The role of vacuum assisted excision in diagnosis of papillary lesions without atypia

Background and purpose: Papillary lesions of the breast exist on a spectrum varying from benign to malignant, with considerable heterogeneity between these subtypes regarding their upgrade rates to malignancy. Given the low upgrade rates of papillary lesions of the breast without atypia it has been hypothesised that these are a cohort of lesions that could be managed conservatively. Vacuum assisted excision has been described as a minimally invasive, cost and resource effective means to diagnosing these lesions. This data assesses patients at North Shore Hospital with benign papillomas without atypia of the breast who underwent vacuum assisted excision of their lesions between 2020-2023, for upgrade to malignancy. Methods: Between 2019-2023, 21 patients undergoing breast biopsy (including those undergoing vacuum-assisted excision with diagnosed benign papilloma of the breast without atypia), were identified by the department of General Surgery at North Shore Hospital. Patient age, ethnicity, specific histology, size of lesion, weight and presence/absence of cytological atypia were recorded. The ATEC Breast Biopsy and Excision System by Hologic was used to perform all vacuum assisted excisions. All procedures were carried out by two trained breast radiologists. Results: All procedures were successfully completed. No patients were admitted to hospital with complications following the procedure. All patients had benign papillomas on final histology. No patients required formal excision. Follow up recommendation is a mammogram at one year. Conclusions: Vacuum assisted excision biopsy of papillary lesions without atypia has been shown to be feasible and safe in our early cohort. There were no cases of upgrade to malignancy. Most patients were advised to continue yearly mammograms as routine follow up, which has been described in the literature as an acceptable time frame (1,2). References: Armes, J. E., Galbraith, C., Gray, J. & Taylor, K. The outcome of papillary lesions of the breast diagnosed by standard core needle biopsy within a BreastScreen Australia service. Pathology 49, 267–270 (2017). Zheng, L et al. Breast lesions excised via vacuum-assisted system: could we get any clues for B3 lesions before excision biopsy? BMC Cancer 21, 1-9 (2021).