Abstract No. 191 Percutaneous Excision of Large (>3 cm) and Giant (>5 cm) Breast Fibroadenomas, Sub-areolar Fibroadenomas, Vascular Fibroadenomas by USG-Guided VABB Technique: Indications Beyond NICE Guidelines

Women feel anxious once lump is detected in the breast. The benign lump which is called fibroadenomas are non-cancerous and more common in young girls and middle-aged women (15-45 years). Traditionally, these benign lumps are removed by open surgery causing much distress related to surgery and anesthesia along, leaving scars on the breast. vacuum-assisted breast biopsy (VABB) under imaging guidance, is the form of pin-hole treatment, done by interventional radiologists for benign breast lumps–fibroadenoma or papilloma which sizes < 3 cm according to NICE guidelines. Pushing boundaries and stretching limitations, we have excised lesions sizing >3 cm including large and giant fibroadenomas up to 7.8 cm through the VABB technique successfully. We have also treated patients with sub-areolar fibroadenoma, fibroadenoma just beneath skin, fibroadenomas with significant vascularity through these technique. The advantage of the procedure is day care, done in local anaesthesia and as there is no incision over skin and hence no stiches or scar on the breast. Multiple ones can be treated in the same sitting. Awareness of this procedure at the community level will help women choose appropriate treatment and prioritize their health. Total 30 patients with large fibroadenomas sizing between (3-8 cm) has been treated with USG-guided VABB under local anaesthesia from single or b/l breasts. Patients who were taken up for VABB, had lesions categorized as BIRAD II on mammosonography. All patients were given the option of open surgery along with VABB. In all patients, the procedure was done under USG guidance in local anaesthesia. Complete excision of the mass was the end point of procedure. Local homeostasis after excision had been achieved by manual compression. All excised fibroadenomas are sent for histopathology. All patients were discharged within 24 hour. Follow up of patients were taken at 1 week, 1 month, 3 months and 6 months, 1 year interval. All fibroadenomas ranging between 3-8 have been removed successfully. One fibroadenoma sized 6 cm was very hard and was not removed through VABB. One patient had asymptomatic serous collection and one patient had hemorrhage where homeostasis is achieved by manual compression. Though the NICE guidelines approve VABB for excision of fibroadenoma less than 3 cm, we have successfully treated 30 patients with 50 fibroadenomas more than 3 cm in size. Though the numbers are small and our experience is limited to 30 patients, treatment of image-guided VABB procedure for excision of fibroadenoma should be extended to lesion sizing more than 3 cm.