Minimal invasive complete excision of benign breast tumors using a three‐dimensional ultrasound‐guided mammotome vacuum device

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Abstract
Objective The aim of this study was to evaluate the use of three‐dimensional (3D) ultrasonography in the complete excision of benign breast tumors using ultrasound‐guided vacuum‐assisted core‐needle biopsy (Mammotome®). A protocol for the management of benign breast tumors is proposed. Method Twenty consecutive patients with sonographically benign breast lesions underwent 3D ultrasound‐guided mammotome biopsy under local anesthesia. The indication for surgical biopsy was a solid lesion with benign characteristics on both two‐dimensional (2D) and 3D ultrasound imaging, increasing in size over time or causing pain or irritation. Preoperatively, the size of the lesion was assessed using 2D and 3D volumetry. During vacuum biopsy the needle was visualized sonographically in all three dimensions, including the coronal plane. Excisional biopsy was considered complete when no residual tumor tissue could be seen sonographically. Ultrasonographic follow‐up examinations were performed on the following day and 3–6 months later to assess residual tissue and scarring. Results All lesions were histologically benign. Follow‐up examinations revealed complete excision of all lesions of < 1.5 mL in volume as assessed by 3D volumetry. 3D ultrasonographic volume assessment was more accurate than 2D using the ellipsoid formula or assessment of the maximum diameter for the prediction of complete excision of the tumor. No bleeding or infections occurred postoperatively and no scarring was seen ultrasonographically on follow‐up examinations. Conclusions Ultrasound‐guided vacuum‐assisted biopsy allows complete excision of benign breast lesions that are ≤1.5 mL in volume (calculated by 3D volumetry), and thus avoids open surgery and postoperative scarring. Under local anesthesia it is a safe procedure with optimal compliance. 3D ultrasound offers the advantage of better preoperative demonstration of the lesions' margins, resulting in better assessment of volumetry, improved intraoperative needle location and perioperative identification of residual tumor tissue. 3D sonographically guided biopsy should be integrated into breast cancer screening programs as a safe therapeutic option for breast lesions presumed to be benign. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.