Improved evaluation of patients with small clusters of microcalcifications on mammograms: Implementation of vacuum assisted excision with “cavity margins shaving” technique

IF 3.2 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Pub Date : 2025-04-26 DOI:10.1016/j.ejrad.2025.112138

Rossella Rella , Giovanna Romanucci , Paolo Belli , Mariagrazia Ramunno , Josè Nunnari , Gianluca Russo , Francesca Morciano , Sebastiano Croce , Lucrezia Papalia , Francesca Fornasa , Oscar Tommasini , Marco Conti

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引用次数: 0

Abstract

Rationale and Objectives: The purpose of our study is to assess the diagnostic performance and treatment effectiveness of vacuum assisted excision (VAE) under digital breast tomosynthesis (DBT) guidance with “cavity margins shaving” technique to ensure total lesion removal in patients with ≤ 15 mm clusters of microcalcifications.

Materials and Methods

Patients with a single cluster of microcalcifications (BI-RADS > 3) < 15 mm who underwent DBT-guided VAE were enrolled. The “cavity margins shaving” technique was used: 12 focus samples (FS) and 12 cleaning samples (CS) were taken and the histopathologic assessment of the FS and CS was performed separately. The presence of residual disease within the CS was assessed. The surgical excision results were compared according to the CS status.

Results

A total of 72 patients were included, with 12 benign (16.7%), 45 B3 (62.5%) and 15 malignant (20.8%) lesions. Among the 13 ductal carcinomas in situ (DCIS) and 17 atypical ductal hyperplasia (ADH) cases without residual disease within the CS (21/30, 70%), in 2 cases residual pathology was detected in the subsequent surgery, without any case of upgrade.

Comparing the presence of malignant disease (residual DCIS or upgrade of ADH) at surgical excision according to the CS status, the rates were 1/5 (20.0 %) and 4/5 (80.0 %) respectively for negative and positive CS (P = 0.007). The NPV of the absence of residual lesion in the CS was 95.24 % (95 %CI: 76.39 %-99.20 %).

Conclusion

VAE with cavity margins shaving technique could represent a valuable alternative to surgical excision in selected patients (such as those with ADH or low-grade DCIS) who met the radiologic and histologic criteria.

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改善乳房x光检查中小簇微钙化患者的评估：采用“腔缘刮除”技术进行真空辅助切除

理由与目的：本研究的目的是评估数字乳腺断层合成（DBT）指导下的真空辅助切除（VAE）与“空腔边缘刮除”技术的诊断性能和治疗效果，以确保≤15 mm微钙化簇的患者病灶完全切除。材料与方法单组微钙化(BI-RADS；3) & lt;入选15例行dbt引导下的VAE。采用“腔缘刮除”技术，取病灶样本（FS） 12个，清洁样本（CS） 12个，分别对FS和CS进行组织病理学评估。评估CS内是否存在残留疾病。根据CS状态比较手术切除结果。结果共纳入72例患者，其中良性病变12例（16.7%），B3病变45例（62.5%），恶性病变15例（20.8%）。13例导管原位癌（DCIS）和17例非典型导管增生（ADH）在CS内无残留病变（21/ 30,70 %），2例在后续手术中发现残留病理，未见升级。根据CS状态比较手术切除时是否存在恶性病变（DCIS残留或ADH升级），CS阴性和阳性的发生率分别为1/5（20.0%）和4/5 (80.0%)（P = 0.007）。CS无残留病变的NPV为95.24% （95% CI: 76.39% ~ 99.20%）。结论对于符合放射学和组织学标准的患者（如ADH或低分级DCIS）， vae联合腔缘刮除技术可作为手术切除的一种有价值的替代方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Radiology 医学-核医学

CiteScore

6.70

自引率

3.00%

发文量

398

审稿时长

42 days

期刊介绍： European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field. Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.