based on Subsequent Surgical Excision. Ann Surg Oncol 2011; 18: 2506-2514
    CrossrefPubMedGoogle Scholar
  • 36 Maxwell AJ. Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience. Clin Radiol 2009; 64: 801-806
    CrossrefPubMedGoogle Scholar
  • 37 Torres-Tabanera M, Alonso-Bartolome P, Vega-Bolivar A et al. Percutaneous microductectomy with a directional vacuum-assisted system guided by ultrasonography for the treatment of breast discharge: experience in 63 cases. Acta Radiol 2008; 49: 271-276
    CrossrefPubMedGoogle Scholar
  • 38 Grady I, Gorsuch H, Wilburn-Bailey S. Ultrasound-guided, vacuum-assisted, percutaneous excision of breast lesions: an accurate technique in the diagnosis of atypical ductal hyperplasia. J Am Coll Surg 2005; 201: 14-17
    CrossrefPubMedGoogle Scholar
  • 39 Reefy S, Osman H, Chao C et al. Surgical excision for B3 breast lesions diagnosed by vacuum-assisted core biopsy. Anticancer Res 2010; 30: 2287-2290
    PubMedGoogle Scholar
  • 40 Londero V, Zuiani C, Linda A et al. Borderline breast lesions: comparison of malignancy underestimation rates with 14-gauge core needle biopsy versus 11-gauge vacuum-assisted device. Eur Radiol 2011; 21: 1200-1206
    CrossrefPubMedGoogle Scholar
  • 41 Kim HS, Kim MJ, Kim EK et al. US-guided vacuum-assisted biopsy of microcalcifications in breast lesions and long-term follow-up results. Korean J Radiol 2008; 9: 503-509
    CrossrefPubMedGoogle Scholar
  • 42 Choo KS, Kwak HS, Tae Bae Y et al. The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications. Breast 2008; 17: 611-616
    CrossrefPubMedGoogle Scholar
  • 43 Breast Imaging Reporting and Data System (BI-RADS) Atlas. 4th ed. American College of Radiology; 2003
    Google Scholar
  • 44 Madjar H, Ohlinger R, Mundinger A et al. BI-RADS-analogue DEGUM criteria for findings in breast ultrasound – consensus of the DEGUM Committee on Breast Ultrasound. Ultraschall in Med 2006; 27: 374-379
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Hahn M, Gall C, Baur S et al. Fehlerquellen bei minimalinvasiven Interventionen der Brust … und wie man sie umgehen kann!. Geburtsh Frauenheilk 2007; 67: 779-781
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Hahn M, Kagan KO, Siegmann KC et al. Mammotome versus ATEC: a comparison of two breast vacuum biopsy techniques under sonographic guidance. Arch Gynecol Obstet 2010; 281: 287-292
    CrossrefPubMedGoogle Scholar
  • 47 Hahn M, Krainick-Strobel U, Wallwiener D. Die ultraschallgesteuerte Vakuumbiospie – Ein Lehrvideo. Tübingen: Universitäts-Frauenklinik; 2006
    Google Scholar
  • 48 Krainick-Strobel U, Majer I, Huber B et al. Development of a gel-simulation model and generation of standard tables for the complete extirpation of benign breast lesions with vacuum assisted biopsy under ultrasound guidance. Ultrasound Med Biol 2006; 32: 1539-1544
    CrossrefPubMedGoogle Scholar
  • 49 Fine RE, Whitworth PW, Kim JA et al. Low-risk palpable breast masses removed using a vacuum-assisted hand-held device. Am J Surg 2003; 186: 362-367
    CrossrefPubMedGoogle Scholar
  • 50 Krainick-Strobel U, Flügel B, Hahn M et al. Komplettresektion benigner Mammabefunde mittels ultraschallgeführter großlumiger Vakuumbiopsie: medianes Follow-up von 13 Monaten. Geburtsh Frauenheilk 2010; 70: 483-487
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 Tagaya N, Nakagawa A, Ishikawa Y et al. Experience with ultrasonographically guided vacuum-assisted resection of benign breast tumors. Clin Radiol 2008; 63: 396-400
    CrossrefPubMedGoogle Scholar
  • 52 Hahn M, Fischbach E, Fehm T et al. Are breast biopsies adequately funded? A process cost & revenue analysis. Fortschr Röntgenstr 2011; 183: 347-357
    Article in Thieme ConnectPubMedGoogle Scholar
  • 53 Alonso-Bartolome P, Vega-Bolivar A, Torres-Tabanera M et al. Sonographically guided 11-G directional vacuum-assisted breast biopsy as an alternative to surgical excision: utility and cost study in probably benign lesions. Acta Radiol 2004; 45: 390-396
    CrossrefPubMedGoogle Scholar
  • 54 Gruber I, Hahn M, Fehm T et al. Relevance and Methods of Interventional Breast Sonography in Preoperative Axillary Lymph Node Staging. Ultraschall in Med 2011; [Epub ahead of print]
    PubMedGoogle Scholar
  • 55 Hille H, Vetter M, Hackeloer BJ. The Accuracy of BI-RADS Classification of Breast Ultrasound as a First-Line Imaging Method. Ultraschall in Med 2012; 33: 160-163
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Hahn M, Roessner L, Krainick-Strobel U et al. Sonographic Criteria for the Differentiation of Benign and Malignant Breast Lesions using Real-Time Spatial Compound Imaging in Combination with XRES Adaptive Image Processing. Ultraschall in Med 2010; [Epub ahead of print]
    PubMedGoogle Scholar