Vacuum-assisted excision: a single-step approach to the diagnosis and treatment of early breast cancers – initial report

Abstract

Objective: The aim of this study was to describe the initial experience applying vacuum-assisted excision (VAE) associated
with cavity margins sampling shaving (CMSH) to breast lesions (BL), smaller than 15 mm and suspected of malignancy,
as a single-step approach in diagnosing and treating early breast cancers (EBC). Methodology: An open interventional
study was conducted recruiting patients with Category 4 and 5 ACR BI-RADS™ BL, smaller than 15 mm, candidates for
VAE. Patients with diagnosed multifocal/multicentric breast cancer (BC) were excluded. The VAE was performed, complete BL excision was achieved, and CMSH was obtained by 12 entire cavity circumference core samples (CS). If BC was
confirmed, patients were submitted to standard surgery (SS) and adjuvant therapy. Data on demographic, imaging, pathology, VAE-CMSH, and surgery were recorded. BREAST-Q core biopsy score (CBS) was applied to analyze patient satisfaction. The SPSS® 20.0 software was used for statistical analyses. Results: From 01/12/2023 to 06/03/2024, 12 patients were
assigned with a mean age of 53.92 years and a mean imaging tumor size (iT) of 10.7 mm (7–15). Mean 40 CS weighting
18.3 g were retrieved in 21 min VAE-CMSH time. Two patients had skin laceration and one diffuse breast bruising, despite
high satisfaction, with a mean BreastQ-CBS of 15.1/16. Three lesions were invasive cancers (IC), four lesions of the indeterminate potential of malignancy (B3 lesions), three fibroadenomas, and two fibrocystic diseases. The IC were BI-RADS
4C masses, 12 mm mean iT, 6.3 mm (6–7) mean pathological size, two lobular and one ductal, all luminal A like in immunohistochemistry, completed resected by ultrasound-guided VAE-CMSH, submitted to lumpectomy with negative sentinel node biopsy (pN0), representing true negative cases (neither residual tumor on CMSH nor on SS). Conclusion: VAECMSH is a feasible, fast, well-tolerated outpatient procedure with high patient satisfaction. It can accurately diagnose and
completely resect suspected BL smaller than 15 mm in a single-step approach, including B3 lesions and EBC, presenting
promising results and no false negatives in the first three BC patients.